Louise Ellard1, Rita Katznelson1, Marcin Wasowicz1, Alan Ashworth1, Jo Carroll1, Thomas Lindsay2, George Djaiani3. 1. Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada. 2. Division of Vascular Surgery, University of Toronto, Toronto, Canada. 3. Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada. Electronic address: george.djaiani@uhn.ca.
Abstract
OBJECTIVE: The purpose of this study was to investigate the association between general (GA), regional (RA), and local (LA) anesthetic techniques with respect to the development of delirium after vascular surgery. The authors hypothesized that patients undergoing GA for vascular surgery would have a higher incidence of postoperative delirium. The role of LA with respect to postoperative delirium in vascular surgery patients previously has not been reported. DESIGN: Retrospective review. SETTING: Tertiary referral center, university hospital. PARTICIPANTS: 500 patients undergoing vascular surgical procedures. INTERVENTIONS: Based on the chosen anesthetic technique, all patients were divided into GA, RA, and LA groups, respectively. Exclusion criteria were patients with preoperative dementia or abnormal level of consciousness, patients undergoing open abdominal aneurysm repair surgery, and patients undergoing carotid endarterectomy. All anesthetic techniques were conducted according to routine institutional practices. Patients in both the RA and LA groups received intravenous sedation. MEASUREMENTS AND MAIN RESULTS: Three hundred ninety-six (79%) patients received GA, 73 (15%) RA, and 31 (6%) LA. The overall incidence of delirium was 19.4% and rates were similar among the 3 groups, with 73 (18.4%) patients in the GA group, 17 (23.2%) in the RA group, and 7 (22.5%) in the LA group (p = 0.56). Patients in the LA group were more likely to have emergency surgery and also had a higher incidence of previous cerebrovascular accidents or transient ischemic attacks. There was no significant difference with respect to either onset or duration of delirium among the 3 groups. Median length of hospital stay and in-hospital mortality were similar among the 3 groups. CONCLUSIONS: Delirium rates after vascular surgery were similar with local, regional, or general anesthesia techniques. The presence of risk factors for the development of postoperative delirium should not influence the type of anesthesia provided.
OBJECTIVE: The purpose of this study was to investigate the association between general (GA), regional (RA), and local (LA) anesthetic techniques with respect to the development of delirium after vascular surgery. The authors hypothesized that patients undergoing GA for vascular surgery would have a higher incidence of postoperative delirium. The role of LA with respect to postoperative delirium in vascular surgery patients previously has not been reported. DESIGN: Retrospective review. SETTING: Tertiary referral center, university hospital. PARTICIPANTS: 500 patients undergoing vascular surgical procedures. INTERVENTIONS: Based on the chosen anesthetic technique, all patients were divided into GA, RA, and LA groups, respectively. Exclusion criteria were patients with preoperative dementia or abnormal level of consciousness, patients undergoing open abdominal aneurysm repair surgery, and patients undergoing carotid endarterectomy. All anesthetic techniques were conducted according to routine institutional practices. Patients in both the RA and LA groups received intravenous sedation. MEASUREMENTS AND MAIN RESULTS: Three hundred ninety-six (79%) patients received GA, 73 (15%) RA, and 31 (6%) LA. The overall incidence of delirium was 19.4% and rates were similar among the 3 groups, with 73 (18.4%) patients in the GA group, 17 (23.2%) in the RA group, and 7 (22.5%) in the LA group (p = 0.56). Patients in the LA group were more likely to have emergency surgery and also had a higher incidence of previous cerebrovascular accidents or transient ischemic attacks. There was no significant difference with respect to either onset or duration of delirium among the 3 groups. Median length of hospital stay and in-hospital mortality were similar among the 3 groups. CONCLUSIONS:Delirium rates after vascular surgery were similar with local, regional, or general anesthesia techniques. The presence of risk factors for the development of postoperative delirium should not influence the type of anesthesia provided.
Authors: Bheeshma Ravi; Daniel Pincus; Stephen Choi; Richard Jenkinson; David N Wasserstein; Donald A Redelmeier Journal: JAMA Netw Open Date: 2019-02-01
Authors: Kristina E Fuest; Ariane Servatius; Bernhard Ulm; Stefan J Schaller; Bettina Jungwirth; Manfred Blobner; Sebastian Schmid Journal: Front Med (Lausanne) Date: 2022-07-13