Delirium in Older Patients after Combined Epidural–General Anesthesia or General Anesthesia for Major Surgery: A Randomized Trial

Li, Yawei; Li, Huai-Jin; Li, Huijuan; Zhao, Bin-Jiang; Guo, Xiangyang; Feng, Yi; Zuo, Mingzhang; Yu, Yong-Pei; Kong, Hao; Zhao, Yi; Huang, Da; Deng, Chonghai; Hu, Xiaoyun; Liu, Pengfei; Li, Yan; An, Haiyan; Zhang, Hongye; Wang, Meirong; Wu, Yangfeng; Wang, Dong‐Xin; Sessler, Daniel I.

doi:10.1097/aln.0000000000003834

Cited by 72 publications

(44 citation statements)

References 49 publications

(118 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This trial was initiated after the end of patient recruitment of our previous trial investigating the impact of epidural anesthesia–analgesia on postoperative delirium with a long-term follow-up. 23,24 The trial was conducted in Peking University First Hospital in Beijing, China, in accordance with Good Clinical Practice guidelines and the Declaration of Helsinki. Written informed consent was obtained from participating patients or authorized surrogates.…”

Section: Methodsmentioning

confidence: 99%

Epidural Anesthesia–Analgesia and Recurrence-free Survival after Lung Cancer Surgery: A Randomized Trial

Xu¹,

Li²,

Li³

et al. 2021

Anesthesiology

Self Cite

View full text Add to dashboard Cite

Background Regional anesthesia and analgesia reduce the stress response to surgery and decrease the need for volatile anesthesia and opioids, thereby preserving cancer-specific immune defenses. This study therefore tested the primary hypothesis that combining epidural anesthesia–analgesia with general anesthesia improves recurrence-free survival after lung cancer surgery. Methods Adults scheduled for video-assisted thoracoscopic lung cancer resections were randomized 1:1 to general anesthesia and intravenous opioid analgesia or combined epidural–general anesthesia and epidural analgesia. The primary outcome was recurrence-free survival (time from surgery to the earliest date of recurrence/metastasis or all-cause death). Secondary outcomes included overall survival (time from surgery to all-cause death) and cancer-specific survival (time from surgery to cancer-specific death). Long-term outcome assessors were blinded to treatment. Results Between May 2015 and November 2017, 400 patients were enrolled and randomized to general anesthesia alone (n = 200) or combined epidural–general anesthesia (n = 200). All were included in the analysis. The median follow-up duration was 32 months (interquartile range, 24 to 48). Recurrence-free survival was similar in each group, with 54 events (27%) with general anesthesia alone versus 48 events (24%) with combined epidural–general anesthesia (adjusted hazard ratio, 0.90; 95% CI, 0.60 to 1.35; P = 0.608). Overall survival was also similar with 25 events (13%) versus 31 (16%; adjusted hazard ratio, 1.12; 95% CI, 0.64 to 1.96; P = 0.697). There was also no significant difference in cancer-specific survival with 24 events (12%) versus 29 (15%; adjusted hazard ratio, 1.08; 95% CI, 0.61 to 1.91; P = 0.802). Patients assigned to combined epidural–general had more intraoperative hypotension: 94 patients (47%) versus 121 (61%; relative risk, 1.29; 95% CI, 1.07 to 1.55; P = 0.007). Conclusions Epidural anesthesia–analgesia for major lung cancer surgery did not improve recurrence-free, overall, or cancer-specific survival compared with general anesthesia alone, although the CI included both substantial benefit and harm. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

show abstract

Section: Methodsmentioning

confidence: 99%

Epidural Anesthesia–Analgesia and Recurrence-free Survival after Lung Cancer Surgery: A Randomized Trial

Xu¹,

Li²,

Li³

et al. 2021

Anesthesiology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Delirium was assessed with the CAM or, for patients who remained intubated, the CAM for the Intensive Care Unit [ 22 ]. Investigators performing delirium assessment had been trained before initiating the trial [ 23 ]. Other postoperative complications were generally defined as newly occurred medical conditions that were harmful for patients’ recovery and required therapeutic intervention, i.e., grade II or higher on the Clavien-Dindo classification [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

Penehyclidine for prevention of postoperative nausea and vomiting following bimaxillary orthognathic surgery: a randomized, double-blind, controlled trial

et al. 2021

Self Cite

View full text Add to dashboard Cite

Purpose To investigate the efficacy and safety of low-dose bolus plus continuous infusion of penehyclidine in preventing postoperative nausea and vomiting (PONV) following bimaxillary surgery. Methods Three hundred fifty-four patients were randomly allocated into three groups. In the Control group, placebo (normal saline) was injected before anesthesia and infused over 48 h after surgery; in the Bolus group, 0.5 mg penehyclidine was injected before anesthesia, whereas placebo was infused after surgery; in the Infusion group, 0.25 mg penehyclidine were injected before anesthesia, another 0.25 mg penehyclidine was infused after surgery. The primary endpoint was the incidence of PONV within 72 h. Results A total of 353 patients were included in intention-to-treat analysis. The PONV incidence was 61.0% (72/118) in the Control group, 40.2% (47/117) in the Bolus group, and 28.0% (33/118) in the Infusion group. The incidence was significantly lower in the Bolus group than in the Control group (RR 0.66; 95% CI 0.51–0.86; adjusted P = 0.003) and in the Infusion group than in the Control group (RR 0.46; 95% CI 0.33–0.63; adjusted P < 0.001); the difference between the Infusion and Bolus groups was not statistically significant (RR 0.70; 95% CI 0.48–1.00; adjusted P = 0.144). Emergence agitation occurred more frequently in the Bolus group than in the Control group (36.8% [43/117] vs. 21.2% [25/118], adjusted P = 0.027), but did not differ significantly between the Infusion and Control groups. Conclusions A low-dose bolus plus continuous infusion of penehyclidine was effective in preventing PONV without increasing emergence agitation. Trial registration Clinicaltrials.gov. Identifier: NCT04454866.

show abstract

“…EA will be assessed immediately after extubation using the Richmond Agitation–Sedation Scale (RASS) and patients with RASS score > +1 are evaluated as EA [ 29 ]. RASS are also assessed in patients who developed delirium to define the types of delirium (patients with delirium are classified into three subtypes: hyperactive (RASS score consistently positive, from +1 to +4), hypoactive (RASS score consistently neutral or negative, from −3 to 0), and mixed) [ 30 ]. Pain severity will be assessed with the visual analogue scale (VAS), when the patients are transferred out of PACU and during postoperative days 1–3.…”

Section: Interventionsmentioning

confidence: 99%

Impact of propofol versus sevoflurane on the incidence of postoperative delirium in elderly patients after spine surgery: study protocol of a randomized controlled trial

Wang

Zhang

et al. 2022

Trials

View full text Add to dashboard Cite

Background Postoperative delirium in elderly patients is a common and costly complication after surgery. Propofol and sevoflurane are commonly used anesthetics during general anesthesia, and the sedative and anti-inflammatory mechanisms of the two medications are different. The aim of this trial is to compare the impact of propofol with sevoflurane on the incidence of postoperative delirium in elderly patients after spine surgery. Methods A single-center randomized controlled trial will be performed at First Affiliated Hospital of Shandong First Medical University, China. A total of 298 participants will be enrolled in the study and randomized to propofol infusion or sevoflurane inhalation groups. The primary outcome is the incidence of delirium within 7 days after surgery. Secondary outcomes include the day of postoperative delirium onset, duration (time from first to last delirium-positive day), and total delirium-positive days among patients who developed delirium; tracheal intubation time in PACU; the length of stay in PACU; the rate of postoperative shivering; the rate of postoperative nausea and vomiting; the rate of emergence agitation; pain severity; QoR40 at the first day after surgery; the length of stay in hospital after surgery; and the incidence of non-delirium complications within 30 days after surgery. Discussion The primary objective of this study is to compare the impact of propofol and sevoflurane on the incidence of postoperative delirium for elderly patients undergoing spine surgery. The results may help inform strategies to the optimal selection of maintenance drugs for general anesthesia in elderly patients undergoing spine surgery. Trial registration ClinicalTrials.govNCT05158998. Registered on 14 December 2021

show abstract

Delirium in Older Patients after Combined Epidural–General Anesthesia or General Anesthesia for Major Surgery: A Randomized Trial

Cited by 72 publications

References 49 publications

Epidural Anesthesia–Analgesia and Recurrence-free Survival after Lung Cancer Surgery: A Randomized Trial

Epidural Anesthesia–Analgesia and Recurrence-free Survival after Lung Cancer Surgery: A Randomized Trial

Penehyclidine for prevention of postoperative nausea and vomiting following bimaxillary orthognathic surgery: a randomized, double-blind, controlled trial

Impact of propofol versus sevoflurane on the incidence of postoperative delirium in elderly patients after spine surgery: study protocol of a randomized controlled trial

Contact Info

Product

Resources

About