The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 20858956 · doi:10.3233/JAD-2010-101086
What was done
Authors conducted a systematic review and meta-analysis of randomized controlled trials comparing general anesthesia against regional anesthesia (spinal, epidural, or intravenous block) or combined techniques. Eligible trials enrolled cognitively normal patients with an average age over 50 years. Outcomes were Post-Operative Delirium (POD), diagnosed using DSM or ICD criteria, and Post-Operative Cognitive Dysfunction (POCD), defined as any objective cognitive impairment. Standard bibliographic databases and citation lists were searched.
What was found
Twenty-one randomized controlled trials were included. Anesthesia type did not significantly influence the risk of developing POD (odds ratio 0.88, 95% CI 0.51 to 1.51). General anesthesia showed a non-significant trend toward increased risk of POCD compared to regional anesthesia (odds ratio 1.34, 95% CI 0.93 to 1.95). There was no detected publication bias.
Why it matters
This review synthesizes randomized trial evidence indicating that choice of general versus regional anesthesia does not significantly alter the risk of postoperative delirium, though a possible trend toward higher POCD with general anesthesia remains inconclusive.
Limits
The total participant count, types of surgery, and follow-up intervals are not reported in the abstract. POCD permitted broad definitions of objective cognitive impairment rather than a uniform testing protocol. Wide confidence intervals for both outcomes indicate imprecision.
Cited by
- supports Scientific studies show that a patient's frailty, baseline neurocognitive reserve, and neurological resilience predict post-surgical cognitive outcomes more than the choice between regional or general anesthetic drugs.