Document Detail


Randomized comparison between sevoflurane anaesthesia and unilateral spinal anaesthesia in elderly patients undergoing orthopaedic surgery.
MedLine Citation:
PMID:  12932066     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVE: This prospective, randomized study was conducted to compare unilateral spinal block using small doses of hyperbaric bupivacaine and single-agent anaesthesia with sevoflurane in elderly patients undergoing hip surgery. METHODS: Thirty patients (> 65 yr) undergoing hip fracture repair were randomly allocated to receive unilateral spinal anaesthesia with hyperbaric bupivacaine 7.5 mg 0.5% (Group Spinal, n = 15) or volatile induction and maintenance anaesthesia with sevoflurane (Group SEVO, n = 15). General anaesthesia was induced by increasing the inspired concentration to 5%. A laryngeal mask airway was placed without muscle relaxants, and the end-tidal concentrations of sevoflurane were adjusted to maintain cardiovascular stability. Hypotension (decrease in systolic arterial pressure > 20% from baseline), hypertension or bradycardia (heart rate < 50 beats min(-1)) requiring treatment, and the length of stay in the postanaesthesia care unit was recorded. Cognitive functions were evaluated the previous day, and 1 and 7 days after surgery with the Mini Mental State Examination test. RESULTS: Hypotension occurred in seven patients of Group Spinal (46%) and in 12 patients of Group SEVO (80%) (P = 0.05). Phenylephrine was required to control hypotension in three spinal patients (21%) and four SEVO patients (26%) (n.s.). SEVO patients had lower heart rates than spinal patients from 15 to 60 min after anaesthesia induction (P = 0.01). Bradycardia was observed in three SEVO patients (22%). Discharge from the postanaesthesia care unit required 15 (range 5-30) min in Group Spinal and 55 (15-80) min in Group SEVO (P = 0.0005). Eight patients in Group Spinal (53%) and nine patients in Group SEVO (60%) showed cognitive decline (Mini Mental State Examination test decreased > or = 2 points from baseline) 24 h after surgery (n.s.). Seven days after surgery, confusion was still present in one patient of Group Spinal (6%) and in three patients of Group SEVO (20%) (n.s.). CONCLUSIONS: In elderly patients undergoing hemiarthroplasty of the hip, induction and maintenance with sevoflurane provide a rapid emergence from anaesthesia without more depression of postoperative cognitive function compared with unilateral spinal anaesthesia. This technique represents an attractive option when patient refusal, lack of adequate co-operation or concomitant anticoagulant therapy contraindicate the use of spinal anaesthesia.
Authors:
A Casati; G Aldegheri; E Vinciguerra; A Marsan; G Fraschini; G Torri
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  European journal of anaesthesiology     Volume:  20     ISSN:  0265-0215     ISO Abbreviation:  Eur J Anaesthesiol     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-08-22     Completed Date:  2004-02-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8411711     Medline TA:  Eur J Anaesthesiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  640-6     Citation Subset:  IM    
Affiliation:
Vita-Salute University, Department of Anaesthesiology, IRCCS H. San Raffaele, Milan, Italy. casati.andrea@hsr.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anesthesia Recovery Period
Anesthesia, Spinal* / adverse effects
Anesthetics, Inhalation / adverse effects,  therapeutic use*
Anesthetics, Local / adverse effects,  therapeutic use
Blood Pressure / drug effects
Bupivacaine / adverse effects,  therapeutic use
Female
Heart Rate / drug effects
Humans
Hypotension / chemically induced,  drug therapy
Length of Stay
Male
Mental Status Schedule
Methyl Ethers / adverse effects,  therapeutic use*
Orthopedic Procedures*
Pain Measurement
Postoperative Complications / etiology
Prospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anesthetics, Inhalation; 0/Anesthetics, Local; 0/Methyl Ethers; 2180-92-9/Bupivacaine; 28523-86-6/sevoflurane

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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