Luger T J, Kammerlander C, Luger M F, Kammerlander-Knauer U, Gosch M
Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstr. 25, 6020, Innsbruck, Austria,
Z Gerontol Geriatr. 2014 Feb;47(2):110-24. doi: 10.1007/s00391-014-0611-3.
In older non-cardiac surgery patients, the influence of the mode of anesthesia on late-term outcome (rehabilitation, mobility, independence) is a controversial issue in the medical literature. In light of an aging society, this review assessed the association between regional (RA), local (LA) and general anesthesia (GA) and mortality and morbidity.
A literature search within the PubMed and Cochrane databases yielded 47 clinical trials and 35 reviews/meta-analyses published between 1965 and 2013. Potential outcome-influencing factors such as mortality, risk factors, early complications (e.g. postoperative confusion, aspiration, vomiting), adverse events (e.g. deep vein thrombosis, pulmonary embolism), discharge, rehabilitation and mobilization were evaluated in relation to the mode of anesthesia (RA, LA or GA).
The current literature contains 82 references covering 74,476 non-cardiac surgery patients. Analysis shows that the particular mode of anesthesia influences mortality and morbidity. RA is associated with reduced early mortality and morbidity, e.g. fewer incidents of deep vein thrombosis and less acute postoperative confusion, as well as a tendency toward fewer myocardial infarctions and fatal pulmonary embolisms. GA has the advantages of a lower incidence of hypotension and reduced surgery time.
Strictly speaking, true anesthesia-related complications appear to be rare and many adverse outcomes may be multifactorial. Postoperative complications are largely related to the perioperative procedure and not to the anesthesia itself. GA and RA are both useful for older non-cardiac patients, but for some procedures, e.g. hip fracture surgery, RA seems to be the technique of choice. The mode of anesthesia may only play a secondary role in mobility, rehabilitation and discharge destination. In general, due to the many different possible outcomes--which are often very difficult or impossible to compare--no other specific recommendations can be made with regard to the type of anesthesia to be preferred for older non-cardiac patients.
在老年非心脏手术患者中，麻醉方式对远期预后（康复、活动能力、独立性）的影响在医学文献中是一个有争议的问题。鉴于社会老龄化，本综述评估了区域麻醉（RA）、局部麻醉（LA）和全身麻醉（GA）与死亡率及发病率之间的关联。
在PubMed和Cochrane数据库中进行文献检索，得到了1965年至2013年间发表的47项临床试验以及35篇综述/荟萃分析。针对麻醉方式（RA、LA或GA），评估了潜在的影响预后因素，如死亡率、风险因素、早期并发症（如术后谵妄、误吸、呕吐）、不良事件（如深静脉血栓形成、肺栓塞）、出院情况、康复及活动能力。
当前文献包含82篇参考文献，涉及74476例非心脏手术患者。分析表明，特定的麻醉方式会影响死亡率和发病率。RA与早期死亡率和发病率降低相关，例如深静脉血栓形成事件较少、术后急性谵妄较少，以及心肌梗死和致命性肺栓塞有减少趋势。GA具有低血压发生率较低和手术时间缩短的优势。
严格来讲，真正与麻醉相关的并发症似乎很少见，许多不良结局可能是多因素导致的。术后并发症在很大程度上与围手术期操作有关，而非麻醉本身。GA和RA对老年非心脏手术患者均有用，但对于某些手术，如髋部骨折手术，RA似乎是首选技术。麻醉方式在活动能力、康复及出院目的地方面可能仅起次要作用。总体而言，由于可能出现的结局多种多样——通常很难或无法进行比较——对于老年非心脏手术患者首选的麻醉类型无法给出其他具体建议。
