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

Abstract

In elderly patients undergoing hemiarthroplasty of the hip, induction and maintenance with sevoflurane provide a rapid emergence from anaesthesia without more depression of postoperative cognitive function compared with unilateral spinal anaesthesia. This technique represents an attractive option when patient refusal, lack of adequate co-operation or concomitant anticoagulant therapy contraindicate the use of spinal anaesthesia.

Neuraxial anesthesia for orthopedic surgery: systematic review and meta-analysis of randomized clinical trials

“…15 Berggren et al 15 Bigler et al 16 Casati et al 18 Davis et al 22 Davis et al 23 Eroglu et al 25 Hole et al 27 Jones et al 28 Juelsgaard et al 30 McKenzie et al 34 McLaren et al 35 Nielson et al 37 Racle et al 38 Riis et al 39 Valentin et al 41 White et al 42 Williams-Russo et al 43 Random = 0.00; Chi 2 = 14.80, df = 10 (P = 0.14); I 2 = 32% Test for overall effect: Z = 1.15 (P = 0.25) Test for subgroup differences: Chi 2 = 1.29, df = 2 (P = 0.53); I 2 = 0% not possible to pool the data for degree of satisfaction, blood transfusion requirements or quality of life. The data on the degree of satisfaction and blood transfusion requirements were not described correctly in the studies included.…”

“…There was no statistically significant difference considering all types of surgeries (MD = -0.05; 95% CI: -0.69 to 0.58; P = 0.87; 870 participants) (Figure 7). 15,18,38,39,42,43 Postoperative cognitive dysfunction: this outcome was analyzed in six studies. 15,18,38,39,42,44 Three types of surgery were conducted in the studies included.…”

“…Thus, 17 articles with the potential to answer our research question were identified. 15,16,18,22,23,25,27,29,30,34,35,[37][38][39]41,42,44 We also analyzed 441 titles from the reference lists of these 17 studies included, but did not find any additional studies (Figure 1). …”

“…The method used by the authors to conceal the allocation sequence was described correctly in four of the studies included. 18,25,27,29 The other studies did not report any details regarding allocation concealment that would make it possible to determine whether this process had been free of bias.…”

“…Postoperative cognitive dysfunction was analyzed in six studies. 15,18,38,39,42,44 Each study included used a different analysis method: Organic Brain Syndrome Scale, 15 Mini Mental State Examination, 18 mental changes, 38 psychologist and attention test, 39 mental confusion 42 and neurophysiological tests. 44 The results relating to this outcome are questionable.…”