Randomized comparison between sevoflurane anaesthesia and unilateral spinal anaesthesia in elderly patients undergoing orthopaedic surgery

Casati, Andrea; Aldegheri, Giorgio; Vinciguerra, F.; Marşan, Anıl; Fraschini, G.; Torri, G.

doi:10.1097/00003643-200308000-00009

Cited by 61 publications

(39 citation statements)

References 18 publications

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“…Postoperatively, the reported effect of epidural analgesia on hypotension varied: frequency was either less (0% versus 33%, P=0.001, evidence level I), greater (40% versus 13%, P=0.01, evidence level II), or not different (evidence level II) as compared with patients receiving systemic analgesia [17,72,73]. Even though the evidence presented in the literature with regard to hypotensive events appears to be overwhelming, it must be remembered that the definition of hypotension is immensely diversified and ranges from a 20% decrease from baseline [28,32,49,65] to a systolic blood pressure of less than 90 mmHg [41]. Therefore, the conclusions of these results have to be weighed carefully.…”

Section: Hypotensionmentioning

confidence: 99%

“…Three citations were considered to provide Level I evidence. Many studies included a small number of patients and only few outcome parameters: there were 12 RCTs with a sample size of ≤40 patients [21,[25][26][27][28][29][30][31][32][33][34][35]. The study by McKenzie et al [36] involves one study population, whereas the other two studies by McKenzie et al [33,37] identified only subgroups of these patients.…”

Section: Quality Of Published Workmentioning

confidence: 99%

“…Others reported no differences regarding hypotension comparing general and regional anaesthesia (evidence level II-III) [7, 25, 27, 29-31, 57, 65]. Three studies showed a tendency towards a higher incidence in general anaesthesia (evidence level II-III) [20,28,39]. Postoperatively, the reported effect of epidural analgesia on hypotension varied: frequency was either less (0% versus 33%, P=0.001, evidence level I), greater (40% versus 13%, P=0.01, evidence level II), or not different (evidence level II) as compared with patients receiving systemic analgesia [17,72,73].…”

Section: Hypotensionmentioning

confidence: 99%

“…Three studies reported a significantly increased blood loss in general anaesthesia patients [28,43,68]. Covert and Fox [2] found no effect in fractured femur neck, but a possible decrease for spinal anaesthesia performed for intertrochanteric femur fracture.…”

Section: Blood Loss and Blood Transfusion Requirementsmentioning

confidence: 99%

“…Pain at 1 h post-surgery, but not later, was worse in the general anaesthesia group (evidence level II) [28]. Kamitani et al [21] reported no difference in diclofenac use between the two groups (evidence level III) [21] and Singelyn et al [17] observed no difference in pain relief in total hip arthroplasty for neither intravenous nor epidural nor femoral nerve analgesia (evidence level II).…”

Section: Postoperative Analgesiamentioning

confidence: 99%

See 4 more Smart Citations

Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?

Luger

Kammerlander

Gosch³

et al. 2010

Osteoporos Int

172

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The influence of the mode of anaesthesia on outcome of geriatric patients with hip fractures is a controversial issue in the medical literature. In the light of an ageing society, a conclusive answer to this question is of growing importance. The purpose of this review was to assess the effect of neuroaxial and general anaesthesia on mortality and morbidity in geriatric patients sustaining a hip fracture. Following a current literature search within the Pubmed and Cochrane database (1967-2010), 34 randomised controlled trials, 14 observational studies and eight reviews/meta-analysis publications were included. Potentially outcome-influencing factors such as mortality, deep vein thrombosis, pulmonary embolism, postoperative confusion and other anaesthesia-related outcomes were evaluated. After analysing the current literature with 56 references, covering 18,715 patients with hip fracture, it can be concluded that spinal anaesthesia is associated with significantly reduced early mortality, fewer incidents of deep vein thrombosis, less acute postoperative confusion, a tendency to fewer myocardial infarctions, fewer cases of pneumonia, fatal pulmonary embolism and postoperative hypoxia. General anaesthesia has the advantages of having a lower incidence of hypotension and a tendency towards fewer cerebrovascular accidents compared to neuroaxial anaesthesia. Otherwise, general anaesthesia and respiratory diseases were significant predictors of morbidity in hip fracture patients. These data suggest that regional anaesthesia is the preferred technique, but the limited evidence available does not permit a definitive conclusion to be drawn for mortality or other outcomes. For hip fracture surgery, the choice of anaesthesia (general or neuroaxial) is made by the anaesthesiologist and is based on the patient's preference, comorbidities, potential general postoperative complications and the clinical experience of the anaesthesiologist. The overall therapeutic approach in hip fracture care should be determined jointly by the orthopaedic surgeon, the geriatrician and the anaesthesiologist (multidisciplinary approach).

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Section: Hypotensionmentioning

confidence: 99%

Section: Quality Of Published Workmentioning

confidence: 99%

Section: Hypotensionmentioning

confidence: 99%

Section: Blood Loss and Blood Transfusion Requirementsmentioning

confidence: 99%

Section: Postoperative Analgesiamentioning

confidence: 99%

See 3 more Smart Citations

Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?

Luger

Kammerlander

Gosch³

et al. 2010

Osteoporos Int

172

View full text Add to dashboard Cite

show abstract

Anaesthesia for hip fracture surgery in adults

Parker

Handoll

Griffiths

2004

Cochrane Database of Systematic Reviews

212

152

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Anaesthesia for hip fracture surgery in adults

Guay

Parker

Gajendragadkar

et al. 2016

Cochrane Database of Systematic Reviews

238

136

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Analysis 1.1. Comparison 1 Neuraxial block (spinal or epidural) versus general anaesthesia, Outcome 1 Mortality -1 month....... Analysis 1.2. Comparison 1 Neuraxial block (spinal or epidural) versus general anaesthesia, Outcome 2 Mortality -3 months...... Analysis 1.3. Comparison 1 Neuraxial block (spinal or epidural) versus general anaesthesia, Outcome 3 Mortality -6 months...... Analysis 1.4. Comparison 1 Neuraxial block (spinal or epidural) versus general anaesthesia, Outcome 4 Mortality -12 months..... Analysis 1.5. Comparison 1 Neuraxial block (spinal or epidural) versus general anaesthesia, Outcome 5 Pneumonia.

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Randomized comparison between sevoflurane anaesthesia and unilateral spinal anaesthesia in elderly patients undergoing orthopaedic surgery

Cited by 61 publications

References 18 publications

Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?

Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?

Anaesthesia for hip fracture surgery in adults

Anaesthesia for hip fracture surgery in adults

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