Compared with general anaesthesia , a central neuraxial block may reduce the zero to 30-day mortality for patients undergoing surgery with intermediate to high cardiac risk ( level of evidence , moderate ) .
BACKGROUND Various beneficial effects derived from neuraxial blocks have been reported .
However , it is unclear whether these effects have an influence on perioperative mortality and major pulmonary/cardiovascular complications .
OBJECTIVES Our primary objective was to summarize Cochrane systematic review s that assess the effects of neuraxial blockade on perioperative rates of death , chest infection and myocardial infa rct ion by integrating the evidence from all such review s that have compared neuraxial blockade with or without general anaesthesia versus general anaesthesia alone for different types of surgery in various population s. Our secondary objective was to summarize the evidence on adverse effects ( an adverse event for which a causal relation between the intervention and the event is at least a reasonable possibility ) of neuraxial blockade .
[The effect of anesthesiologic technique on the mental state of elderly patients submitted for orthopedic surgery of the lower limbs].
UNLABELLED Influence of anesthetic technique on mental status in elderly patients su bmi tted to major orthopedic procedures of lower limbs . Mental impairment is a common occurrence in elderly patients after major orthopedic surgery . Few studies have been published so far on this topic in spite of its relevant clinical and economic implication s. OBJECTIVE 1 ) To verify whether anesthesia has a causative role in postoperative mental confusion in elderly patients ; 2 ) to compare the effects of General Anesthesia ( GA ) and Spinal Anesthesia ( SA ) on mental status . DESIGN Controlled , comparative study . PATIENTS Sixty patients aged > or = 70 , ASA I-II , su bmi tted to femoral neck repair . SETTING Anesthesia Dept . and Orthopedic Dept . of a District Hospital in Italy . METHOD The day before surgery the mental status of elected patients was evaluated employing a modified Organic Brain Syndrome ( OBS ) scale ( Gustafsson ) . The better the mental status , the lesser the OBS score . It was possible therefore to distinguish " oriented " from " confuse " patients ( 38 vs 22 ) if they scored < or = 6 or > 6 respectively . Patients from each group were than r and omly assigned to receive either GA or selective SA . Neither group was premedicated . GA was induced with propofol 1 mg/kg and maintained with O2/N2O 40/60 % and isoflurane ; atracurium was employed to facilitate mioresolution . Spinal anesthesia was performed with hyperbaric 1 % bupivacaine . All patients were monitored in the Recovery Room ( RR ) for at least one hour . Occurrence of hypotension and /or hypoxia in the Operating Room ( OR ) or the RR was immediately treated . Mental status was reassessed on the 1st and 2nd postoperative day and results were compared with the corresponding preoperative OBS scores both in GA patients and in SA patients . RESULTS No statistically significant differences were found between pre- and postoperative OBS scores in both GA and SA group , whether " oriented " or " confuse " . CONCLUSIONS Mental status of elderly patients su bmi tted to femoral neck repair does n't seem to be influenced by the anesthetic technique chosen , independent of preoperative psychic conditions
Compared with general anaesthesia , a central neuraxial block may reduce the zero to 30-day mortality for patients undergoing surgery with intermediate to high cardiac risk ( level of evidence , moderate ) .
BACKGROUND Various beneficial effects derived from neuraxial blocks have been reported .
However , it is unclear whether these effects have an influence on perioperative mortality and major pulmonary/cardiovascular complications .
OBJECTIVES Our primary objective was to summarize Cochrane systematic review s that assess the effects of neuraxial blockade on perioperative rates of death , chest infection and myocardial infa rct ion by integrating the evidence from all such review s that have compared neuraxial blockade with or without general anaesthesia versus general anaesthesia alone for different types of surgery in various population s. Our secondary objective was to summarize the evidence on adverse effects ( an adverse event for which a causal relation between the intervention and the event is at least a reasonable possibility ) of neuraxial blockade .