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EPIDURAL VS. GENERAL ANESTHESIA: A COIN FLIP.

Is regional anesthesia a safer option for older patients undergoing surgery? This clinical trial randomized 262 patients with a median age of 69 to receive epidural or general anesthesia for elective total knee replacement and monitored their outcomes, including short-term complications and longer-term neuropsychological status. Perioperative mortality was similar in both groups (below 1 percent), as were rates of major cardiovascular complications (2.9 percent with epidural and 2.4 percent with general anesthesia) and postoperative delirium. Long- term cognitive outcomes were also similar: most patients showed a pattern of cognitive decline at one week, followed within six months by a return to baseline or improvement on most of the 10 neuropsychological tests conducted. Comment: There may be other reasons to prefer epidural or general anesthesia for individual patients, but this study shows that short-term cardiovascular complications and longer-term cognitive outcomes are similar with either strategy.

— TH Lee

Published in Journal Watch General Medicine July 14, 1995

Citation(s):

Williams-Russo P, et al. Cognitive effects after epidural vs general anesthesia in older adults: a randomized trial. JAMA 1995 Jul 5 274 44-50.

• Medline abstract (Free)