Zhuang Xuhui, He Yuewen, Liu Yurui, Li Jingjing, Ma Wuhua
Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
Department of Anesthesiology, Jincheng People's Hospital, Jincheng, China.
Front Aging Neurosci. 2022 Nov 3;14:935716. doi: 10.3389/fnagi.2022.935716. eCollection 2022.
Postoperative delirium (POD) is one of the serious postoperative complications in elderly patients, which is always related to long-term mortality. Anesthesia is often considered a risk factor for POD. This systematic review and network meta-analysis (NMA) aimed to assess the impact of different anesthesia methods and anesthetics on POD.
We searched for studies published in PubMed, Embase, Web of Science, Scopus, and Cochrane Library (CENTRAL) from inception to 18 March 2022. RevMan 5.3 and CINeMA 2.0.0 were used to assess the risk of bias and confidence. Data analysis using STATA 17.0 and R 4.1.2. STATA 17.0 was used to calculate the surface under the cumulative ranking curve (SUCRA) and provide network plots with CINeMA 2.0.0. NMA was performed with R 4.1.2 software gemtc packages in RStudio.
This NMA included 19 RCTs with 5,406 patients. In the pairwise meta-analysis results, only regional anesthesia (RA) with general anesthesia (GA) vs. GA (Log OR: -1.08; 95% CI: -1.54, -0.63) were statistically different in POD incidence. In the NMA results, there was no statistical difference between anesthesia methods, and psoas compartment block (PCB) with bupivacaine was superior to the desflurane, propofol, sevoflurane, and spinal anesthesia with bupivacaine of POD occurrence.
Our study indicated that RA and GA had no significant effect on POD, and there was no difference between anesthesia methods. Pairwise meta-analysis showed that, except for RA with GA vs. GA, the rest of the results were not statistically different. Besides, PCB with bupivacaine may benefit to reduce POD incidence.
https://www.crd.york.ac.uk/prospero/dis play_record.php?ID=CRD42022319499, identifier PROSPERO 2022 CRD42022319499.
术后谵妄（POD）是老年患者严重的术后并发症之一，常与长期死亡率相关。麻醉常被认为是POD的一个危险因素。本系统评价和网状Meta分析（NMA）旨在评估不同麻醉方法和麻醉药物对POD的影响。
我们检索了从创刊至2022年3月18日在PubMed、Embase、Web of Science、Scopus和Cochrane图书馆（CENTRAL）上发表的研究。使用RevMan 5.3和CINeMA 2.0.0评估偏倚风险和可信度。使用STATA 17.0和R 4.1.2进行数据分析。使用STATA 17.0计算累积排序曲线下面积（SUCRA），并使用CINeMA 2.0.0提供网状图。使用R 4.1.2软件的gemtc包在RStudio中进行NMA。
本NMA纳入了19项随机对照试验，共5406例患者。在成对Meta分析结果中，仅区域麻醉（RA）联合全身麻醉（GA）与单纯GA相比，POD发生率有统计学差异（对数比值比：-1.08；95%可信区间：-1.54，-0.63）。在NMA结果中，麻醉方法之间无统计学差异，布比卡因腰大肌间隙阻滞（PCB）在POD发生方面优于地氟醚、丙泊酚、七氟醚和布比卡因脊髓麻醉。
我们的研究表明，RA和GA对POD无显著影响，麻醉方法之间无差异。成对Meta分析表明，除RA联合GA与单纯GA相比外，其余结果无统计学差异。此外，布比卡因PCB可能有助于降低POD发生率。
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022319499，标识符PROSPERO 2022 CRD42022319499。
