Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery

Abstract

We are uncertain whether maintenance with propofol-based TIVA or with inhalational agents affect incidences of postoperative delirium, mortality, or length of hospital stay because certainty of the evidence was very low. We found low-certainty evidence that maintenance with propofol-based TIVA may reduce POCD. We were unable to perform meta-analysis for intraoperative hypotension or length of stay in the PACU because of heterogeneity between studies. We identified 11 ongoing studies from clinical trials register searches; inclusion of these studies in future review updates may provide more certainty for the review outcomes.

Postanesthesia care unit delirium following robot‐assisted vs open retropubic radical prostatectomy: A prospective observational study

“…The influence of anesthetic medication on neurocognitive function in general and postoperative delirium in particular has been the subject of some controversy owing to contradictory findings in previous studies . In a recent meta‐analysis the influence of propofol‐based total intravenous anesthesia on postoperative neurocognitive disorders was compared with inhalational agents for anesthesia maintenance . The authors concluded that the type of anesthetic maintenance agent did not affect the incidence of postoperative delirium in elderly patients undergoing noncardiac surgery.…”

Delir – ein evidenzbasierter Überblick

“…Im Einklang mit früheren Daten, die zeigten, dass die Anäthesiemethode keine Einfluss auf das Delirrisiko hat [60], stellte auch ein rezenter Review dar, dass es bei Älteren mit Hüftoperationen keine Evidenz für ein geringeres Delirrisiko von Regionalanästhesien (Spinal-und Epiduralanästhesie) im Vergleich zu Allgemeinnarkosen gibt [61]. Zwischen Gas-Narkosen und Propofol ließ sich in einem Cochrane Review kein klarer Unterschied in der Delirinzidenz feststellen [62]. Allerdings zeigte sich, dass ein zerebral orientiertes Monitoring (mittels bispektralem Index, akustisch evozierten Potenzialen oder Elektroenzephalographie) zur Steuerung der Anäthesietiefe mit einem signifikant reduzierten Risiko für POD assoziiert ist [63,64].…”

Recovery after laparoscopic anesthesia: Three different anaesthesia techniques: Recovery after laparoscopic anesthesia

“…Naša studija je pokazala da je u LFGF SS grupi period P5 bio najkraći, a da je u VIMA grupi bio statistički značajno duži nego u druge dve grupe. Metaanaliza koja je uključila kliničke studije koje su ispitivale uticaj inhalacione i intravenske anestezije na postoperativni kognitivni ishod kod starijih pacijenata tokom nekardioloških operacija, utvrdila je da nema značajnih razlika u dužini boravka bolesnika u sobi za postoperativni oporavak nakon ove dve tehnike anestezije 15 . Može se reći da LFGF SS tehnika, zato što kombinuje prednosti druge dve tehnike (brz uvod inhalacionim anestetikom uz održavanje protoka svežih gasova niskim, a uz adekvatnu kontinuiranu analgeziju sufentanilom, koji dozvoljava manju količinu administriranog sevoflurana i stoga manju akumulaciju anestetika u organizmu u odnosu na VIMA tehniku) logično skraćuje trajanje P5.…”