Specific aims: is randomized trial will assess the impact of hypotensive versus normotensive anesthesia on cognitive, cardiac and renal complications in an elderly population undergoing total hip replacement. Secondly, this trial will document and comprehensively assess the incidence of persistent, post-operative josses in cognitive function in an elderly population undergoing elective non-cardiac surgery. Thirdly, this trial will assess the impact of deliberate hypotensive anesthesia on intraoperative blood loss and the need for non-autologous transfusions in this population. Experimental design and methods: A prospective randomized trial in elderly patients with comorbid medical conditions undergoing elective total hip replacement assessing the effect of hypotensive vs normotensive anesthesia on the outcomes of cardiac, renal and cognitive complications. Baseline clinical and demographic data and comprehensive intra-operative monitoring data will be collected and analyzed. Occurrence of persistent deterioration of performance will be assessed in three cognitive domains of linguistic, psychomotor/attention, and memory function. Outcome will be measured by intrasubject comparison of psychometric test results three months post-operatively versus pre-operatively. Occurrence of major cardiac and renal complications will be evaluated using a sensitive surveillance protocol to detect perioperative myocardial infarction, pulmonary edema, pulmonary emboli, congestive heart failure, and renal injury. The administrator of the cognitive tests, the co-investigators assessing and reviewing post-operative cardiac outcomes, and the coinvestigators reviewing and analyzing the cognitive test results will be blinded to the type of anesthesia intervention. Functional impact will be assessed with an evaluative scale administered pre-operatively and three months post-operatively. The results of the functional scale will be correlated with the results of serial psychometric testing to provide a context in which changes on psychometric tests can be interpreted. Long term objective: The long term objective is to assess the risks and benefits of hypotensive anesthesia in elderly patients undergoing elective surgery.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG008562-05
Application #
3120275
Study Section
Human Development and Aging Subcommittee 3 (HUD)
Project Start
1989-07-01
Project End
1995-06-30
Budget Start
1993-07-01
Budget End
1994-06-30
Support Year
5
Fiscal Year
1993
Total Cost
Indirect Cost
Name
Hospital for Special Surgery
Department
Type
DUNS #
City
New York
State
NY
Country
United States
Zip Code
10021
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Williams-Russo, P; Sharrock, N E; Mattis, S et al. (1999) Randomized trial of hypotensive epidural anesthesia in older adults. Anesthesiology 91:926-35
Sharrock, N E; Go, G; Williams-Russo, P et al. (1997) Comparison of extradural and general anaesthesia on the fibrinolytic response to total knee arthroplasty. Br J Anaesth 79:29-34
Williams-Russo, P; Sharrock, N E; Haas, S B et al. (1996) Randomized trial of epidural versus general anesthesia: outcomes after primary total knee replacement. Clin Orthop Relat Res :199-208
Williams-Russo, P; Sharrock, N E; Mattis, S et al. (1995) Cognitive effects after epidural vs general anesthesia in older adults. A randomized trial. JAMA 274:44-50
Williams-Russo, P; Urquhart, B L; Sharrock, N E et al. (1992) Post-operative delirium: predictors and prognosis in elderly orthopedic patients. J Am Geriatr Soc 40:759-67