Postoperative cognitive function as an outcome of regional anesthesia and analgesia.
OBJECTIVE
It has been suggested that intraoperative neuraxial (spinal, epidural) anesthesia may decrease postoperative cognitive dysfunction when compared with general anesthesia, but the issue remains controversial. We systematically reviewed the data from published studies to determine the effect of intraoperative neuraxial anesthesia versus general anesthesia on postoperative cognitive dysfunction and delirium.


METHODS
Studies were identified by searching the PubMed database of the National Library of Medicine (1966 to 2003) for terms related to cognitive dysfunction after surgery. Inclusion criteria were a comparison of intraoperative neuraxial anesthesia versus general anesthesia, and the outcome of postoperative cognitive dysfunction. A total of 196 abstracts were identified, and 24 articles were analyzed. Each article was reviewed, and data were extracted from tables or text or extrapolated from figures as needed.


RESULTS
Of the 24 trials obtained, 19 were randomized and 4 were observational (nonrandomized) trials (1 trial was a combination of randomized and observational data). The age of patients studied was typically greater than 60 years, and a wide range of neuropsychometric tests were used to evaluate cognitive function. The majority of trials (23/24 of all trials and 18/19 of randomized trials) did not demonstrate a benefit from neuraxial anesthesia in decreasing the incidence of postoperative cognitive dysfunction.


CONCLUSIONS
The use of intraoperative neuraxial anesthesia does not appear to decrease the incidence of postoperative cognitive dysfunction when compared with general anesthesia. There are methodologic and study-design issues present in many studies, and further elucidation of the pathophysiology of postoperative cognitive dysfunction may provide a direction for future studies.
Wu
Christopher L
CL
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Carnegie 280, 600 North Wolfe Street, Baltimore, MD 21287, USA. chwu@jhmi.edu
Hsu
Wesley
W
Richman
Jeffrey M
JM
Raja
Srinivasa N
SN
D015360:Analgesia, Epidural / Q000009:adverse effects / Q000706:statistics & numerical data; D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000706:statistics & numerical data*; D000768:Anesthesia, General / Q000009:adverse effects / Q000706:statistics & numerical data*; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data*; D003072:Cognition Disorders / Q000139:chemically induced / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology; D011184:Postoperative Period