• Br J Anaesth · Nov 2014

    Randomized Controlled Trial

    Incidence of postoperative cognitive dysfunction after general or spinal anaesthesia for extracorporeal shock wave lithotripsy.

    • B S Silbert, L A Evered, and D A Scott.
    • Centre for Anaesthesia and Cognitive Function, Department of Anaesthesia, St Vincent's Hospital, Melbourne, PO Box 2900, Fitzroy, VIC 3065, Australia Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne, Australia brendan.silbert@svhm.org.au.
    • Br J Anaesth. 2014 Nov 1;113(5):784-91.

    BackgroundSince general anaesthesia invariably accompanies surgery, the contribution of each to the development of postoperative cognitive dysfunction (POCD) has been difficult to identify.MethodsA prospective randomized controlled trial was undertaken in elderly patients undergoing extracorporeal shock wave lithotripsy (ESWL). Between 2005 and 2011, 2706 individuals were screened to recruit 100 eligible patients. Patients were randomly assigned to receive general or spinal anaesthesia alone. A battery of eight neuropsychological tests was administered before operation and at 7 days and 3 months after operation. The reliable change index was used to calculate the incidence of POCD. Intention-to-treat analysis was used to compare rates of POCD.ResultsFutility analysis led to stopping of the trial after recruitment of 100 patients. Fifty patients were randomly assigned to general anaesthesia, and 48 patients to spinal anaesthesia without sedation or postoperative opioids. At 3 months, POCD was detected in 6.8% [95% confidence interval (CI): 1.4-18.7%] of patients in the general anaesthesia group and 19.6% (95% CI: 9.4-33.9%) in the spinal group (P=0.07). At 7 days after operation, the incidence of POCD was 4.1% (95% CI: 0.5-14%) in the general anaesthesia group and 11.9% (95% CI: 4.0-26.6%) in the spinal group (P=0.16).ConclusionsWe found no significant difference in the rates of POCD when comparing general anaesthesia with spinal anaesthesia, suggesting that the surgical or procedural process itself may contribute to the development of POCD.Clinical Trial RegistrationAustralian Clinical Trials Registry number ACTRN12605000150640.© The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

      Pubmed     Free full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…