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. 1990 Jun 30;300(6741):1683–1687. doi: 10.1136/bmj.300.6741.1683

Cognitive and functional competence after anaesthesia in patients aged over 60: controlled trial of general and regional anaesthesia for elective hip or knee replacement.

M J Jones 1, S E Piggott 1, R S Vaughan 1, A J Bayer 1, R G Newcombe 1, T C Twining 1, J Pathy 1, M Rosen 1
PMCID: PMC1663336  PMID: 2390547

Abstract

OBJECTIVE--To determine the influence of general or regional anaesthesia on long term mental function in elderly patients. DESIGN--Prospective study of patients randomly allocated to receive general or regional anaesthesia. SETTING--The patients' homes and a large teaching hospital in Cardiff. SUBJECTS--146 Patients aged 60 and over scheduled for elective hip or knee replacement. MAIN OUTCOME MEASURES--Scores achieved in tests of cognitive function and functional competence. RESULTS--72 Patients were allocated to receive general anaesthesia and 74 regional anaesthesia. Anaesthetic technique did not influence the duration of the operation, time to mobilisation postoperatively, requirements for analgesia after the operation, or duration of stay in hospital. Three months after the operation there was an improvement in the score for the recognition component (76 ms, 95% confidence interval 9 to 144) and the response component (82 ms, 5 to 158) of the choice reaction time in the group receiving general anaesthesia compared with the group receiving regional anaesthesia. This was the only significant difference between the two groups in the assessments of cognitive and functional competence. Eleven patients receiving regional anaesthesia and 12 receiving general anaesthesia reported that their memory and concentration were worse than before the operation, but this was not confirmed by testing. CONCLUSION--Cognitive and functional competence in elderly patients was not detectably impaired after either general or regional anaesthesia when attention was paid to the known perioperative influences on mental function.

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Selected References

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  1. BEDFORD P. D. Adverse cerebral effects of anaesthesia on old people. Lancet. 1955 Aug 6;269(6884):259–263. doi: 10.1016/s0140-6736(55)92689-1. [DOI] [PubMed] [Google Scholar]
  2. Berggren D., Gustafson Y., Eriksson B., Bucht G., Hansson L. I., Reiz S., Winblad B. Postoperative confusion after anesthesia in elderly patients with femoral neck fractures. Anesth Analg. 1987 Jun;66(6):497–504. [PubMed] [Google Scholar]
  3. Bigler D., Adelhøj B., Petring O. U., Pederson N. O., Busch P., Kalhke P. Mental function and morbidity after acute hip surgery during spinal and general anaesthesia. Anaesthesia. 1985 Jul;40(7):672–676. doi: 10.1111/j.1365-2044.1985.tb10949.x. [DOI] [PubMed] [Google Scholar]
  4. Blundell E. A psychological study of the effects of surgery on eighty-six elderly patients. Br J Soc Clin Psychol. 1967 Dec;6(4):297–303. doi: 10.1111/j.2044-8260.1967.tb00531.x. [DOI] [PubMed] [Google Scholar]
  5. Bulstrode C. Keeping up with orthopaedic epidemics. Br Med J (Clin Res Ed) 1987 Aug 29;295(6597):514–514. doi: 10.1136/bmj.295.6597.514. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Chung F., Meier R., Lautenschlager E., Carmichael F. J., Chung A. General or spinal anesthesia: which is better in the elderly? Anesthesiology. 1987 Sep;67(3):422–427. doi: 10.1097/00000542-198709000-00026. [DOI] [PubMed] [Google Scholar]
  7. Davison L. A., Steinhelber J. C., Eger E. I., 2nd, Stevens W. C. Psychological eff-cts of halothane and isoflurane anesthesia. Anesthesiology. 1975 Sep;43(3):313–324. doi: 10.1097/00000542-197509000-00008. [DOI] [PubMed] [Google Scholar]
  8. EGBERT L. D., OECH S. R., ECKENHOFF J. E. Comparison of the recovery from methohexital and thiopental anesthesia in man. Surg Gynecol Obstet. 1959 Oct;109:427–430. [PubMed] [Google Scholar]
  9. Edwards H., Rose E. A., Schorow M., King T. C. Postoperative deterioration in psychomotor function. JAMA. 1981 Apr 3;245(13):1342–1343. [PubMed] [Google Scholar]
  10. Ghoneim M. M., Hinrichs J. V., O'Hara M. W., Mehta M. P., Pathak D., Kumar V., Clark C. R. Comparison of psychologic and cognitive functions after general or regional anesthesia. Anesthesiology. 1988 Oct;69(4):507–515. doi: 10.1097/00000542-198810000-00010. [DOI] [PubMed] [Google Scholar]
  11. Herbert M., Healy T. E., Bourke J. B., Fletcher I. R., Rose J. M. Profile of recovery after general anaesthesia. Br Med J (Clin Res Ed) 1983 May 14;286(6377):1539–1542. doi: 10.1136/bmj.286.6377.1539. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hindmarch I. A 1,4-benzodiazepine, temazepam (K 3917), its effect on some psychological parameters of sleep and behaviour. Arzneimittelforschung. 1975 Nov;25(11):1836–1839. [PubMed] [Google Scholar]
  13. Hodkinson H. M. Mental impairment in the elderly. J R Coll Physicians Lond. 1973 Jul;7(4):305–317. [PMC free article] [PubMed] [Google Scholar]
  14. Hole A., Terjesen T., Breivik H. Epidural versus general anaesthesia for total hip arthroplasty in elderly patients. Acta Anaesthesiol Scand. 1980 Aug;24(4):279–287. doi: 10.1111/j.1399-6576.1980.tb01549.x. [DOI] [PubMed] [Google Scholar]
  15. James F. M., 3rd The effects of cyclopropane anesthesia without surgical operation on mental functions of normal man. Anesthesiology. 1969 Mar;30(3):264–272. doi: 10.1097/00000542-196903000-00004. [DOI] [PubMed] [Google Scholar]
  16. Karhunen U., Jönn G. A comparison of memory function following local and general anaesthesia for extraction of senile cataract. Acta Anaesthesiol Scand. 1982 Aug;26(4):291–296. doi: 10.1111/j.1399-6576.1982.tb01769.x. [DOI] [PubMed] [Google Scholar]
  17. Millar H. R. Psychiatric morbidity in elderly surgical patients. Br J Psychiatry. 1981 Jan;138:17–20. doi: 10.1192/bjp.138.1.17. [DOI] [PubMed] [Google Scholar]
  18. Murrin K. R., Nagarajan T. M. Hyperventilation and psychometric testing. A preliminary study. Anaesthesia. 1974 Jan;29(1):50–58. doi: 10.1111/j.1365-2044.1974.tb00582.x. [DOI] [PubMed] [Google Scholar]
  19. Newcombe R. G. Explanatory and pragmatic estimates of the treatment effect when deviations from allocated treatment occur. Stat Med. 1988 Nov;7(11):1179–1186. doi: 10.1002/sim.4780071111. [DOI] [PubMed] [Google Scholar]
  20. Prior F. N., Chander P. Air as a vaporizing gas. Cognitive functions in elderly patients undergoing anaesthesia. Br J Anaesth. 1982 Nov;54(11):1207–1212. doi: 10.1093/bja/54.11.1207. [DOI] [PubMed] [Google Scholar]
  21. SIMPSON B. R., WILLIAMS M., SCOTT J. F., SMITH A. C. The effects of anesthesia and elective surgery on old people. Lancet. 1961 Oct 21;2(7208):887–893. [PubMed] [Google Scholar]
  22. Sarno J. E., Sarno M. T., Levita E. The functional life scale. Arch Phys Med Rehabil. 1973 May;54(5):214–220. [PubMed] [Google Scholar]
  23. Thompson G. E., Miller R. D., Stevens W. C., Murray W. R. Hypotensive anesthesia for total hip arthroplasty: a study of blood loss and organ function (brain, heart, liver, and kidney). Anesthesiology. 1978 Feb;48(2):91–96. [PubMed] [Google Scholar]
  24. Thorburn J., Louden J. R., Vallance R. Spinal and general anaesthesia in total hip replacement: frequency of deep vein thrombosis. Br J Anaesth. 1980 Nov;52(11):1117–1121. doi: 10.1093/bja/52.11.1117. [DOI] [PubMed] [Google Scholar]
  25. Williams E. I., Fitton F. Factors affecting early unplanned readmission of elderly patients to hospital. BMJ. 1988 Sep 24;297(6651):784–787. doi: 10.1136/bmj.297.6651.784. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Wollman S. B., Orkin L. R. Postoperative human reaction time and hypocarbia during anaesthesia. Br J Anaesth. 1968 Dec;40(12):920–926. doi: 10.1093/bja/40.12.920. [DOI] [PubMed] [Google Scholar]
  27. Zelen M. A new design for randomized clinical trials. N Engl J Med. 1979 May 31;300(22):1242–1245. doi: 10.1056/NEJM197905313002203. [DOI] [PubMed] [Google Scholar]
  28. Zelen M. Alternatives to classic randomized trials. Surg Clin North Am. 1981 Dec;61(6):1425–1432. doi: 10.1016/s0039-6109(16)42596-x. [DOI] [PubMed] [Google Scholar]

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