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Delirium in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: a multicentre randomised trial

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机构: [1]Department of Anesthesiology, Peking University First Hospital, Beijing, China, [2]Clinical Research Institute, ShenzhenPeking UniversityeThe Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong,China, [3]Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei,China, [4]Department of Anesthesiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi ZhuangAutonomous Region, China, [5]Department of Anesthesiology, Tangdu Hospital, Air Force Medical University (Fourth MilitaryMedical University), Xi’an, Shaanxi, China, [6]Department of Anesthesiology, Affiliated Hospital of Qinghai University,Xining, Qinghai, China, [7]Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha,Hunan, China, [8]Department of Anesthesiology, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, NingxiaHui Autonomous Region, China, [9]Department of Anesthesiology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou,China, [10]Department of Anesthesiology, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China, [11]Department ofAnesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan,China, [12]Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China, [13]Departmentof Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin,China, [14]Department of Anesthesiology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of ShenzhenUniversity, Health Science Center, Shenzhen, Guangdong, China, [15]Department of Anesthesiology, Zhongda Hospital,Medical School of Southeast University, Nanjing, Jiangsu, China, [16]Department of Anesthesiology, Sir Run Run Hospital,Nanjing Medical University, Nanjing, Jiangsu, China, [17]Department of Biostatistics, Peking University First Hospital, Beijing,China, [18]Peking University Clinical Research Institute, Peking University Health Science Center, Beijing,China, [19]Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA, [20]Outcomes Research Consortium,Cleveland, OH, USA, [21]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 [22]The Children’sHospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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关键词: Aged Anaesthesia Intravenous Propofol Inhalation Sevoflurane Delirium General Surgery Thoracic Surgery

摘要:
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.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.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.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.Chinese Clinical Trial Registry (ChiCTR-IPR-15006209) and ClinicalTrials.gov (NCT02662257).Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

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大类 | 1 区 医学
小类 | 1 区 麻醉学
最新[2025]版:
大类 | 1 区 医学
小类 | 1 区 麻醉学
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出版当年[2023]版:
Q1 ANESTHESIOLOGY
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Q1 ANESTHESIOLOGY

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第一作者机构: [1]Department of Anesthesiology, Peking University First Hospital, Beijing, China,
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通讯机构: [1]Department of Anesthesiology, Peking University First Hospital, Beijing, China, [20]Outcomes Research Consortium,Cleveland, OH, USA,
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