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Nitrous oxide does not change the incidence of postoperative delirium or cognitive decline in elderly surgical patients.

Abstract：

BACKGROUND:Postoperative delirium and cognitive decline are common in elderly surgical patients after non-cardiac surgery. Despite this prevalence and clinical importance, no specific aetiological factor has been identified for postoperative delirium and cognitive decline. In experimental setting in a rat model, nitrous oxide (N(2)O) produces neurotoxic effect at high concentrations and in an age-dependent manner. Whether this neurotoxic response may be observed clinically has not been previously determined. We hypothesized that in the elderly patients undergoing non-cardiac surgery, exposure to N(2)O resulted in an increased incidence of postoperative delirium than would be expected for patients not receiving N(2)O. METHODS:Patients who were >or=65 yr of age, undergoing non-cardiac surgery and requiring general anaesthesia were randomized to receive an inhalational agent and either N(2)O with oxygen or oxygen alone. A structured interview was conducted before operation and for the first two postoperative days to determine the presence of delirium using the Confusion Assessment Method. RESULTS:A total of 228 patients were studied with a mean (range) age of 73.9 (65-95) yr. After operation, 43.8% of patients developed delirium. By multivariate logistic regression, age [odds ratio (OR) 1.07; 95% confidence interval (CI) 1.02-1.26], dependence on performing one or more independent activities of daily living (OR 1.54; 95% CI 1.01-2.35), use of patient-controlled analgesia for postoperative pain control (OR 3.75; 95% CI 1.27-11.01) and postoperative use of benzodiazepine (OR 2.29; 95% CI 1.21-4.36) were independently associated with an increased risk for postoperative delirium. In contrast, the use of N(2)O had no association with postoperative delirium. CONCLUSIONS:Exposure to N(2)O resulted in an equal incidence of postoperative delirium when compared with no exposure to N(2)O.

journal_name

Br J Anaesth

journal_title

British journal of anaesthesia

authors

Leung JM,Sands LP,Vaurio LE,Wang Y

doi

10.1093/bja/ael106

subject

Has Abstract

pub_date

2006-06-01 00:00:00

pages

754-60

issue

eissn

0007-0912

issn

1471-6771

pii

S0007-0912(17)35096-1

journal_volume

pub_type

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Nitrous oxide does not change the incidence of postoperative delirium or cognitive decline in elderly surgical patients.