دورية أكاديمية
Delirium in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: a multicentre randomised trial.
| العنوان: | Delirium in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: a multicentre randomised trial. |
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| المؤلفون: | Cao SJ; Department of Anesthesiology, Peking University First Hospital, Beijing, China., Zhang Y; Department of Anesthesiology, Peking University First Hospital, Beijing, China; Clinical Research Institute, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong, China., Zhang YX; Department of Anesthesiology, Peking University First Hospital, Beijing, China., Zhao W; Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China., Pan LH; Department of Anesthesiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China., Sun XD; Department of Anesthesiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, Shaanxi, China., Jia Z; Department of Anesthesiology, Affiliated Hospital of Qinghai University, Xining, Qinghai, China., Ouyang W; Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China., Ye QS; Department of Anesthesiology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia Hui Autonomous Region, China., Zhang FX; Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China., Guo YQ; Department of Anesthesiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China., Ai YQ; Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China., Zhao BJ; Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China., Yu JB; Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China., Liu ZH; Department of Anesthesiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, Guangdong, China., Yin N; Department of Anesthesiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China; Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China., Li XY; Department of Biostatistics, Peking University First Hospital, Beijing, China., Ma JH; Department of Anesthesiology, Peking University First Hospital, Beijing, China., Li HJ; Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China., Wang MR; Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China., Sessler DI; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Outcomes Research Consortium, Cleveland, OH, USA., Ma D; Division of Anesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK; The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China., Wang DX; Department of Anesthesiology, Peking University First Hospital, Beijing, China; Outcomes Research Consortium, Cleveland, OH, USA. Electronic address: wangdongxin@hotmail.com. |
| مؤلفون مشاركون: | First Study of Perioperative Organ Protection (SPOP1) investigators |
| المصدر: | British journal of anaesthesia [Br J Anaesth] 2023 Aug; Vol. 131 (2), pp. 253-265. Date of Electronic Publication: 2023 Jun 04. |
| نوع المنشور: | Journal Article; Comment |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: England NLM ID: 0372541 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1471-6771 (Electronic) Linking ISSN: 00070912 NLM ISO Abbreviation: Br J Anaesth Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2018- : [London] : Elsevier Original Publication: London, Eng. [etc.] |
| مواضيع طبية MeSH: | Propofol*/adverse effects , Anesthetics, Inhalation*/adverse effects , Emergence Delirium*/chemically induced , Neoplasms*/surgery, Humans ; Female ; Aged ; Male ; Sevoflurane/adverse effects ; Follow-Up Studies ; Anesthesia, General/adverse effects |
| مستخلص: | Background: Delirium is a common and disturbing postoperative complication that might be ameliorated by propofol-based anaesthesia. We therefore tested the primary hypothesis that there is less delirium after propofol-based than after sevoflurane-based anaesthesia within 7 days of major cancer surgery. Methods: This multicentre randomised trial was conducted in 14 tertiary care hospitals in China. Patients aged 65-90 yr undergoing major cancer surgery were randomised to either propofol-based anaesthesia or to sevoflurane-based anaesthesia. The primary endpoint was the incidence of delirium within 7 postoperative days. Results: A total of 1228 subjects were enrolled and randomised, with 1195 subjects included in the modified intention-to-treat analysis (mean age 71 yr; 422 [35%] women); one subject died before delirium assessment. Delirium occurred in 8.4% (50/597) of subjects given propofol-based anaesthesia vs 12.4% (74/597) of subjects given sevoflurane-based anaesthesia (relative risk 0.68 [95% confidence interval {CI}: 0.48-0.95]; P=0.023; adjusted relative risk 0.59 [95% CI: 0.39-0.90]; P=0.014). Delirium reduction mainly occurred on the first day after surgery, with a prevalence of 5.4% (32/597) with propofol anaesthesia vs 10.7% (64/597) with sevoflurane anaesthesia (relative risk 0.50 [95% CI: 0.33-0.75]; P=0.001). Secondary endpoints, including ICU admission, postoperative duration of hospitalisation, major complications within 30 days, cognitive function at 30 days and 3 yr, and safety outcomes, did not differ significantly between groups. Conclusions: Delirium was a third less common after propofol than sevoflurane anaesthesia in older patients having major cancer surgery. Clinicians might therefore reasonably select propofol-based anaesthesia in patients at high risk of postoperative delirium. Clinical Trial Registration: Chinese Clinical Trial Registry (ChiCTR-IPR-15006209) and ClinicalTrials.gov (NCT02662257). (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.) |
| التعليقات: | Comment in: Br J Anaesth. 2023 Aug;131(2):191-193. (PMID: 37330310) Comment on: Br J Anaesth. 2023 Aug;131(2):266-275. (PMID: 37474242) Comment in: Br J Anaesth. 2023 Oct;131(4):e142-e143. (PMID: 37541950) Comment in: Br J Anaesth. 2023 Oct;131(4):629-631. (PMID: 37544837) Comment in: Br J Anaesth. 2023 Dec;131(6):e185-e186. (PMID: 37793958) |
| فهرسة مساهمة: | Keywords: Aged; Anaesthesia, Inhalation; Anaesthesia, Intravenous; Delirium; General Surgery; Propofol; Sevoflurane; Thoracic Surgery |
| سلسلة جزيئية: | ClinicalTrials.gov NCT02662257 |
| المشرفين على المادة: | YI7VU623SF (Propofol) 38LVP0K73A (Sevoflurane) 0 (Anesthetics, Inhalation) |
| تواريخ الأحداث: | Date Created: 20230720 Date Completed: 20230921 Latest Revision: 20231117 |
| رمز التحديث: | 20231117 |
| DOI: | 10.1016/j.bja.2023.04.024 |
| PMID: | 37474241 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1471-6771 |
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| DOI: | 10.1016/j.bja.2023.04.024 |