Department of Anaesthesiology, A.C.Camargo Cancer Center, São Paulo, Brazil.
Department of Epidemiology and Statistics, A.C.Camargo Cancer Center, São Paulo, Brazil.
PLoS One. 2021 May 17;16(5):e0249808. doi: 10.1371/journal.pone.0249808. eCollection 2021.
Delirium is the most common postsurgical neurological complication and has a variable incidence rate. Laparoscopic surgery, when associated with the Trendelenburg position, can cause innumerable physiological changes and increase the risk of neurocognitive changes. The association of general anesthesia with a spinal block allows the use of lower doses of anesthetic agents for anesthesia maintenance and facilitates better control over postoperative pain. Our primary outcome was to assess whether a spinal block influences the incidence of delirium in oncologic patients following laparoscopic surgery in the Trendelenburg position. Our secondary outcome was to analyze whether there were other associated factors. A total of 150 oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position were included in this randomized controlled trial. The patients were randomized into 2 groups: the general anesthesia group and the general anesthesia plus spinal block group. Patients were immediately evaluated during the postoperative period and monitored until they were discharged, to rule out the presence of delirium. Delirium occurred in 29 patients in total (22.3%) (general anesthesia group: 30.8%; general anesthesia plus spinal block: 13.8% p = 0.035). Patients who received general anesthesia had a higher risk of delirium than patients who received general anesthesia associated with a spinal block (odds ratio = 3.4; 95% confidence interval: 1.2-9.6; p = 0.020). Spinal block was associated with reduced delirium incidence in oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position.
谵妄是最常见的术后神经系统并发症，其发病率不一。腹腔镜手术联合头高脚低位可引起无数的生理变化，并增加神经认知变化的风险。全身麻醉与椎管内阻滞联合应用可减少麻醉维持所需的麻醉药物剂量，并更便于术后疼痛的控制。我们的主要结局是评估在头高脚低位行腹腔镜手术的肿瘤患者中，椎管内阻滞是否会影响谵妄的发生率。我们的次要结局是分析是否存在其他相关因素。这项随机对照试验共纳入 150 例择期行腹腔镜手术的肿瘤患者，这些患者采用头高脚低位。患者随机分为两组：全身麻醉组和全身麻醉加椎管内阻滞组。术后立即对患者进行评估，并监测至出院，以排除谵妄的发生。共有 29 例（22.3%）患者发生谵妄（全身麻醉组：30.8%；全身麻醉加椎管内阻滞组：13.8%，p = 0.035）。与接受全身麻醉的患者相比，接受全身麻醉联合椎管内阻滞的患者发生谵妄的风险更高（比值比=3.4；95%置信区间：1.2-9.6；p = 0.020）。在头高脚低位行择期腹腔镜手术的肿瘤患者中，椎管内阻滞与降低谵妄发生率相关。
