scholarly journals Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery: A prospective cohort clinical trial

EBioMedicine ◽  
2021 ◽  
Vol 70 ◽  
pp. 103490
Author(s):  
Yanan Song ◽  
Yajie Liu ◽  
Yi Yuan ◽  
Xixi Jia ◽  
Wenchao Zhang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Prospective Cohort ◽  
Postoperative Delirium ◽  
Melatonin Rhythm ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

scholarly journals Effects of general versus regional anaesthesia on circadian melatonin rhythm and its association with postoperative delirium in elderly patients undergoing hip fracture surgery: study protocol for a prospective cohort clinical trial

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043720
Author(s):  
Yi Yuan ◽  
Yanan Song ◽  
Geng Wang ◽  
Yunyang Jia ◽  
Yang Zhou ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Circadian Rhythm ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Prospective Cohort ◽  
Regional Anaesthesia ◽  
Postoperative Delirium ◽  
Melatonin Rhythm ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

IntroductionPostoperative delirium (POD) is a common neurological complication after hip fracture surgery and is associated with high morbidity and mortality in elderly patients. Although the specific mechanism of POD remains unclear, circadian rhythm disruptions have recently drawn increased attention. To date, only limited postoperative time points of plasma melatonin level measurements were recorded in previous studies, and such data cannot represent a comprehensive melatonin rhythm. The process of anaesthesia (either general anaesthesia (GA) or regional anaesthesia (RA)) is known to influence the melatonin rhythm. However, how these two anaesthesia methods differently affect the postoperative melatonin rhythm is still unknown. Therefore, we hypothesise that RA may attenuate the disruption of the melatonin rhythm, which might decrease the incidence of POD in elderly patients undergoing hip surgery.Methods and analysisIn this prospective cohort clinical trial, 138 patients scheduled for hip fracture surgery will be divided into two groups to receive either GA or RA. The primary aim is to compare the circadian rhythm of melatonin secretion between the two groups and explore its association with the incidence of POD.Ethics and disseminationThe study has been approved by the Medical Science Research Ethics Committees of Beijing Jishuitan Hospital (JLKS201901-04). The results of the study will be published in peer-reviewed international journals.Trial registration numberChiCTR1900027393.

Impact of length of red blood cells transfusion on postoperative delirium in elderly patients undergoing hip fracture surgery: A cohort study

Injury ◽  
2016 ◽  
Vol 47 (2) ◽  
pp. 408-412 ◽  
Author(s):  
Zhuang-Yun Zhang ◽  
Da-Peng Gao ◽  
Jiao-jiao Yang ◽  
Xiao-ru Sun ◽  
Hui Zhang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Postoperative Delirium ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

scholarly journals Comparison of regional with general anaesthesia on postoperative delirium (RAGA-delirium) in the older patients undergoing hip fracture surgery: study protocol for a multicentre randomised controlled trial

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016937 ◽  
Author(s):  
Ting Li ◽  
Joyce Yeung ◽  
Jun Li ◽  
Yan Zhang ◽  
Teresa Melody ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Hip Fracture ◽  
General Anaesthesia ◽  
Older Patients ◽  
Postoperative Delirium ◽  
Controlled Trial ◽  
Controlled Clinical Trial ◽  
Hip Fracture Surgery ◽  
Randomised Controlled ◽  
Fracture Surgery

IntroductionPostoperative delirium (POD) is a common serious postoperative complication especially in older people and is associated with increased mortality, morbidity and healthcare costs. There is no clear consensus which anaesthesia is associated with less incidence of POD for older patients. We aim to assess whether regional anaesthesia results in lower incidence of POD comparing with general anaesthesia (GA) among older patients undergoing hip fracture surgery.Methods and analysisRAGA-delirium is a pragmatic, multicentre, prospective, parallel grouped, randomised controlled clinical trial comparing RA or GA for hip fracture surgery. A total of 1000 patients who are 65 years or over and who are having planned hip fracture surgery in nine clinical trial centres of China will be randomised in a 1:1 ratio to receive either anaesthesia for the surgery. The primary endpoint will be the incidence of POD at day 7. The secondary endpoints will be the subtype, severity and duration of delirium, postoperative acute pain score, incidence of other postoperative non-delirium complications, quality of life and cost-effective outcomes. Randomisation will be performed at the patient level using computer-generated assignment. Outcome assessors will be blinded from intervention assignment. Assessments will be conducted before surgery, intraoperatively, postoperatively, during the hospital stay, at 30-day, 6-month and 1-year postoperative intervals.Potential impact of studyThis study will provide clinical evidence with a more robust methodology to help anaesthetists in selecting appropriate anaesthesia for older patients with high risk for POD. At the era of increasing emphasis on delirium prevention, this trial has the potential to inform the future national guideline to reduce POD.Ethics and disseminationEthical approved by the local institutional review board. Trial results will be presented at national and international academic conferences, and published in peer-reviewed journals.Trial registration numberClinicalTrials.gov (NCT02213380); pre-results.

scholarly journals Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery in the Sugammadex Era: A Retrospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Chung-Sik Oh ◽  
Ka Young Rhee ◽  
Tae-Gyoon Yoon ◽  
Nam-Sik Woo ◽  
Seung Wan Hong ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
General Anesthesia ◽  
Cholinesterase Inhibitor ◽  
Postoperative Delirium ◽  
Neuromuscular Block ◽  
Pulmonary Complications ◽  
Laboratory Findings ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Background.Residual neuromuscular block (NMB) after general anesthesia has been associated with pulmonary dysfunction and hypoxia, which are both associated with postoperative delirium (POD). We evaluated the effects of sugammadex on POD in elderly patients who underwent hip fracture surgery.Methods.Medical records of 174 consecutive patients who underwent hip fracture surgery with general anesthesia were reviewed retrospectively to compare the perioperative incidence of POD, pulmonary complications, time to extubation, incidence of hypoxia, and laboratory findings between patients treated with sugammadex and those treated with a conventional cholinesterase inhibitor.Results.The incidence of POD was not significantly different between the two groups (33.3% versus 36.5%, resp.;P=0.750). Postoperative pulmonary complications and laboratory findings did not showed significant intergroup difference. However, time to extubation (6 ± 3 versus 8 ± 3 min;P<0.001) and the frequency of postoperative hypoxia were significantly lower (23% versus 43%;P=0.010) in the sugammadex group than in the conventional cholinesterase inhibitor group.Conclusion.Sugammadex did not reduce POD or pulmonary complications compared to conventional cholinesterase inhibitors, despite reducing time to extubation and postoperative hypoxia in elderly patients who underwent hip fracture surgery under general anesthesia.

scholarly journals Comparison of Effects between Combined Lumbar-Sacral Plexus Block plus General Anesthesia and Unilateral Spinal Anesthesia in Elderly Patients Undergoing Hip Fracture Surgery: A Pilot Randomized Controlled Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Lili Tang ◽  
Panpan Fang ◽  
Yuxin Fang ◽  
Yao Lu ◽  
Guanghong Xu ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Postoperative Delirium ◽  
Sacral Plexus ◽  
Hip Fracture Surgery ◽  
Unilateral Spinal Anesthesia ◽  
Plexus Block ◽  
Fracture Surgery

Purpose. Hip fracture is a common injury in geriatric populations, which is associated with poor quality of life. However, the ideal anesthesia technique for this disease is yet to be identified. This study aimed to compare the combined lumbar-sacral plexus block (CLSB) plus general anesthesia (bispectral index (BIS) 60–80) with the unilateral spinal anesthesia (SA) on activity of daily living in elderly patients undergoing hip fracture surgery. Methods. A total of 124 elderly patients undergoing hip fracture surgery were randomly assigned to two groups. Patients in the SA group received light-specific gravity spinal anesthesia, and patients in the CLSB group received lumbar and sacral plexus block with general anesthesia (BIS 60–80). The primary outcomes were 30-day activity of daily living (ADL). The secondary outcomes were postoperative pain scores, postoperative delirium, in-hospital cost, and major complications. Results. The ADL scores of postoperative day 30 (POD30) in the CLSB group are higher than those in the SA group (27.34 ± 7.01 versus 24.70 ± 6.40, P = 0.045 ). Compared to preoperative ADL scores, there were higher increased scores in the CLSB group than in POD30 (CLSB group 8.09 ± 3.39 versus SA group 4.87 ± 3.90, P < 0.001 ). Mild-to-moderate pain did not have differences between the two groups (rest pain: 3 versus 2, P = 0.344 ; motion pain: 5 versus 4, P = 0.073 ). There were no significant differences in incidence of postoperative delirium, PONV, and other complications. Conclusion. The unilateral SA can reduce the deterioration of ADL after hip fracture surgery and provide a better postoperative recovery.

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