The Effect of General Anesthesia vs. Regional Anesthesia on Postoperative Delirium—A Systematic Review and Meta-Analysis

Abstract

BackgroundPostoperative delirium (POD) commonly occurs in patients following major surgeries and is associated with adverse prognosis. The modes of anesthesia may be associated with POD occurrence. General anesthesia (GA) causes loss of consciousness in the patient by altering the levels of some neurotransmitters as well as signaling pathways. We conducted this meta-analysis to investigate the effect of GA vs. regional anesthesia (RA) on POD incidence in surgical patients.MethodsThe databases of Pubmed, Embase, and Cochrane Library were searched till October 22, 2021. The eligible criteria were participants aged 18 years or older, patients undergoing surgery under GA and RA, and articles reporting the effect of GA vs. RA on POD incidence. RevMan 5.3 was used to perform statistical analyses.ResultsA total of 21 relevant trials with a total of 1,702,151 patients were included. The pooled result using random-effects model with OR demonstrated significant difference in POD incidence between patients with GA and RA (OR = 1.15, 95% CI: [1.02, 1.31], I2 = 83%, p for effect = 0.02). We did not obtain the consistent pooled result after sensitivity analysis (OR = 0.95, 95% CI: [0.83, 1.08], I2 =13%, p for effect = 0.44) and excluded the articles without the information on preoperative cognitive or neuropsychological assessment (OR = 1.12, 95% CI: [1.00, 1.25], I2 =80%, p for effect = 0.05), respectively.ConclusionThis meta-analysis could not identify that GA was significantly associated with POD occurrence in surgical patients compared with RA.

Effect of Anaesthesia Depth on Postoperative Delirium and Postoperative Cognitive Dysfunction in High-Risk Patients: A Systematic Review and Meta-Analysis

“…Some studies were done to compare the incidence of POD and POCD among the use of propofol, benzodiazepines, or dexmedetomidine, but the results were conflicting [46][47][48]. A lot of studies reviewed the incidence of POD and POCD between general anesthesia and regional anesthesia, but the results were still debatable [49][50][51]. More studies are required to study the effect of anesthesia on POD and POCD, in order to minimize the impact of anesthesia on patients.…”

Comparison of intravenous butorphanol vs. tramadol for post-spinal anesthesia shivering: a meta-analysis and systematic review

“…The heterogeneity analysis was conducted using the chi-square test, and the heterogeneity of the included studies was assessed using I 2 . When the I 2 -values were < 40%, 40–60%, and >60%, the heterogeneity levels corresponded to low, medium, and high ( 38 ), respectively. Due to the anticipated heterogeneity in this study, a random-effects model was employed.…”

Early postoperative cognitive decline—are there any preventive strategies for surgical patients in the emergency setting?

“…The evaluation of CRP perioperatively may facilitate to pinpoint higher risk patients and proceed to an individualized intervention. Although shaping anesthetic techniques was hypothesized to decrease the incidence of early cognitive disorder, both spinal and general anaesthesia seem to involve similar risks [72][73][74]. Changes in brain functional connectivity has been related to both peripheral nerve block and spinal anesthesia as a result of deafferentation on pain sensitivity [75,76].…”