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. 2011 Jul;55(4):358-63.
doi: 10.4103/0019-5049.84850.

General anaesthesia does not contribute to long-term post-operative cognitive dysfunction in adults: A meta-analysis

Joanne Guay  1
Affiliations

General anaesthesia does not contribute to long-term post-operative cognitive dysfunction in adults: A meta-analysis

Joanne Guay. Indian J Anaesth. 2011 Jul.

Abstract

Context: The contribution of anaesthesia itself to post-operative cognitive dysfunction (POCD) or the potential protective effect of one specific type of anaesthesia on the occurrence of POCD is unclear.

Aims: This is a meta-analysis evaluating the effects of the anaesthetic technique (regional vs. general anaesthesia) on POCD of patients undergoing non-cardiac surgery.

Settings and design: Meta-analysis performed in a University affiliated hospital.

Methods: A search for randomized controlled trials (RCT) comparing regional anaesthesia to general anaesthesia for surgery was done in PUBMED, MEDLINE, EMBASE, EBM Reviews-Cochrane Central Register of Controlled Trials, PsychINFO and Current Contents/all editions in 2009.

Statistical analysis: Data were analyzed with comprehensive Meta-analysis Version 2.2.044.

Results: Twenty-six RCTs including 2365 patients: 1169 for regional anaesthesia and 1196 for general anaesthesia were retained. The standardized difference in means for the tests included in the 26 RCTs was -0.08 (95% confidence interval: -0.17-0.01; P value 0.094; I-squared = 0.00%). The assessor was blinded to the anaesthetic technique for 12 of the RCTs including only 798 patients: 393 for regional anaesthesia and 405 for general anaesthesia. The standardized difference in means for these 12 studies is 0.05 (-0.10-0.20; P=0.51; I-squared = 0.00%).

Conclusions: The present meta-analysis does not support the concerns that a single exposure to general anaesthesia in an adult would significantly contribute to permanent POCD after non-cardiac surgery.

Keywords: Meta-analysis; post-operative cognitive dysfunction; regional anaesthesia.

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Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
The bias risk assessment of the 26 included studies
Figure 2
Figure 2
Forest plot. Two studies[629] are presented as subgroups (elderliesa and youngb) There was no statistical difference between the two anaesthetic techniques.
Figure 3
Figure 3
Meta-regression of the effect size by year of publication. P value of the slope = 0.29
Figure 4
Figure 4
Funnel plot of published studies included (blue dots) with their combined effect size (blue diamond) and after the trim and fill technique (red dots and red diamond)
See this image and copyright information in PMC

References

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