Relationship among anesthesia technique, surgical stress, and cognitive dysfunction following spinal surgery: a randomized trial.

Autor:	Ezhevskaya AA; 1Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhniy Novgorod, Russian Federation., Ovechkin AM; 2I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation; and., Prusakova ZB; 1Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhniy Novgorod, Russian Federation., Zagrekov VI; 1Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhniy Novgorod, Russian Federation., Mlyavykh SG; 1Federal State Budgetary Educational Institution of Higher Education Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhniy Novgorod, Russian Federation., Anderson DG; 3Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Spine [J Neurosurg Spine] 2019 Sep 06; Vol. 31 (6), pp. 894-901. Date of Electronic Publication: 2019 Sep 06 (Print Publication: 2019).
DOI:	10.3171/2019.4.SPINE184
Abstrakt:	Objective: Surgical trauma is known to result in systemic inflammatory changes that can lead to postoperative cognitive dysfunction. In the present study, the authors compared the effects of an epidural anesthesia protocol to those of traditional anesthesia with regard to postoperative inflammatory changes, cellular immunity, and cognitive dysfunction. Methods: Forty-eight patients, ages 45-60 years, underwent multilevel thoracolumbar decompression and fusion and were randomly assigned to one of two groups: group 1 (27 patients) had combined epidural and general anesthesia, followed by epidural analgesia for 48 hours after surgery, and group 2 (21 patients) had general anesthesia, followed by traditional opioid pain management after surgery. At multiple time points, data on pain control, cognitive function, cellular immunity, and inflammatory markers were collected. Results: Group 1 patients demonstrated lower pain levels, less systemic inflammation, less cellular immune dysfunction, and less postoperative cognitive dysfunction than group 2 patients. Conclusions: The use of combined epidural and general anesthesia followed by postoperative epidural analgesia during the first 48 hours after multilevel thoracolumbar decompression and fusion surgery had a significant positive effect on pain management, cellular immune function, systemic inflammation, and postoperative cognitive function.Clinical trial registration no.: 115080510080 (http://rosrid.ru).
Databáze:	MEDLINE
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