Evidence-based clinical update: General anesthesia and the risk of delirium and postoperative cognitive dysfunction

General Anesthesia

Abstract

Purpose

The purpose of this structured, evidence-based, clinical update was to identify the best evidence comparing general and regional anesthesia and their influence on delirium or cognitive dysfunction (POCD) in the postoperative period.

Source

In June 2005 a structured search of MEDLINE from 1966 to present using OVID software was undertaken. Medical subject headings and textwords describing both delirium and POCD were employed. OVID’s Therapy (sensitivity) algorithm was used to maximize the detection of randomized trials. The bibliographies of eligible publications were hand-searched to identify trials not identified in the electronic search. Publications enrolling children were excluded. Levels of evidence and grades of recommendations were scored using Centre for Evidence Based Medicine criteria.

Principal findings

A total of 18 unique randomized controlled trials were identified: two evaluating delirium; ten evaluating POCD; and six evaluating both. Outcomes for delirium were abstracted from eight trials that enrolled 765 patients (387 regional anesthesia; 378 general anesthesia). Outcomes for POCD were identified from 16 trials that enrolled 2,708 patients (1,313 regional anesthesia; 1,395 general anesthesia). Both delirium (11-43%) and POCD (15-25%) were relatively common in trials actively seeking these outcomes. Consistent Level 2b evidence suggests no significant increase in delirium in patients receiving general anesthesia compared with those receiving regional anesthesia. Similarly, consistent Level 1 evidence indicates that exposure to general anesthesia is not significantly associated with POCD.

Conclusion

Available randomized controlled trials suggest that there is no significant difference in the incidence of delirium or POCD when general anesthesia and regional anesthesia are compared.

Keywords

General Anesthesia Cognitive Outcome Postoperative Delirium Consistent Level Jadad Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Mise à jour clinique fondée sur des données probantes: l’anesthésie générale et le risque de délire et de dysfonctionnement cognitif postopératoire

Résumé

Objectif

Identifier, par une mise à jour clinique structurée et fondée sur des données probantes, la meilleure preuve en comparant l’anesthésie générale et régionale et leur influence sur le délire ou le dysfonctionnement cognitif postopératoires (DCPO).

Source

En juin 2005, une recherche structurée a été entreprise dans MEDLINE, de 1966 à nos jours, en utilisant le logiciel OVID. Les vedettes-matières et les textes décrivant le délire et le DCPO ont été utilisés. Un algorithme thérapeutique (sensibilité) tiré de OVID a servi à optimaliser la détection d’études randomisées. Les bibliographies des études admissibles ont été fouillées manuellement pour découvrir les études non repérées dans la recherche électronique. Les recherches portant sur des enfants ont été exclues. Les niveaux d’évidence et les degrés de recommandations ont été évalués selon les critères du Centre for Evidence Based Medicine.

Constatations principales

Nous avons trouvé 18 études randomisées et contrôlées originales : deux évaluaient le délire, dix le DCPO et six évaluaient les deux. Les données sur le délire ont été extraites de huit études regroupant 765 patients (387 pour l’anesthésie régionale et 378 pour l’anesthésie générale). Les données sur le DCPO ont été tirées de 16 études sur 2 708 patients (1 313 pour l’anesthésie régionale et 1 395 pour l’anesthésie générale). Le délire (11 - 43 %) et le DCPO (15 - 25 %) étaient relativement fréquents dans les études qui recherchaient activement ces résultats. l’évidence d’un niveau 2b persistant montre qu’il n’y a pas d’augmentation significative du délire chez les patients sous anesthésie générale comparée à l’anesthésie régionale. De même, l’évidence d’un niveau 1 persistant indique que l’exposition à l’anesthésie générale n’est pas significativement associée au DCPO.

Conclusion

Les études randomisées et contrôlées accessibles montrent que l’incidence de délire ou de DCPO n’est pas significativement différente avec l’anesthésie générale ou régionale.

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Copyright information

© Canadian Anesthesiologists 2006

Authors and Affiliations

  1. 1.Department of AnesthesiologyThe Ottawa Hospital — Civic CampusOttawaCanada

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