BACKGROUND There is no consensus on the optimal anesthesia method for intertrochanteric fracture surgeries in elderly patients. Our study aimed to compare the hemodynamics and perioperative outcomes of general anesthesia with endotracheal intubation, combined spinal-epidural anesthesia, and general anesthesia with laryngeal mask airway (LMA) and nerve block for intertrochanteric fracture surgeries in elderly patients. METHODS This is a retrospective study of 75 patients aged > 60 years scheduled for intertrochanteric fracture surgeries with general anesthesia with intubation (n = 25), combined spinal-epidural anesthesia (n = 25), and general anesthesia with LMA and nerve block (n = 25). The intraoperative hemodynamics were recorded, and the maximum variation rate was calculated. Postoperative analgesic effect was evaluated using the visual analog scale (VAS). Postoperative cognitive status was assessed using the Mini-Mental State Exam (MMSE). RESULTS The maximum variation rate of intraoperative heart rate, systolic blood pressure, diastolic blood pressure differed significantly between the three groups (general anesthesia with intubation > combined spinal-epidural anesthesia > general anesthesia with LMA and nerve block). The VAS scores postoperative 2 h, 4 h, 6 h, and 8 h also differed significantly between the three groups (general anesthesia with intubation > combined spinal-epidural anesthesia > general anesthesia with LMA and nerve block). The VAS scores postoperative 24 h were significantly lower in the general anesthesia with LMA/nerve block group than the general anesthesia with intubation group and the combined spinal-epidural anesthesia group. The MMSE scores postoperative 15 min and 45 min differed significantly between the three groups (general anesthesia with intubation < combined spinal-epidural anesthesia < general anesthesia with LMA and nerve block). The MMSE scores postoperative 120 min in the general anesthesia with intubation group were the lowest among the three groups. There was no significant difference in the incidence of respiratory infection postoperative 24 h, 48 h, and 72 h between the three groups. CONCLUSION Compared to general anesthesia with intubation and combined spinal-epidural anesthesia, general anesthesia with LMA and nerve block had better postoperative analgesic effect and less disturbances on intraoperative hemodynamics and postoperative cognition for elderly patients undergoing intertrochanteric fracture surgeries.

中文翻译：

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老年患者股骨转子间骨折手术全麻与气管插管，脊柱-硬膜外联合麻醉以及喉罩气道和神经阻滞全麻的比较：一项回顾性队列研究。

背景技术关于老年患者股骨粗隆间骨折手术的最佳麻醉方法尚无共识。我们的研究旨在比较气管插管，全身硬膜外麻醉，脊柱-硬膜外麻醉，喉罩气道（LMA）和神经阻滞的全身麻醉对老年患者股骨粗隆间骨折手术的血液动力学和围手术期效果。方法这是一项回顾性研究，对75例年龄大于60岁的患者进行了计划，这些患者计划在粗隆间骨折手术中进行全麻插管（n = 25），脊柱-硬膜外麻醉（n = 25）以及LMA和神经阻滞（n = 25）。记录术中血流动力学，并计算最大变化率。使用视觉模拟量表（VAS）评估术后镇痛效果。术后认知状态使用迷你精神状态检查（MMSE）进行评估。结果三组术中心率，收缩压，舒张压的最大变化率差异显着（插管全身麻醉>脊柱-硬膜外联合麻醉> LMA和神经阻滞全麻）。三组患者术后2 h，4 h，6 h和8 h的VAS评分也有显着差异（插管全身麻醉>脊柱-硬膜外联合麻醉> LMA和神经阻滞全麻）。LMA /神经阻滞组的全麻术后24 h VAS评分明显低于插管组和脊柱-硬膜外联合麻醉组的全麻。术后15分钟和45分钟的MMSE评分在三组之间有显着差异（插管全麻<硬脊膜联合麻醉<LMA和神经阻滞全麻）。插管组全麻术后120min的MMSE评分在三组中最低。三组患者术后24、48和72小时呼吸道感染的发生率无显着差异。结论与插管加脊柱-硬膜外麻醉相结合的全身麻醉相比，