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. 2018 Aug 21;2018(8):CD012317. doi: 10.1002/14651858.CD012317.pub2

Liu 2013.

Methods RCT, parallel design, single‐centre
Participants Total number of randomized participants: 120
Inclusion criteria
  1. People with aMCI, history of spinal surgery, ASA I to II, aged 65 to 75 years


Exclusion criteria
  1. History of general anaesthetic exposure or surgery

  2. Neurological diseases that may affect cognitive function (e.g. subdural haematoma, vascular dementia, frontotemporal dementia)

  3. Hypothyroidism

  4. Alcoholic dementia

  5. Vitamin B12 deficiency

  6. Encephalitis

  7. Cerebral infarction

  8. Brain tumour

  9. Insufficient education to complete the tests


Type of surgery: spinal surgery
Baseline characteristics
TIVA group
  1. Age, mean (SD): 69.33 (± 2.90) years

  2. Gender, M/F: 24/28

  3. ASA grade: all ASA I to II


Inhalational maintenance group
  1. Age, mean (SD): 69.56 (± 2.99) years

  2. Gender, M/F: 27/28

  3. ASA grade: all ASA I to II


Country: China
Setting: hospital
Interventions TIVA group
Participants: n = 60; 8 losses (reasons reported overall, not by group, to include: 'lost to follow‐up', death, other surgeries before 2‐year follow‐up time point); 52 analysed
Induction details: midazolam 0.05 mg/kg, sufentanil 0.5 µg/kg, vecuronium 0.5 µg/kg, propofol 1.0 mg/kg
Maintenance details: propofol 4 mg/kg/hour to 6 mg/kg/hour continuously, intermittent vecuronium 0.5 mg/kg. To maintain BIS 40 to 50
Other information: during surgery, patients given lactated Ringer's solution and hetastarch. Continuous infusion of sufentanil 0.6 µg/kg/hour, tropisetron 6 µg/kg/hour, single bolus of sufentanil 0.015 µg/kg and tropisetron 1.5 µg/kg over a 15‐minute interval for postoperative pain relief
Inhalational maintenance group
Participants: n = 60; 5 losses (reasons reported overall, not by group, to include: 'lost to follow‐up', death, other surgeries before 2‐year follow‐up time point); 55 analysed
Induction details: midazolam 0.05 mg/kg, sufentanil 0.5 µg/kg, vecuronium 0.5 µg/kg, propofol 1.0 mg/kg
Maintenance details: sevoflurane 2% to 3 % in pure O2. Adjusted to maintain BIS 40 to 50
Other information: fluids and analgesic management etc. same as TIVA group
Outcomes
  1. Progression of aMCI. Measured at follow‐up of 2 years

Notes Funding/declarations of interest: supported by the Department of Anesthesiology, Beijing Military General Hospital. The authors have no financial or other conflicts of interest to disclose
Study dates: January 2007 to January 2009
Note: study has 3 arms: propofol vs sevoflurane vs lidocaine epidural. We have not included data for the lidocaine comparison arm
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Use of computer‐generated randomization
Allocation concealment (selection bias) Unclear risk No details
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Not feasible to blind anaesthetists to intervention groups
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk Only review outcome of interest is mortality. Blinding of assessors is not described but lack of blinding is unlikely to influence mortality data
Incomplete outcome data (attrition bias) 
 All outcomes Unclear risk High number of losses, which are reported with reasons. We have used this as data for mortality outcome
Selective reporting (reporting bias) Unclear risk Study authors do not report clinical trials registration. It is not feasible to assess risk of selective outcome reporting
Other bias Low risk No other sources of bias identified