Effect of General Versus Spinal Anesthesia on Postoperative Delirium and Early Cognitive Dysfunction in Elderly Patients

Ehsani, Roghayeh; Motlagh, Soudabeh Djalali; Zaman, Behrooz; Kashani, Saloumeh Sehat; Ghodraty, Mohammad Reza

doi:10.5812/aapm.101815

Cited by 37 publications

(34 citation statements)

References 25 publications

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“…Several previous studies have demonstrated the link between a disturbed circadian pattern of melatonin secretion and delirium [12,57,58]. In this study, the POD incidence in the GA group was significantly higher than that in the SA group, which is consistent with previous studies [59]. As perioperative inflammatory markers were not different between the two groups, we suggest that the different incidence of POD mainly derives from pain and rhythm disturbance.…”

Section: Discussionsupporting

confidence: 91%

Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery: A prospective cohort clinical trial

et al. 2021

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Background: Circadian rhythm disturbance is common postoperatively in older patients with hip fractures, which may contribute to the development of postoperative delirium (POD). As a reliable biomarker of endogenous circadian rhythms, melatonin regulates the sleep-wake cycle and environmental adaptation, and its secretory rhythm may be modified by anaesthesia and surgery. This study compared the impact of subarachnoid anaesthesia (SA) and general anaesthesia (GA), on the peak of melatonin secretion (primary outcome), the circadian rhythm of melatonin, cortisol and sleep, and the POD incidence (secondary outcome). Methods: In this prospective cohort observational study, hip fracture surgery patients were enrolled and assigned to receive either SA or GA. Postoperative plasma melatonin and cortisol levels were dynamically measured every six hours on seven time-points, and the circadian rhythm parameters including mesor, amplitude, and acrophase were calculated. Subjective and objective sleep assessments were performed by sleep diaries and sleep trackers, respectively. The Confusion Assessment Method was used twice daily by a specific geriatrician to screen for POD occurrence. Findings: In a cohort of 138 patients who underwent hip fracture surgery, the circadian rhythm disruption of the patients in the GA group (n=69) was greater than the SA group (n=69). Compared with SA, GA provided the lower peak concentration, mesor, and amplitude of melatonin secretion on postoperative day 1 (p < 0.05). Patients in the GA group experienced higher awakenings, more sleep deprivation, and poor sleep quality on surgery day (p < 0.05). A proportion of 12 patients in the SA group (17.4%) and 24 patients in the GA group (34.8%) experienced POD (p = 0.020). Interpretation: These results suggest that SA may be superior to GA in elderly patients undergoing hip fracture surgery as SA is associated with less impairment of the melatonin rhythm and sleep patterns, and fewer POD occurrences.

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Section: Discussionsupporting

confidence: 91%

Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery: A prospective cohort clinical trial

et al. 2021

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“…An overview of Cochrane systematic reviews found that when EA or spinal anaesthesia were used to replace GA, the risk of dying during the surgery or during the following 30 days was reduced by approximately 29%, the risk of developing pneumonia was reduced by 55%, and no serious side effects were reported 16 . Furthermore, it has been seen that delirium increases with age when patients are anaesthetised with GA compared to spinal anaesthesia 39 …”

Section: Discussionmentioning

confidence: 99%

“…16 Furthermore, it has been seen that delirium increases with age when patients are anaesthetised with GA compared to spinal anaesthesia. 39 The disadvantages of pre-operatively initiated EA can be that patients may experience a long waiting time before optimal pain control due to the practical requirements of the technique as it often requires more staffing resources and because it must be performed under sterile conditions. Furthermore, many side effects of EA are known, including low blood pressure (especially in dehydrated patients), loss of bladder control, persistent positional headache, temporary nerve damage, infection, and intraspinal haematoma.…”

Section: Relation To Current Evidencementioning

confidence: 99%

Pre‐operative epidural analgesia in hip fracture patients ‐ A systematic review and meta‐analysis

Rubin

Stark

Hårsmar³

et al. 2020

Acta Anaesthesiol Scand

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Hip fracture is a common injury among the elderly and is associated with a high risk of functional decline and impaired quality of life, setting high requirements for care and treatment of the patients. 1 A study conducted in five European countries associated hip fractures with a 30-day mortality rate of 4.0%-13.7% and a one-year mortality rate of 19.1%-39.7%. 2 Globally, the annual incidence of hip fractures is 55 to 439 per 100,000 inhabitants, with large variation between countries. 3 Owing to changing demographics, global incidence is expected to rise and many patients with hip fracture are anticipated to have comorbidities and risk factors for fracture associated with advanced age. [4][5][6][7] Older patients are often at risk of falling due to impaired cognitive function,

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“…According to this theory, anticholinergic drugs can increase the risk of delirium. Dexmedetomidine reduces the risk of delirium due to its sedative effects, besides reducing the need for anticholinergic drugs, such as benzodiazepines and narcotics (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Effects of Haloperidol and Dexmedetomidine on Delirium and Agitation in Patients with a Traumatic Brain Injury Admitted to the Intensive Care Unit

et al. 2021

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Background: Patients under mechanical ventilation in the Intensive Care Unit (ICU) have a higher risk of delirium. To date, the ideal sedative combination for delirium treatment in terms of cost and side effects has not been determined. Objectives: This study was designed to compare the effects of haloperidol and dexmedetomidine on delirium in trauma patients under mechanical ventilation in the ICU. Methods: Sixty patients with a moderate traumatic brain injury were randomly divided into two groups. Patients in the haloperidol group received 2.5 mg of haloperidol intravenously every eight hours for ten minutes daily, and the dexmedetomidine group received 0.5 µg/kg of dexmedetomidine via intravenous infusion every other day. Delirium, agitation, length of hospitalization, duration of mechanical ventilation, and need for sedation up to seven days were measured and recorded in both groups. The Richmond Agitation-Sedation scale (RASS) and Acute Physiology and Chronic Health evaluation (APACHE II) scales were used to determine the level of agitation in patients. The Confusion Assessment method (CAM)-ICU criteria were used to determine the incidence of delirium. Results: Based on the results of this study, age and sex of the two groups were not significantly different. The mean age of the patients was 36.83 years in the haloperidol group and 40.1 years in the dexmedetomidine group. After the intervention, there was no significant difference in terms of the level of consciousness, number of days required for ventilation (P = 0.17), and number of days in the ICU (P = 0.49); however, there was a significant difference between the two groups three to seven days after the intervention. Besides, there was a significant difference between the two groups regarding the incidence of delirium five to seven days after the intervention (P < 0.05). Conclusions: There was a significant difference between the two groups in terms of the incidence of delirium and the level of agitation; the patients in the dexmedetomidine group were calmer and experienced less delirium.

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Effect of General Versus Spinal Anesthesia on Postoperative Delirium and Early Cognitive Dysfunction in Elderly Patients

Cited by 37 publications

References 25 publications

Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery: A prospective cohort clinical trial

Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery: A prospective cohort clinical trial

Pre‐operative epidural analgesia in hip fracture patients ‐ A systematic review and meta‐analysis

Comparison of the Effects of Haloperidol and Dexmedetomidine on Delirium and Agitation in Patients with a Traumatic Brain Injury Admitted to the Intensive Care Unit

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