At the moment , the evidence available can not prove that neuraxial anesthesia is more effective and safer than general anesthesia for urological surgery .
There were insufficient data to pool the results relating to mortality , stroke , myocardial infa rct ion , length of hospitalization , quality of life , degree of satisfaction , postoperative cognitive dysfunction and blood transfusion requirements
CONTEXT AND OBJECTIVE Choosing the best anesthetic technique for urological surgery with the aim of mortality reduction remains controversial .
The objective here was to compare the effectiveness and safety of neuraxial anesthesia versus general anesthesia for urological surgery .
Early postoperative cognitive dysfunction and postoperative delirium after anaesthesia with various hypnotics: study protocol for a randomised controlled trial - The PINOCCHIO trial
Background Postoperative delirium can result in increased postoperative morbidity and mortality , major dem and for postoperative care and higher hospital costs . Hypnotics serve to induce and maintain anaesthesia and to abolish patients ' consciousness . Their persisting clinical action can delay postoperative cognitive recovery and favour postoperative delirium . Some evidence suggests that these unwanted effects vary according to each hypnotic 's specific pharmacodynamic and pharmacokinetic characteristics and its interaction with the individual patient . We design ed this study to evaluate postoperative delirium rate after general anaesthesia with various hypnotics in patients undergoing surgical procedures other than cardiac or brain surgery . We also aim ed to test whether delayed postoperative cognitive recovery increases the risk of postoperative delirium . Methods / Design After local ethics committee approval , enrolled patients will be r and omly assigned to one of three treatment groups . In all patients anaesthesia will be induced with propofol and fentanyl , and maintained with the anaesthetics desflurane , or sevoflurane , or propofol and the analgesic opioid fentanyl . The onset of postoperative delirium will be monitored with the Nursing Delirium Scale every three hours up to 72 hours post anaesthesia . Cognitive function will be evaluated with two cognitive test batteries ( the Short Memory Orientation Memory Concentration Test and the Rancho Los Amigos Scale ) preoperatively , at baseline , and postoperatively at 20 , 40 and 60 min after extubation . Statistical analysis will investigate differences in the hypnotics used to maintain anaesthesia and the odds ratios for postoperative delirium , the relation of early postoperative cognitive recovery and postoperative delirium rate . A subgroup analysis will be used to categorize patients according to demographic variables relevant to the risk of postoperative delirium ( age , sex , body weight ) and to the preoperative score index for delirium . Discussion The results of this comparative anaesthesiological trial should whether each the three hypnotics tested is related to a significantly different postoperative delirium rate . This information could ultimately allow us to select the most appropriate hypnotic to maintain anaesthesia for specific subgroups of patients and especially for those at high risk of postoperative delirium . Registered at Trial.gov Number Clinical Trials.gov :
At the moment , the evidence available can not prove that neuraxial anesthesia is more effective and safer than general anesthesia for urological surgery .
There were insufficient data to pool the results relating to mortality , stroke , myocardial infa rct ion , length of hospitalization , quality of life , degree of satisfaction , postoperative cognitive dysfunction and blood transfusion requirements
CONTEXT AND OBJECTIVE Choosing the best anesthetic technique for urological surgery with the aim of mortality reduction remains controversial .
The objective here was to compare the effectiveness and safety of neuraxial anesthesia versus general anesthesia for urological surgery .