The influence of general and regional anesthesia on cognitive status in elderly and senile patients undergoing primary and revision arthroplasty of lower limb joints
Bibliographic record
Abstract
BACKGROUND: Recently, the impact of general anaesthesia on the patient's cognitive state has been increasingly discussed. The detrimental effects of the general anaesthetic components can be clinically manifested in the form of impaired memory, coordination and attention, as well as in the development of delirium, which increases postoperative mortality. AIM: To evaluate the influence of methods of general anaesthesia and the combination of regional anaesthesia and intravenous sedation on the development of early postoperative cognitive dysfunction in older and elderly patients undergoing surgery for endoprosthesis of large joints of the lower limb, such as knee and hip joints. MATERIALS AND METHODS: A single-blind, randomized study was conducted in 122 aged patients with orthopedic pathology of the lower limb joints undergoing treatment in the Priorov National Medical Research Center of Traumatology and Otrhopaedics. The effect of general anesthesia and its components in combination with spinal anesthesia with bupivacaine or levobupivacaine on the development of cognitive impairment in the early postoperative period was assessed using the Montreal Mental Status Assessment Scale MoCA. RESULTS: Postoperative delirium developed in 3.3% of patients in the spinal anaesthesia group with intravenous midazolam sedation, early postoperative cognitive dysfunction developed in 26.7% of patients in the spinal anaesthesia group with intravenous midazolam and diazepam sedation, and in 16.7% of patients in the dexmedetomidine group with intravenous dexmedetomidine sedation. In the sevoflurane general anaesthesia group, the incidence of cognitive impairment was significantly higher than in the spinal anaesthesia groups: postoperative delirium developed in 6.3% of patients, and postoperative cognitive dysfunction was found in 50% of older and elderly patients. CONCLUSION: The use of spinal anaesthesia with intravenous sedation with benzodiazepines or dexmedetomidine has a significantly lower effect on the incidence of early postoperative cognitive impairment compared with general anaesthesia with sevoflurane in elderly and older patients undergoing major joint replacement surgery. Intravenous sedation with dexmedetomidine is preferable to spinal anaesthesia.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".