Sedation depth during spinal anesthesia and survival in elderly patients undergoing hip fracture repair.
Sedation depth during spinal anesthesia and survival in elderly patients undergoing hip fracture repair.
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DOI：
10.1213/ane.0000000000000157
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发表时间：
2014-05
影响因子：
5.7
通讯作者：
Sieber FE
中科院分区：
文献类型：
--
作者：
Brown CH 4th;Azman AS;Gottschalk A;Mears SC;Sieber FE
术中脑电双频指数（BIS）值较低可能与死亡率增加相关。在先前报道的一项预防谵妄的试验中，我们将在脊髓麻醉下接受髋部骨折修复术的患者随机分为轻度（BIS>80）或深度（BIS~50）镇静组。我们分析了原始试验中患者的生存率。在所有患者中，镇静组的死亡率相当。然而，在有严重合并症（Charlson评分>4）的患者中，轻度镇静组（22.2%）与深度镇静组（43.6%）在脊髓麻醉期间的1年死亡率降低（风险比[HR]，0.43; 95%CI，0.19-0.97; P=0.04）。同样，在Charlson评分>6的患者中，轻度镇静组（28.6%）与深度镇静组（52.6%）在脊髓麻醉期间的1年死亡率降低（HR 0.33; 95%CI 0.12-0.94; P=0.04）。需要进一步研究脊髓麻醉期间轻度镇静后死亡率的降低。
Low intraoperative Bispectral Index (BIS) values may be associated with increased mortality. In a previously reported trial to prevent delirium, we randomized patients undergoing hip fracture repair under spinal anesthesia to light (BIS>80) or deep (BIS~50) sedation. We analyzed survival of patients in the original trial. Among all patients, mortality was equivalent across sedation groups. However, among patients with serious comorbidities (Charlson score >4), 1-year mortality was reduced in the light (22.2%) versus deep (43.6%) sedation group (Hazard Ratio [HR], 0.43; 95% CI, 0.19–0.97; P=0.04) during spinal anesthesia. Similarly, among patients with Charlson score >6, 1-year mortality was reduced in the light (28.6%) versus deep (52.6%) sedation group (HR 0.33; 95%CI 0.12–0.94; P=0.04) during spinal anesthesia. Further research on reduced mortality after light sedation during spinal anesthesia is needed.