The Impact of General and Regional Anesthesia on the Incidence of Post-Operative Cognitive Dysfunction and Post-Operative Delirium: a Systematic Review with Meta-Analysis.

03:54 EDT 22nd August 2014 | BioPortfolio

Summary of "The Impact of General and Regional Anesthesia on the Incidence of Post-Operative Cognitive Dysfunction and Post-Operative Delirium: a Systematic Review with Meta-Analysis."

Post-operative cognitive complications such as delirium have been consistently associated with poor short and long term outcomes, and the role of anesthesia, particularly the role of general versus regional anesthesia, remains unclear. The objective of this systematic review with meta-analysis was to compare the influence of general, regional, or a combination of anesthesia on the development of Post-Operative Cognitive Dysfunction (POCD) and Post-Operative Delirium (POD). Standard bibliographic databases were searched and complimented by hand searching of original and review article references. Included studies were randomized controlled trials comparing general to regional (spinal, epidural, or intravenous block) or a combination of these in a cohort who were pre-operatively cognitively normal and had an average age exceeding fifty. Where POD was the principle outcome, studies must have employed the DSM or ICD criteria. Where POCD was the principal outcome, this was defined as any objective cognitive impairment. Twenty one studies were considered suitable for inclusion. There was no effect of anesthesia type on the odds ratio of developing POD (0.88, 0.51-1.51 with 95% confidence) however general anesthesia was marginally non-significantly associated with POCD (odds ratio of 1.34, 0.93-1.95 with 95% confidence). There was no evidence of publication bias. In conclusion, it appears that general anesthesia, compared to others, may increase the risk of developing POCD; however this has not been shown for POD. Possible reasons for this finding have been explored. This data would advocate for the use of regional anesthesia wherever possible especially in people otherwise vulnerable to developing cognitive symptoms.

Affiliation

Centre for Mental Health Claybrook Centre, Imperial College London, Hammersmith, London, UK.

Journal Details

This article was published in the following journal.

Name: Journal of Alzheimer's disease : JAD
ISSN: 1875-8908
Pages:

Links

PubMed Articles [21226 Associated PubMed Articles listed on BioPortfolio]

A randomized clinical trial comparing the efficacy and safety of ramosetron versus ondansetron in patients undergoing abdominal surgery under general anesthesia.

Post-operative nausea and vomiting is one of the most common and distressing complications after anesthesia and surgery. It may lead to serious post-operative complications. Ramosetron is a newer 5-HT...

Regional Anesthesia, Time to Hospital Discharge, and In-Hospital Mortality: A Propensity Score Matched Analysis.

The anesthetic technique used during surgery can affect postoperative length of stay and outcomes, even after controlling for other clinically important factors. This study evaluated the impact of reg...

The effect of intravenous infusion of paracetamol before anesthesia induction on the core and peripheral temperature changes and post-operative shivering in patients undergoing general anesthesia.

Post-operative shivering is an unpleasant complication that various drugs are used to prevent and treat. It is tried to advice a suitable drug with the least side-effects. This study was carried out t...

No Superiority of Granisetron Over Metoclopramide in Prevention of Post-operative Nausea and Vomiting: A Randomized Clinical Trial.

Post-operative nausea and vomiting (PONV) is considered as one of the most disturbing sequels of surgeries under general anesthesia, which if not controlled appropriately increases post-operative morb...

Age-dependent postoperative cognitive impairment and Alzheimer-related neuropathology in mice.

Post-operative cognitive dysfunction (POCD) is associated with increased cost of care, morbidity, and mortality. However, its pathogenesis remains largely to be determined. Specifically, it is unknown...

Clinical Trials [5164 Associated Clinical Trials listed on BioPortfolio]

A Multi-site Randomized Controlled Trial Comparing Regional and General Anesthesia for Effects on Neurodevelopmental Outcome and Apnea in Infants

The primary purpose of the GAS study is to determine whether different types of anesthesia (Regional versus General) given to 660 infants undergoing inguinal hernia repair results in equiv...

Cognitive Effects of Inhalational Versus Intravenous General Anesthesia in the Elderly

The purpose of this research is to determine if post-operative cognition will be better if the general anesthesia for surgery is done with an inhaled (gas through a breathing tube) or intr...

Risk Factors for Post Operative Nausea and Vomiting(PONV) in Patients Underwent Gynecological Operation Under General Anesthesia

Risk factors for postoperative nausea and vomiting(PONV) such as past history of PONV and/or motion sickness, non-smoking status, female gender, planned opiate use for post-operative analg...

Perioperative Epidural Trial (POET) Pilot Study

To investigate if the use of perioperative neuraxial blockade reduces post-operative mortality and cardiorespiratory events compared to intraoperative general anesthesia AND postoperative...

Regional Anesthesia in Colon Rectal Surgery

This study will compare recurrence rates in patients with colorectal cancer who will be randomly assigned to epidural anesthesia/analgesia combined with general anesthesia or to general an...

Medical and Biotech [MESH] Definitions

Abnormally slow pace of regaining CONSCIOUSNESS after general anesthesia (ANESTHESIA, GENERAL) usually given during surgical procedures. This condition is characterized by persistent somnolence.

Capacity that enables an individual to cope with and/or recover from the impact of a neural injury or a psychotic episode.

The period of emergence from general anesthesia, where different elements of consciousness return at different rates.

A barbiturate that is administered intravenously for the production of complete anesthesia of short duration, for the induction of general anesthesia, or for inducing a hypnotic state. (From Martindale, The Extra Pharmacopoeia, 30th ed, p919)

Agents that induce various degrees of analgesia; depression of consciousness, circulation, and respiration; relaxation of skeletal muscle; reduction of reflex activity; and amnesia. There are two types of general anesthetics, inhalation and intravenous. With either type, the arterial concentration of drug required to induce anesthesia varies with the condition of the patient, the desired depth of anesthesia, and the concomitant use of other drugs. (From AMA Drug Evaluations Annual, 1994, p.173)

Search BioPortfolio: