Sedation Depth During Spinal Anesthesia and the Development of Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Repair
Sedation Depth During Spinal Anesthesia and the Development of Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Repair
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DOI：
10.4065/mcp.2009.0469
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发表时间：
2010-01-01
影响因子：
8.9
通讯作者：
Mears, Simon C.
中科院分区：
文献类型：
--
作者：
Sieber, Frederick E.;Zakriya, Khwaji J.;Mears, Simon C.
目的：探讨腰麻下限制术中镇静深度能否降低老年髋部骨折修补术后精神分裂症的发生率。方法与方法：我们在一个学术医学中心进行了一项双盲随机对照试验，研究对象为65岁、术前无精神分裂症或严重痴呆的老年患者，他们在异丙酚麻醉下接受髋部骨折修补术。使用脑电双频指数(BIS)对镇静深度进行滴定，患者随机接受深度(BIS，约50)或轻度(BIS，=80)镇静。根据《精神疾病诊断与统计手册》(第三版修订本)标准，从术后第2天开始，采用混淆评价法对术后精神障碍进行评估。结果：从2005年4月2日至2008年10月30日，共有114例患者被随机分为两组。轻度镇静组术后妄想发生率(11/57[19%])明显低于深度镇静组(23/57[40%]，P=0.02)，说明每4.7例接受轻度镇静治疗的患者中，就有1例可以预防术后精神障碍的发生。轻度镇静组住院期间平均+/-SD妄想天数低于深度镇静组(0.5+/-1.5天比1.4+/-4.0天；P=.01)。结论：与深度镇静相比，轻度异丙酚镇静可使术后妄想发生率降低50%。腰麻期间限制镇静深度是预防老年患者术后精神障碍的一种简单、安全和经济有效的干预措施，可广泛采用。
OBJECTIVE: To determine whether limiting Intraoperative sedation depth during spinal anesthesia for hip fracture repair In elderly patients can decrease the prevalence of postoperative delirium.PATIENTS AND METHODS: We performed a double-blind, randomized controlled trial at an academic medical center of elderly patients (>= 65 years) without preoperative delirium or severe dementia who underwent hip fracture repair under spinal anesthesia with propofol sedation. Sedation depth was titrated using processed electroencephalography with the bispectral Index (BIS), and patients were randomized to receive either deep (BIS, approximately 50) or light (BIS, >= 80) sedation. Postoperative delirium was assessed as defined by Diagnostic and Statistical Manual of Mental Disorders (Third Edition Revised) criteria using the Confusion Assessment Method beginning at any time from the second day after surgery.RESULTS: From April 2, 2005, through October 30, 2008, a total of 114 patients were randomized. The prevalence of postoperative delirium was significantly lower In the light sedation group (11/57 [19%] vs 23/57 [40%] in the deep sedation group; P = .02), Indicating that I incident of delirium will be prevented for every 4.7 patients treated with light sedation. The mean +/- SD number of days of delirium during hospitalization was lower In the light sedation group than In the deep sedation group (0.5 +/- 1.5 days vs, 1.4 +/- 4.0 days; P = .01).CONCLUSION: The use of light propofol sedation decreased the prevalence of postoperative delirium by 50% compared with deep sedation. Limiting depth of sedation during spinal anesthesia Is a simple, safe, and cost-effective Intervention for preventing postoperative delirium in elderly patients that could be widely and readily adopted.