Evidence map›Paper›PMID 20042557›Full record

Trial reportMayo Clinic proceedings2010

Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair.

Frederick E Sieber, Khwaji J Zakriya, Allan Gottschalk, Mary-Rita Blute, Hochang B Lee, Paul B Rosenberg, Simon C Mears

Erratum issued 6 registry-linked trialsOpen access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Mayo Clinic proceedings, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 6 registered trials, which are not on this map. Cited by 158 papers, 16 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
158citing papers in PubMed, 16 pooled it
11.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02190903 nacompletednot on this mapstarted 2013, after this paper: background citation

A Randomized Controlled Trial To Assess Risk of Delirium in Older Adults Undergoing Hip Fracture Surgery With Spinal or General Anesthesia

TypeinterventionalSponsorUniversity of PennsylvaniaRan2013 to 2015Enrolled15ConditionsPostoperative Complications, Hip Fracture, DeliriumArmsGeneral endotracheal anesthesia, Regional (spinal) Anesthesia
NCT02213380 nacompletednot on this mapstarted 2014, after this paper: background citation

Effect of Regional Anaesthesia and General Anaesthesia on Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery: a Multicenter Randomized Controlled Trial.

TypeinterventionalSponsorWenzhou Medical UniversityRan2014 to 2020Enrolled950ConditionsPost Operative DeliriumArmsmethod of anesthesia
NCT02360982 completednot on this mapstarted 2012, after this paper: background citation

Cukurova University Faculty of Medicine

TypeobservationalSponsorCukurova UniversityRan2012 to 2013Enrolled120ConditionsPostoperative DeliriumArmspropofol and esmeron(rokuronyum), marcaine and fentanyl
NCT02848599 phase2completednot on this mapstarted 2016, after this paper: background citation

The Influence of Postoperative Analgesia on Systemic Inflammatory Response and Postoperative Cognitive Disfunction in Elderly Patients After Surgical Repair of Femoral Fractures

TypeinterventionalSponsorOsijek University HospitalRan2016 to 2017Enrolled86ConditionsPostoperative Cognitive DysfunctionArmsmorphine, levobupivacaine
NCT03120442 naunknown statusnot on this mapstarted 2017, after this paper: background citation

Postoperative Delirium After Total Knee Arthroplasty Under Regional Anesthesia: a Comparison Between Intraoperative Sedation With Fentanyl, Fentanyl-dexmedetomidine and Fentanyl-propofol

TypeinterventionalSponsorMahidol UniversityRan2017 to 2022Enrolled600ConditionsPostoperative DeliriumArmsPropofol, Dexmedetomidine, Fentanyl
NCT06962046 narecruitingnot on this mapstarted 2024, after this paper: background citation

Can the Use of Virtual Reality Improve Outcomes Following Total Knee Arthroplasty With Spinal Anaesthesia? - A Pilot Study

TypeinterventionalSponsorBelfast Health and Social Care TrustRan2024 to 2025Enrolled40ConditionsTotal Knee ArthroplastyArmsVirtual Reality
3 · Its place in the literature

Who cites it

158 citing papers in PubMed, 16 syntheses or guidelines pooled it, 421 citations in OpenAlex.

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  7. Investigating how electroencephalogram measures associate with delirium: A systematic review.Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2021
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  14. Interventions for preventing delirium in hospitalised non-ICU patients.The Cochrane database of systematic reviews · 2016
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98 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Frederick E SieberDepartment of Anesthesiology & Critical Care Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, Baltimore, MD 21224, USA. fsieber1@jhmi.edu
Khwaji J Zakriya
Allan Gottschalk
Mary-Rita Blute
Hochang B Lee
Paul B Rosenberg
Simon C Mears
Johns Hopkins University · US

Funding

PET imaging of activated microglia in Alzheimer's DiseaseK08AG029157 · NIA · JOHNS HOPKINS UNIVERSITY · PI ROSENBERG, PAUL B · 2008 to 2012
$539k
NIA NIH HHS K08 AG029157
6 · The paper itself

Abstract

objectiveTo determine whether limiting intraoperative sedation depth during spinal anesthesia for hip fracture repair in elderly patients can decrease the prevalence of postoperative delirium. PATIENTS AND

methodsWe performed a double-blind, randomized controlled trial at an academic medical center of elderly patients (>or=65 years) without preoperative delirium or severe dementia who underwent hip fracture repair under spinal anesthesia with propofol sedation. Sedation depth was titrated using processed electroencephalography with the bispectral index (BIS), and patients were randomized to receive either deep (BIS, approximately 50) or light (BIS, >or=80) sedation. Postoperative delirium was assessed as defined by Diagnostic and Statistical Manual of Mental Disorders (Third Edition Revised) criteria using the Confusion Assessment Method beginning at any time from the second day after surgery.

resultsFrom April 2, 2005, through October 30, 2008, a total of 114 patients were randomized. The prevalence of postoperative delirium was significantly lower in the light sedation group (11/57 [19%] vs 23/57 [40%] in the deep sedation group; P=.02), indicating that 1 incident of delirium will be prevented for every 4.7 patients treated with light sedation. The mean +/- SD number of days of delirium during hospitalization was lower in the light sedation group than in the deep sedation group (0.5+/-1.5 days vs 1.4+/-4.0 days; P=.01).

conclusionThe use of light propofol sedation decreased the prevalence of postoperative delirium by 50% compared with deep sedation. Limiting depth of sedation during spinal anesthesia is a simple, safe, and cost-effective intervention for preventing postoperative delirium in elderly patients that could be widely and readily adopted.

Indexed as

Aged, 80 and overAnesthesia, SpinalDeep SedationDeliriumDouble-Blind MethodFemaleHip FracturesHumansHypnotics and SedativesMalePostoperative ComplicationsProcedural SedationPropofolRisk FactorsHypnotics and SedativesPropofol

Identifiers

PMID20042557
PMCPMC2800291
OpenAlexW2068233333

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.