Trial reportAnesthesiology2021
Delirium in Older Patients after Combined Epidural-General Anesthesia or General Anesthesia for Major Surgery: A Randomized Trial.
Trial report in Anesthesiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 75 papers, 3 of them syntheses that pooled it.
What it found
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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.
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.
Perioperative Use of Dexmedetomidine-esketamine Combination and Transcranial Direct Current Stimulation for Prevention of Neurocognitive Complications in Older Patients After Non-cardiac Surgery: a 2×2 Factorial Trial
Long-term Follow-up of Perioperative Dexmedetomidine-esketamine Combination and Transcranial Direct Current Stimulation for Prevention of Neurocognitive Complications in Older Patients After Non-cardiac Surgery
Who cites it
75 citing papers in PubMed, 3 syntheses or guidelines pooled it, 154 citations in OpenAlex.
- Inflammation and delirium in critically Ill patients: a review.Frontiers in aging neuroscience · 2026Pooled it
- Pooled it
- The effects of anesthesia methods and anesthetics on postoperative delirium in the elderly patients: A systematic review and network meta-analysis.Frontiers in aging neuroscience · 2022Pooled it
- Lidocaine combined with low-dose esketamine for movement-evoked pain after hepatectomy: a double-blind randomised controlled trial.Anaesthesia · 2026Trial
- Increasing dose of esketamine for supplemental analgesia after complex spinal fusion surgery: a randomized and double-blind trial.BMC anesthesiology · 2026Trial
- Effect of esketamine on postinduction hypotension in elderly patients undergoing elective noncardiac surgery: a secondary analysis of a randomized clinical trial.Scientific reports · 2025Trial
- Comparison of Remimazolam and Propofol on Postoperative Delirium in Elderly Patients Undergoing Radical Resection of Colon Cancer: A Single-Center Prospective Randomized Controlled Study.Medical science monitor : international medical journal of experimental and clinical research · 2024Trial
- Pulse pressure variation guided goal-direct fluid therapy decreases postoperative complications in elderly patients undergoing laparoscopic radical resection of colorectal cancer: a randomized controlled trial.International journal of colorectal disease · 2024Trial
- Effects of Ultrasound-Guided Thoracic Paravertebral Nerve Block Combined with Perineural or IV Dexmedetomidine on Acute and Chronic Pain After Thoracoscopic Resection of Lung Lesions: A Double-Blind Randomized Trial.Drug design, development and therapy · 2024Trial
- Tight perioperative blood pressure management to reduce complications: a randomised feasibility trial.BMJ open · 2023Trial
- Hypotension Prediction Index guided Goal Directed therapy and the amount of Hypotension during Major Gynaecologic Oncologic Surgery: a Randomized Controlled clinical Trial.Journal of clinical monitoring and computing · 2023Trial
- Dexmedetomidine potential in attenuating postoperative delirium in elderly patients after total hip joint replacement.Revista da Associacao Medica Brasileira (1992) · 2022Trial
- Penehyclidine for prevention of postoperative nausea and vomiting following bimaxillary orthognathic surgery: a randomized, double-blind, controlled trial.Journal of anesthesia · 2022Trial
- Understanding the Unique Ethical Challenges in Randomized Controlled Trials of Delirium Interventions for Older Adults: A Rapid Review.Anesthesia and analgesia · 2026Review
- Thoracic Epidural Analgesia in Major Cancer Surgery: An Update.Medicina (Kaunas, Lithuania) · 2026Review
- Association between the preoperative stress hyperglycemia ratio and postoperative delirium in older adults undergoing non-cardiac surgery: a retrospective cohort study.European geriatric medicine · 2026Article
- Defining estimands in anaesthesia clinical trials: a scoping review and framework.British journal of anaesthesia · 2026Article
- Effects of Peripheral Nerve Block on Perioperative Recovery following Major Thoracic and Abdominal Surgery: A Retrospective Cohort Study With Propensity-score Matching.Annals of surgery · 2026Article
- Associations of postoperative delirium with perioperative frailty worsening and their combined effect on 1-year mortality in older surgical patients: a prospective cohort study.European geriatric medicine · 2026Article
- [Special considerations in geriatric anesthesiology : Aspects of perioperative management in older adults].Zeitschrift fur Gerontologie und Geriatrie · 2026Review
15 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
22 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDelirium is a common and serious postoperative complication, especially in the elderly. Epidural anesthesia may reduce delirium by improving analgesia, reducing opioid consumption, and blunting stress response to surgery. This trial therefore tested the hypothesis that combined epidural-general anesthesia reduces the incidence of postoperative delirium in elderly patients recovering from major noncardiac surgery.
methodsPatients aged 60 to 90 yr scheduled for major noncardiac thoracic or abdominal surgeries expected to last 2 h or more were enrolled. Participants were randomized 1:1 to either combined epidural-general anesthesia with postoperative epidural analgesia or general anesthesia with postoperative intravenous analgesia. The primary outcome was the incidence of delirium, which was assessed with the Confusion Assessment Method for the Intensive Care Unit twice daily during the initial 7 postoperative days.
resultsBetween November 2011 and May 2015, 1,802 patients were randomized to combined epidural-general anesthesia (n = 901) or general anesthesia alone (n = 901). Among these, 1,720 patients (mean age, 70 yr; 35% women) completed the study and were included in the intention-to-treat analysis. Delirium was significantly less common in the combined epidural-general anesthesia group (15 [1.8%] of 857 patients) than in the general anesthesia group (43 [5.0%] of 863 patients; relative risk, 0.351; 95% CI, 0.197 to 0.627; P < 0.001; number needed to treat 31). Intraoperative hypotension (systolic blood pressure less than 80 mmHg) was more common in patients assigned to epidural anesthesia (421 [49%] vs. 288 [33%]; relative risk, 1.47, 95% CI, 1.31 to 1.65; P < 0.001), and more epidural patients were given vasopressors (495 [58%] vs. 387 [45%]; relative risk, 1.29; 95% CI, 1.17 to 1.41; P < 0.001).
conclusionsOlder patients randomized to combined epidural-general anesthesia for major thoracic and abdominal surgeries had one third as much delirium but 50% more hypotension. Clinicians should consider combining epidural and general anesthesia in patients at risk of postoperative delirium, and avoiding the combination in patients at risk of hypotension. EDITOR’S PERSPECTIVE:
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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.