COGNITIVE EFFECTS AFTER EPIDURAL VS GENERAL-ANESTHESIA IN OLDER ADULTS - A RANDOMIZED TRIAL
COGNITIVE EFFECTS AFTER EPIDURAL VS GENERAL-ANESTHESIA IN OLDER ADULTS - A RANDOMIZED TRIAL
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DOI：
10.1001/jama.274.1.44
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发表时间：
1995-07-05
影响因子：
120.7
通讯作者：
CHARLSON, ME
中科院分区：
文献类型：
--
作者：
WILLIAMSRUSSO, P;SHARROCK, NE;CHARLSON, ME
客观。-比较硬膜外麻醉与全身麻醉对老年人全膝关节置换术后长期认知功能障碍的影响。随机对照临床试验。设置。-骨科专科学术医院.病人. -共有262例患者接受择期初次全膝关节置换术，中位年龄为69岁; 70%为女性。随机分配硬膜外或全身麻醉。主要结果测量。术前进行全面的神经心理学评估，并在术后1周和6个月重复评估。认知结果通过10项记忆、心理和语言技能测试的患者内变化进行评估。对心血管并发症进行前瞻性标准化监测，以同时评估麻醉对认知和心血管结局的影响。两组在基线时的年龄、性别、合并症和认知功能方面相似。硬膜外麻醉组和全身麻醉组在1周或6个月时10项认知测试结果中任何一项的受试者内相对于基线的变化均无显著差异。总体而言，5%的患者表现出认知功能的长期临床显著恶化。麻醉组之间主要心血管并发症的发生率没有差异（总体为3%）。全麻或硬膜外麻醉的类型不影响择期全膝关节置换术老年患者术后认知功能障碍的程度或模式，也不影响主要心血管并发症的发生率。这是迄今为止报道的关于全身麻醉与区域麻醉对脑功能影响的最大规模试验，具有超过99%的把握度来检测任何神经心理学测试的临床显著差异。
Objective.-To compare the effect of epidural vs general anesthesia on the incidence of long-term cognitive dysfunction after total knee replacement surgery in older adults.Design.-Randomized controlled clinical trial.Setting.-Orthopedic specialty academic hospital.Patients.-A total of 262 patients undergoing elective primary total knee replacement with a median age of 69 years; 70% women.Intervention.-Random assignment to either epidural or general anesthesia.Main Outcome Measures.-A thorough neuropsychological assessment was performed preoperatively and repeated at 1 week and 6 months postoperatively. Cognitive outcome was assessed by within-patient change on 10 tests of memory, psychomotor, and language skills. Prospective standardized surveillance for cardiovascular complications was performed to allow simultaneous assessment of anesthetic effects on cognitive and cardiovascular outcomes.Results.-The two groups were similar at baseline in terms of age, sex, comorbidity, and cognitive function. There were no significant differences between the epidural and general anesthesia groups in within-subject change from baseline on any of the 10 cognitive test results at either 1 week or 6 months. Overall, 5% of patients showed a long-term clinically significant deterioration in cognitive function. There was no difference between the anesthesia groups in the incidence of major cardiovascular complications (3% overall).Conclusions.-The type of anesthesia, general or epidural, does not affect the magnitude or pattern of postoperative cognitive dysfunction or the incidence of major cardiovascular complications in older adults undergoing elective total knee replacement. This is the largest trial of the effects of general vs regional anesthesia on cerebral function reported to date, with more than 99% power to detect a clinically significant difference on any of the neuropsychological tests.