Cognitive and functional competence after anaesthesia in patients aged over 60: controlled trial of general and regional anaesthesia for elective hip or knee replacement
OBJECTIVE--To determine the influence of general or regional anaesthesia on long term mental function in elderly patients. DESIGN--Prospective study of patients randomly allocated to receive general or regional anaesthesia. SETTING--The patients' homes and a large teaching hospital in Cardiff....
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| Veröffentlicht in: | BMJ 1990-06, Vol.300 (6741), p.1683-1687 |
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| creator | Jones, M J Piggott, S E Vaughan, R S Bayer, A J Newcombe, R G Twining, T C Pathy, J Rosen, M |
| description | OBJECTIVE--To determine the influence of general or regional anaesthesia on long term mental function in elderly patients. DESIGN--Prospective study of patients randomly allocated to receive general or regional anaesthesia. SETTING--The patients' homes and a large teaching hospital in Cardiff. SUBJECTS--146 Patients aged 60 and over scheduled for elective hip or knee replacement. MAIN OUTCOME MEASURES--Scores achieved in tests of cognitive function and functional competence. RESULTS--72 Patients were allocated to receive general anaesthesia and 74 regional anaesthesia. Anaesthetic technique did not influence the duration of the operation, time to mobilisation postoperatively, requirements for analgesia after the operation, or duration of stay in hospital. Three months after the operation there was an improvement in the score for the recognition component (76 ms, 95% confidence interval 9 to 144) and the response component (82 ms, 5 to 158) of the choice reaction time in the group receiving general anaesthesia compared with the group receiving regional anaesthesia. This was the only significant difference between the two groups in the assessments of cognitive and functional competence. Eleven patients receiving regional anaesthesia and 12 receiving general anaesthesia reported that their memory and concentration were worse than before the operation, but this was not confirmed by testing. CONCLUSION--Cognitive and functional competence in elderly patients was not detectably impaired after either general or regional anaesthesia when attention was paid to the known perioperative influences on mental function. |
| doi_str_mv | 10.1136/bmj.300.6741.1683 |
| format | Article |
| fullrecord | <record><control><sourceid>jstor_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_1663336</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><jstor_id>29708286</jstor_id><sourcerecordid>29708286</sourcerecordid><originalsourceid>FETCH-LOGICAL-b519t-cd612480fb9260610032611fcd5cde50110b25e46a9c00377ec793bf626a71e13</originalsourceid><addsrcrecordid>eNqFUsuO0zAUjRBoqIb5ABZIkZBYkWLHiZ2wQEIVMEhTYMFjaTnOTetOYmdsp4JP4i-5mVadgQ0rP865555rnyR5SsmSUsZfNcNuyQhZclHQJeUVe5AsaMGrrKwYe5gsSF3WWUVZ9Ti5CGFHCMmZqGpeniVnOatJWYhF8nvlNtZEs4dU2TbtJqujcVb1qXbDCBGsRqSL4BFXEOIWglGpsemoogEbQ6o20KZujwxOXmOZjd71Pd5Fb1DHdekGLHjczh08bA769-U651PoQd_62JoxxfO1BUD22CsNAzZ6kjzqVB_g4rieJ9_ev_u6usyuPn_4uHp7lTUlrWOmW07zoiJdU-eccEoIyzmlnW5L3UJJKCVNXkLBVa0REwK0qFnT8ZwrQYGy8-TNQXecmgFaja3Ruxy9GZT_JZ0y8m_Emq3cuL2knDPGOAq8OAp4dzPhjHIwQUPfKwtuClLU-DH0lvj8H-LOTR7fJkgqBC9ywUuGLHpgae9C8NCdrFAi5yBIDILEIMg5CHIOAtY8uz_DqeL47Xf4LkTn7-BakCqvZmfZATchws8Trvw1NmGilJ--r-R6Xf0Ql-svctZ7eeDPVv5v7w_TK9hk</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1776427653</pqid></control><display><type>article</type><title>Cognitive and functional competence after anaesthesia in patients aged over 60: controlled trial of general and regional anaesthesia for elective hip or knee replacement</title><source>Jstor Complete Legacy</source><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Jones, M J ; Piggott, S E ; Vaughan, R S ; Bayer, A J ; Newcombe, R G ; Twining, T C ; Pathy, J ; Rosen, M</creator><creatorcontrib>Jones, M J ; Piggott, S E ; Vaughan, R S ; Bayer, A J ; Newcombe, R G ; Twining, T C ; Pathy, J ; Rosen, M</creatorcontrib><description>OBJECTIVE--To determine the influence of general or regional anaesthesia on long term mental function in elderly patients. DESIGN--Prospective study of patients randomly allocated to receive general or regional anaesthesia. SETTING--The patients' homes and a large teaching hospital in Cardiff. SUBJECTS--146 Patients aged 60 and over scheduled for elective hip or knee replacement. MAIN OUTCOME MEASURES--Scores achieved in tests of cognitive function and functional competence. RESULTS--72 Patients were allocated to receive general anaesthesia and 74 regional anaesthesia. Anaesthetic technique did not influence the duration of the operation, time to mobilisation postoperatively, requirements for analgesia after the operation, or duration of stay in hospital. Three months after the operation there was an improvement in the score for the recognition component (76 ms, 95% confidence interval 9 to 144) and the response component (82 ms, 5 to 158) of the choice reaction time in the group receiving general anaesthesia compared with the group receiving regional anaesthesia. This was the only significant difference between the two groups in the assessments of cognitive and functional competence. Eleven patients receiving regional anaesthesia and 12 receiving general anaesthesia reported that their memory and concentration were worse than before the operation, but this was not confirmed by testing. CONCLUSION--Cognitive and functional competence in elderly patients was not detectably impaired after either general or regional anaesthesia when attention was paid to the known perioperative influences on mental function.</description><identifier>ISSN: 0959-8138</identifier><identifier>EISSN: 1468-5833</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.300.6741.1683</identifier><identifier>PMID: 2390547</identifier><language>eng</language><publisher>England: British Medical Journal Publishing Group</publisher><subject>Activities of Daily Living ; Aged ; Anesthesia ; Anesthesia, Conduction - psychology ; Anesthesia, General - psychology ; Cognition ; Conduction anesthesia ; Female ; Follow-Up Studies ; General anesthesia ; Hip Prosthesis ; Hospital admissions ; Hospitalization ; Humans ; Intravenous anesthesia ; Knee Prosthesis ; Knee replacement ; Male ; Memory ; Mental concentration ; Mental Processes ; Middle Aged ; Older adults ; Postoperative Period ; Prospective Studies ; Random Allocation ; Spinal anesthesia</subject><ispartof>BMJ, 1990-06, Vol.300 (6741), p.1683-1687</ispartof><rights>Copyright 1990 British Medical Journal</rights><rights>Copyright BMJ Publishing Group LTD Jun 30, 1990</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b519t-cd612480fb9260610032611fcd5cde50110b25e46a9c00377ec793bf626a71e13</citedby><cites>FETCH-LOGICAL-b519t-cd612480fb9260610032611fcd5cde50110b25e46a9c00377ec793bf626a71e13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/29708286$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/29708286$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>230,314,776,780,799,881,27903,27904,57995,58228</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/2390547$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jones, M J</creatorcontrib><creatorcontrib>Piggott, S E</creatorcontrib><creatorcontrib>Vaughan, R S</creatorcontrib><creatorcontrib>Bayer, A J</creatorcontrib><creatorcontrib>Newcombe, R G</creatorcontrib><creatorcontrib>Twining, T C</creatorcontrib><creatorcontrib>Pathy, J</creatorcontrib><creatorcontrib>Rosen, M</creatorcontrib><title>Cognitive and functional competence after anaesthesia in patients aged over 60: controlled trial of general and regional anaesthesia for elective hip or knee replacement</title><title>BMJ</title><addtitle>BMJ</addtitle><description>OBJECTIVE--To determine the influence of general or regional anaesthesia on long term mental function in elderly patients. DESIGN--Prospective study of patients randomly allocated to receive general or regional anaesthesia. SETTING--The patients' homes and a large teaching hospital in Cardiff. SUBJECTS--146 Patients aged 60 and over scheduled for elective hip or knee replacement. MAIN OUTCOME MEASURES--Scores achieved in tests of cognitive function and functional competence. RESULTS--72 Patients were allocated to receive general anaesthesia and 74 regional anaesthesia. Anaesthetic technique did not influence the duration of the operation, time to mobilisation postoperatively, requirements for analgesia after the operation, or duration of stay in hospital. Three months after the operation there was an improvement in the score for the recognition component (76 ms, 95% confidence interval 9 to 144) and the response component (82 ms, 5 to 158) of the choice reaction time in the group receiving general anaesthesia compared with the group receiving regional anaesthesia. This was the only significant difference between the two groups in the assessments of cognitive and functional competence. Eleven patients receiving regional anaesthesia and 12 receiving general anaesthesia reported that their memory and concentration were worse than before the operation, but this was not confirmed by testing. CONCLUSION--Cognitive and functional competence in elderly patients was not detectably impaired after either general or regional anaesthesia when attention was paid to the known perioperative influences on mental function.</description><subject>Activities of Daily Living</subject><subject>Aged</subject><subject>Anesthesia</subject><subject>Anesthesia, Conduction - psychology</subject><subject>Anesthesia, General - psychology</subject><subject>Cognition</subject><subject>Conduction anesthesia</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>General anesthesia</subject><subject>Hip Prosthesis</subject><subject>Hospital admissions</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Intravenous anesthesia</subject><subject>Knee Prosthesis</subject><subject>Knee replacement</subject><subject>Male</subject><subject>Memory</subject><subject>Mental concentration</subject><subject>Mental Processes</subject><subject>Middle Aged</subject><subject>Older adults</subject><subject>Postoperative Period</subject><subject>Prospective Studies</subject><subject>Random Allocation</subject><subject>Spinal anesthesia</subject><issn>0959-8138</issn><issn>1468-5833</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1990</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFUsuO0zAUjRBoqIb5ABZIkZBYkWLHiZ2wQEIVMEhTYMFjaTnOTetOYmdsp4JP4i-5mVadgQ0rP865555rnyR5SsmSUsZfNcNuyQhZclHQJeUVe5AsaMGrrKwYe5gsSF3WWUVZ9Ti5CGFHCMmZqGpeniVnOatJWYhF8nvlNtZEs4dU2TbtJqujcVb1qXbDCBGsRqSL4BFXEOIWglGpsemoogEbQ6o20KZujwxOXmOZjd71Pd5Fb1DHdekGLHjczh08bA769-U651PoQd_62JoxxfO1BUD22CsNAzZ6kjzqVB_g4rieJ9_ev_u6usyuPn_4uHp7lTUlrWOmW07zoiJdU-eccEoIyzmlnW5L3UJJKCVNXkLBVa0REwK0qFnT8ZwrQYGy8-TNQXecmgFaja3Ruxy9GZT_JZ0y8m_Emq3cuL2knDPGOAq8OAp4dzPhjHIwQUPfKwtuClLU-DH0lvj8H-LOTR7fJkgqBC9ywUuGLHpgae9C8NCdrFAi5yBIDILEIMg5CHIOAtY8uz_DqeL47Xf4LkTn7-BakCqvZmfZATchws8Trvw1NmGilJ--r-R6Xf0Ql-svctZ7eeDPVv5v7w_TK9hk</recordid><startdate>19900630</startdate><enddate>19900630</enddate><creator>Jones, M J</creator><creator>Piggott, S E</creator><creator>Vaughan, R S</creator><creator>Bayer, A J</creator><creator>Newcombe, R G</creator><creator>Twining, T C</creator><creator>Pathy, J</creator><creator>Rosen, M</creator><general>British Medical Journal Publishing Group</general><general>British Medical Association</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>19900630</creationdate><title>Cognitive and functional competence after anaesthesia in patients aged over 60: controlled trial of general and regional anaesthesia for elective hip or knee replacement</title><author>Jones, M J ; Piggott, S E ; Vaughan, R S ; Bayer, A J ; Newcombe, R G ; Twining, T C ; Pathy, J ; Rosen, M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b519t-cd612480fb9260610032611fcd5cde50110b25e46a9c00377ec793bf626a71e13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1990</creationdate><topic>Activities of Daily Living</topic><topic>Aged</topic><topic>Anesthesia</topic><topic>Anesthesia, Conduction - psychology</topic><topic>Anesthesia, General - psychology</topic><topic>Cognition</topic><topic>Conduction anesthesia</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>General anesthesia</topic><topic>Hip Prosthesis</topic><topic>Hospital admissions</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Intravenous anesthesia</topic><topic>Knee Prosthesis</topic><topic>Knee replacement</topic><topic>Male</topic><topic>Memory</topic><topic>Mental concentration</topic><topic>Mental Processes</topic><topic>Middle Aged</topic><topic>Older adults</topic><topic>Postoperative Period</topic><topic>Prospective Studies</topic><topic>Random Allocation</topic><topic>Spinal anesthesia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jones, M J</creatorcontrib><creatorcontrib>Piggott, S E</creatorcontrib><creatorcontrib>Vaughan, R S</creatorcontrib><creatorcontrib>Bayer, A J</creatorcontrib><creatorcontrib>Newcombe, R G</creatorcontrib><creatorcontrib>Twining, T C</creatorcontrib><creatorcontrib>Pathy, J</creatorcontrib><creatorcontrib>Rosen, M</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jones, M J</au><au>Piggott, S E</au><au>Vaughan, R S</au><au>Bayer, A J</au><au>Newcombe, R G</au><au>Twining, T C</au><au>Pathy, J</au><au>Rosen, M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cognitive and functional competence after anaesthesia in patients aged over 60: controlled trial of general and regional anaesthesia for elective hip or knee replacement</atitle><jtitle>BMJ</jtitle><addtitle>BMJ</addtitle><date>1990-06-30</date><risdate>1990</risdate><volume>300</volume><issue>6741</issue><spage>1683</spage><epage>1687</epage><pages>1683-1687</pages><issn>0959-8138</issn><eissn>1468-5833</eissn><eissn>1756-1833</eissn><abstract>OBJECTIVE--To determine the influence of general or regional anaesthesia on long term mental function in elderly patients. DESIGN--Prospective study of patients randomly allocated to receive general or regional anaesthesia. SETTING--The patients' homes and a large teaching hospital in Cardiff. SUBJECTS--146 Patients aged 60 and over scheduled for elective hip or knee replacement. MAIN OUTCOME MEASURES--Scores achieved in tests of cognitive function and functional competence. RESULTS--72 Patients were allocated to receive general anaesthesia and 74 regional anaesthesia. Anaesthetic technique did not influence the duration of the operation, time to mobilisation postoperatively, requirements for analgesia after the operation, or duration of stay in hospital. Three months after the operation there was an improvement in the score for the recognition component (76 ms, 95% confidence interval 9 to 144) and the response component (82 ms, 5 to 158) of the choice reaction time in the group receiving general anaesthesia compared with the group receiving regional anaesthesia. This was the only significant difference between the two groups in the assessments of cognitive and functional competence. Eleven patients receiving regional anaesthesia and 12 receiving general anaesthesia reported that their memory and concentration were worse than before the operation, but this was not confirmed by testing. CONCLUSION--Cognitive and functional competence in elderly patients was not detectably impaired after either general or regional anaesthesia when attention was paid to the known perioperative influences on mental function.</abstract><cop>England</cop><pub>British Medical Journal Publishing Group</pub><pmid>2390547</pmid><doi>10.1136/bmj.300.6741.1683</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0959-8138 |
| ispartof | BMJ, 1990-06, Vol.300 (6741), p.1683-1687 |
| issn | 0959-8138 1468-5833 1756-1833 |
| language | eng |
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| source | Jstor Complete Legacy; MEDLINE; Alma/SFX Local Collection |
| subjects | Activities of Daily Living Aged Anesthesia Anesthesia, Conduction - psychology Anesthesia, General - psychology Cognition Conduction anesthesia Female Follow-Up Studies General anesthesia Hip Prosthesis Hospital admissions Hospitalization Humans Intravenous anesthesia Knee Prosthesis Knee replacement Male Memory Mental concentration Mental Processes Middle Aged Older adults Postoperative Period Prospective Studies Random Allocation Spinal anesthesia |
| title | Cognitive and functional competence after anaesthesia in patients aged over 60: controlled trial of general and regional anaesthesia for elective hip or knee replacement |
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