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Randomized comparison between sevoflurane anaesthesia and unilateral spinal anaesthesia in elderly patients undergoing orthopaedic surgery

Published online by Cambridge University Press:  12 July 2005

A. Casati ,
G. Aldegheri ,
F. Vinciguerra ,
A. Marsan ,
G. Fraschini  and
G. Torri
A. Casati
Affiliation:
Vita-Salute University, Department of Anaesthesiology, IRCCS H. San Raffaele, Milan, Italy
G. Aldegheri
Affiliation:
Vita-Salute University, Department of Anaesthesiology, IRCCS H. San Raffaele, Milan, Italy
F. Vinciguerra
Affiliation:
Vita-Salute University, Department of Anaesthesiology, IRCCS H. San Raffaele, Milan, Italy
A. Marsan
Affiliation:
Vita-Salute University, Department of Anaesthesiology, IRCCS H. San Raffaele, Milan, Italy
G. Fraschini
Affiliation:
Vita-Salute University, Orthopaedic Surgery, IRCCS H. San Raffaele, Milan, Italy
G. Torri
Affiliation:
Vita-Salute University, Department of Anaesthesiology, IRCCS H. San Raffaele, Milan, Italy
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Abstract

Summary

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 ≥ 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.

Keywords

ADULT, agedANAESTHESIA, CONDUCTION, anaesthesia spinalANAESTHETICS INHALATION, sevofluraneANAESTHETICS, LOCAL, bupivacaineMENTAL PROCESSES, cognition
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 8 , September 2003 , pp. 640 - 646
Copyright
2003 European Society of Anaesthesiology

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References

World Health Organization. The World Health Report 1998: Life in the 21st Century – A Vision for All.Geneva, Switzerland: WHO, 1998.
Klopfenstein CE, Herrmann FR, Michel JP, Clergue F, Forster A. The influence of an aging surgical population on the anesthesia workload: a ten-year survey. Anesth Analg 1998; 86: 1165–1170.Google Scholar
Casati A, Fanelli G, Cappelleri G, Borghi B, Cedrati V, Torri G. Low dose hyperbaric bupivacaine for unilateral spinal anaesthesia. Can J Anaesth 1998; 45: 850–854.Google Scholar
Casati A, Fanelli G, Aldegheri G, et al. Frequency of hypotension during conventional or asymmetric hyperbaric spinal block. Reg Anesth Pain Med 1999; 24: 214–219.Google Scholar
Moller JT, Cluitmans P, Rasmussen LS, et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet 1998; 351: 857–861.Google Scholar
Chung F, Meier R, Lautenschlager E, Carmichael FJ. General or spinal anesthesia: which is better in the elderly? Anesthesiology 1987; 67: 422–427.Google Scholar
Peduto VA, Peli S, Amicucci G, et al. Maintenance and recovery from anaesthesia in elderly patients. A clinical comparison between sevoflurane and isoflurane. Minerva Anestesiol 1998; 64 (9 Suppl 3): 18–25.Google Scholar
Chen X, Zhao M, White PF, et al. The recovery of cognitive function after general anesthesia in elderly patients: a comparison of desflurane and sevoflurane. Anesth Analg 2001; 93: 1489–1494.Google Scholar
Torri G, Casati A. Cardiovascular homeostasis during inhalational general anesthesia: a clinical comparison between sevoflurane and isoflurane. J Clin Anesth 2000; 12: 117–122.Google Scholar
Watson KR, Shah MV. Clinical comparison of single agent anaesthesia with sevoflurane versus target controlled infusion of propofol. Br J Anaesth 2000; 85: 541–546.Google Scholar
Folstein M, Folstein S, McHugh P. ‘Mini Mental State’. A practical method for grading the cognitive state of patients for clinician. J Psychiatr Res 1975; 12: 189–198.Google Scholar
Mondimore FM, Damlouji N, Folstein MF, Tune L. Post-ECT confusional states associated with elevated serum anticholinergic levels. Am J Psychiatry 1983; 140: 930–931.Google Scholar
Casati A, Fanelli G, Cappelleri GL, et al. Arterial to end-tidal carbon dioxide tension difference in anaesthetized adults mechanically ventilated via a laryngeal mask or a cuffed oropharyngeal airway. Eur J Anaesthesiol 1999; 16: 534–538.Google Scholar
Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg 1970; 49: 924–934.Google Scholar
Berti M, ed. Dolore postoperatorio: la teoria e la pratica.Milan, Italy: Edizioni CE.DI.S., 1999.
Renck H. The elderly patient after anaesthesia and surgery. Acta Anaesthesiol Scand 1969; 34 (Suppl): 1–36.Google Scholar
Kirkbride DA, Parker JL, Williams GD, Buggy DJ. Induction of anesthesia in the elderly ambulatory patient: a double-blinded comparison of propofol and sevoflurane. Anesth Analg 2001; 93: 1185–1187.Google Scholar
Enk D. Unilateral spinal anaesthesia: gadget or tool? Curr Opin Anaesthesiol 1998; 11: 511–515.Google Scholar
Collins KJ, Exton-Smith AN, James MH, Oliver DJ. Functional changes in autonomic nervous responses with ageing. Age Ageing 1980; 9: 17–24.Google Scholar
McKinney MS, Fee JPH, Clarke RSJ. Cardiovascular effects of isoflurane and halothane in young and elderly patients. Br J Anaesth 1993; 71: 696–701.Google Scholar
Takeshima R, Dohi S. Comparison of arterial baroreflex function in humans anesthetized with enflurane or isoflurane. Anesth Analg 1989; 69: 284–290.Google Scholar
D'Ambrosio A, Borghi B, Damato A, D'Amato G, Antonacci D, Valeri F. Reducing perioperative blood loss in patients undergoing total hip arthroplasty. Int J Artif Organs 1999; 22: 47–51.Google Scholar
Rodgers A, Walker N, Shug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000; 321: 1493–1497.Google Scholar
Rigg JRA, Jamrozik K, Myles PS, et al. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet 2002; 359: 1276–1282.Google Scholar
Torri G, Casati A, Albertin A, et al. A prospective randomized comparison between isoflurane or sevoflurane anesthesia for laparoscopic gastric banding in morbidly obese patients. J Clin Anesth 2001; 13: 565–570.Google Scholar