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Introduction Of Spinal Anaesthesia Vs General Anaesthesia In Elderly Orthopaedic Patients
- At the time of conducting the research, several; articles have been researched on the basis of the ERAS or the “early recovery after surgery” in orthopaedic
- Comparison between the effectiveness of general anaesthesia and spinal anaesthesia in recovery in the post-operative stage for elderly people
- Spinal anaesthesia in elderly orthopaedic patients may cause fewer postoperative complications than general anaesthesia.
- In addition to it, the ethical governance of the research will be beneficial as many of the patients may prefer the treatment of elderly people or patients with co-morbidities.
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SN: In this study, a critique range of the research was published as the relevant article to the agreed strategies of the research. The research has also increased interest in making a comparison between the effectiveness of general anaesthesia and spinal anaesthesia in recovery in the post-operative stage for elderly people. The evidence of the research refers that spinal anaesthesia in elderly orthopaedic patients may cause lesser postoperative complications than general anaesthesia. In some studies, it has been shown that spinal anaesthesia is related to a lower incidence of nausea and vomiting, opioid consumption, shorter hospital stays, and reduced pain in the post-operative stage
Background
- General anaesthesia in elderly people is related to nausea, vomiting, and longer stay in the hospital.
- Spinal anaesthesia is associated with fewer adverse effects among patients in comparison to general anaesthesia (Ehsani et al. 2020).
- Reducing the risk of postoperative delirium among older patients with the application of spinal anaesthesia (Capdevila et al. 2020)
- Spinal anaesthesia is associated with lowering the risk of side effects regarding cognition and heart issues.
SN: In the application of general anaesthesia patients especially elderly people may show may develop signs of postoperative delirium which is related to disorientation, confusion and lack of awareness among the patients. Spinal anaesthesia is preferred by the patients and medical persons as it contains a lesser dose of the drug compared to general anaesthesia.
PICO
| Population |
Elderly orthopaedic patients |
| Intervention |
Spinal anaesthesia |
| Comparison |
General anaesthesia |
| Outcome |
Postoperative recovery |
By combining these PICO elements, the research question is formulated as: "In elderly orthopaedic patients, how does spinal anaesthesia compare to general anaesthesia in terms of postoperative recovery?"
SN: The above slide provides PICO table.
Research Question Formulation
- Population: The word population is associated with the individual or the group of patients on which the study is focused. In the recent case, the selected population is "elderly orthopaedic patients."
- Intervention: Intervention refers to the treatment of the study (Neuman et al. 2021). In the recent case, the Intervention is Spinal anaesthesia.
- Comparison: the comparison is associated with the alternative treatment that may be offered to the patients (Weibel et al. 2020). In this case, General anaesthesia has been chosen as the alternative medication for spinal anaesthesia.
- Outcome: The outcome is based on the results of the test objectives to be investigated. Here postoperative recovery is selected as the outcome on the basis of the factors such as mobility, and relief from pain.
SN: The above slide demonstrates research question construction with PICO Framework
Facet Analysis
| Patient Population |
Anaesthesia Techniques |
Comparison |
Postoperative Recovery |
| Age |
Spinal Anaesthesia |
Comparative Effectiveness |
Pain Management |
| Orthopaedic patients |
General Anaesthesia |
Safety and Complications |
Functional Recovery |
| Surgical Conditions |
Complications |
| Length of staying in the Hospital |
- Patient Population:
- Age: Older people especially patients above the age of 65
- Orthopaedic patients: Patients who need orthopaedic procedures, in the situations like fracture repair or joint replacement.
- Anaesthesia Techniques
- Spinal Anaesthesia: Injection of anaesthetic treatment into the CSF or cerebrospinal fluid around the spinal cord for making numb the lower part of the patient's body.
- General Anaesthesia: Introducing the condition of painlessness and unconsciousness within the use of inhaled gases and intravenous drugs.
- Comparison:
- Comparison is done on the basis of Comparative Effectiveness, Safety Complications and Surgical Conditions.
- Postoperative Recovery
- Pain Management, Functional Recovery and Complications are the basic outcomes of the research.
SN: The above slide demonstrates facet analysis for the research question.
Database Search
- Proquest, PubMed or “National Library of Medicine”, and Science direct has been chosen here as the database for searching the articles.
- Among all of them, PubMed and Science Direct are found to contain more peer-reviewed articles.
Key Terms that have been used here in this part:
- “Elder patients” with “Orthopaedic issues” or “old orthopaedic patients”
- “Anesthesia”
- “Spinal Anaesthesia”
- “General Anaesthesia”
- “Postoperative Recovery”
SN: The above slide demonstrates the databases used for identification of the articles selected for critique.
Research Strategies
- Multiple Search engines are used here. These search engines were identified and analyzed to exhibit the research work within time duration of the last 10 years.
- All the research which has been conducted is requested to be translated into the English Language. Studies considering clinical trials have been considered in this study.
- The “Boolean Terms” have been used here. These Boolean Terms were - “AND”, “OR”, & “NOT” during the time of searching. Example: Spinal Anaesthesia and General Anaesthesia
- Most of the articles were limited to the “FULL-TEXT” mode because those articles do not allow the researchers with scope to criticise those works. Authentic and peer-reviewed journal articles have been selected here.
SN: The above slide shows search strategy
Log Sheet 1
| Literature search-Elderly, spinal anaesthesia, general anaesthesia |
| Keywords: elderly people, general anaesthesia, spinal anaesthesia |
| Limits: |
Publication date-2013-2023 |
Source type- Pubmed or National Library of Medicine |
| Database: |
Keywords |
Hits |
Hits with Limits |
Papers Discarded/Chosen |
| Pubmed |
elderly people, general anaesthesia, spinal anaesthesia |
11,156 |
1142 |
Suto, T., Takazawa, T., Nishikawa, K., & Goto, F. (2007). Effects of spinal anesthesia on the peripheral and deep core temperature in elderly diabetic patients undergoing urological surgery.Journal of anesthesia,21, 336-339. This article is not selected as it is not appropriate for the study as it is focusing on diabetic patients and it is does not appropriate with the present data. |
| AND |
Chen, Y., Liu, W., Gong, X., & Cheng, Q. (2019). Comparison of effects of general anesthesia and combined spinal/epidural anesthesia for cesarean delivery on umbilical cord blood gas values: a double-blind, randomized, controlled study.Medical science monitor: international medical journal of experimental and clinical research,25, 5272. This is not selected in the article as it is not fully focused on the factors of the critique objectives. |
| AND |
Qian, M., Yang, F., Zhao, L., Shen, J., & Xie, Y. (2021). Individualized positive end-expiratory pressure titration on respiration and circulation in elderly patients undergoing spinal surgery in prone position under general anesthesia.American Journal of Translational Research,13(12), 13835. This article has been selected for the critique as it is based on all the factors required for the project. |
LOG SHEET 2
| Literature search-General Anaesthesia in an elderly patients |
| Keywords: |
General Anaesthesia |
Orthopaedic surgery, |
Old orthopaedic patients, Comparative Effectiveness, Surgical Conditions, |
| Limits:2013- 2023 Critical AuthorPublication date: 2021 Subject- Subarachnoid anesthesia Source type- Pubmed |
| Database: |
keywords |
Hits |
Hits with Limits |
Papers Discarded/Chosen |
| National Library of Medicine |
Subarachnoid anaesthesia, |
43,437 |
1347 |
Song, Y., Liu, Y., Yuan, Y., Jia, X., Zhang, W., Wang, G., ... & Li, Z. (2021). Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery: a prospective cohort clinical trial.EBioMedicine,70. DOI: https://doi.org/10.1016/j.ebiom.2021.103490 This paper was the chosen one because this included all the necessary data about information on Subarachnoid anaesthesia and circadian melatonin |
| AND |
Yuan, Y., Song, Y., Wang, G., Jia, Y., Zhou, Y., Mi, X., ... & Li, Z. (2021). Protocol: Effects of general versus regional anaesthesia on circadian melatonin rhythm and its association with postoperative delirium in elderly patients undergoing hip fracture surgery: study protocol for a prospective cohort clinical trial.BMJ Open,11(2). doi: 10.1136/bmjopen-2020-043720 This was not chosen because it did not contain proper information about the Subarachnoid anaesthesia and its usage |
| AND |
Oh, E. S., Leoutsakos, J. M., Rosenberg, P. B., Pletnikova, A. M., Khanuja, H. S., Sterling, R. S., ... & Neufeld, K. J. (2021). Effects of ramelteon on the prevention of postoperative delirium in older patients undergoing orthopedic surgery: the RECOVER randomized controlled trial.The American Journal of Geriatric Psychiatry,29(1), 90-100. doi: 10.1016/j.jagp.2020.05.006 This one was discarded because it did not contain appropriate hypotheses and practical data. |
Log Sheet 3
| Literature search-Spinal Anaesthesia versus General Anaesthesia in the elderly patients |
| Keywords:Functional Recovery, Spinal Anaesthesia, General Anaesthesia |
General Anaesthesia |
| Limits: 2013- 2023 Critical Author Publication date- 2018 Subject- Spinal AnaesthesiaSource type- Pubmed |
| Database: |
Keywords |
Hits |
Hits with Limits |
Papers Discarded/Chosen |
| National Library of Medicine |
Elderly patient, Spinal aneasthesia |
12,456 |
1097 |
Meuret, P., Bouvet, L., Villet, B., Hafez, M., Allaouchiche, B., & Boselli, E. (2018). Hypobaric unilateral spinal anaesthesia versus general anaesthesia in elderly patients undergoing hip fracture surgical repair: a prospective randomised open trial.Turkish Journal of Anaesthesiology and Reanimation,46(2), 121. doi: 10.5152/TJAR.2018.90699 This is chosen as it is focused on our topic that was important for research purposes |
| AND |
Chen, D. X., Yang, L., Ding, L., Li, S. Y., Qi, Y. N., & Li, Q. (2019). Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis.Medicine,98(49). doi: 10.1097/MD.0000000000018220 This journal was discarded because it was not giving a detailed idea of the concerned topic |
| AND |
Tang, L., Fang, P., Fang, Y., Lu, Y., Xu, G., & Liu, X. (2021). Comparison of effects between combined lumbar-sacral plexus block plus general anaesthesia and unilateral spinal anaesthesia in elderly patients undergoing hip fracture surgery: a pilot randomized controlled trial.Evidence-Based Complementary and Alternative Medicine,2021. https://doi.org/10.1155/2021/6685497 This journal was also discarded due to its ineffectiveness on the topic. |
Papers Chosen
- Qian, M., Yang, F., Zhao, L., Shen, J., & Xie, Y. (2021). Individualized positive end-expiratory pressure titration on respiration and circulation in elderly patients undergoing spinal surgery in prone position under general anesthesia.American Journal of Translational Research,13(12), 13835.
- Meuret, P., Bouvet, L., Villet, B., Hafez, M., Allaouchiche, B., & Boselli, E. (2018). Hypobaric unilateral spinal anaesthesia versus general anaesthesia in elderly patients undergoing hip fracture surgical repair: a prospective randomised open trial. Turkish Journal of Anaesthesiology and Reanimation, 46(2), 121. doi: 10.5152/TJAR.2018.90699
- Song, Y., Liu, Y., Yuan, Y., Jia, X., Zhang, W., Wang, G., ... & Li, Z. (2021). Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery: a prospective cohort clinical trial. EBioMedicine, 70. DOI: https://doi.org/10.1016/j.ebiom.2021.103490
PubMed: it is easily available and can be easily pinpointed.
Science Direct: Various types of papers and research studies in full-text mode are available.
SN: The above slide shows the selected articles.
Importance Of Critiquing
- The importance and requirement of critiquing any pre-existed research paper is needed to meet the ultimate goal to create a balanced view of that journal.
- Based on Maugeri, & Musumeci, (2020). The viewers who read the journals are the ones who analyse and find out the specific strengths and their limitations which can be visible in the methods which have been used in those journals or research papers.
- This critiquing is also important to get proper knowledge of the application of the theories.
- It is important to have a balanced examination so that there is no room left for biased-ness towards any views.
SN: This helps the readers to create a judgment of the topic and critically understand and analyse it based on their own knowledge. The process of critiquing is carried out with the help of a well-organised framework of valid and reasonable questions to gain knowledge and understanding of the chosen topic. Greenhalgh framework was used during this literature review.
Paper One
Article 1: Qian, M., Yang, F., Zhao, L., Shen, J., & Xie, Y. (2021). Individualized positive end-expiratory pressure titration on respiration and circulation in elderly patients undergoing spinal surgery in prone position under general anesthesia.American Journal of Translational Research,13(12), 13835.)
| Evaluation Framework Grid |
Questions |
Evaluation |
| The academic perspective |
Was there a clearly formulated hypothesis? |
No |
| Was the research method appropriate? |
Yes |
| Is the sample size appropriate? |
Yes, |
| Methods - what quality control measures were used? |
| Conclusions -are they justified? |
Yes, |
| The practitioner perspective |
Is there any obvious application that could lead to an improvement in patient care? |
Yes |
| Does the research have relevance to everyday patient care? |
Yes |
| The management perspective |
Does the article suggest how any resulting evidence could be disseminated? |
No |
| Would the application of the research have a positive or negative economic impact? |
No |
| The strategic perspective |
Does the research explain the underlying reasons for events? |
Yes |
| Will the research assist in the delivery of national NHS (or other healthcare systems) strategies? |
Yes |
(Source: Self-developed)
| Strengths |
Limitations |
| Prospective design This study involves the prospective design |
Generalizability This study involves a particular population of older patients undergoing spinal surgery |
| Randomized control of the trial: This study involves a controlled trial of randomized design |
Limitation in the long-term outcomes The study focuses on the effect in the limited time rather than the long term effect |
| Sample size and population The sample size is appropriate in understanding the effect in many people |
Single-center study Biasness in the outcome is observes |
SN:Strength-Prospective design is usually considered stronger than retrospective designs as it makes us allowed for the gathering of data in real time and reduces the recall bias. That is considered as the gold standard for the evaluation of the effectiveness of the interventions. The randomization process helps in decreasing selection biases and makes insurance a more balanced distribution of all the factors between the age groups.Weakness-The findings may not be directly applicable to other surgical procedures or patient populations, limiting the generalizability of the results. The effect in the limited time does not give a clear indication of the long-term effect of the medication.
Paper Two
Article 2: Song, Y., Liu, Y., Yuan, Y., Jia, X., Zhang, W., Wang, G., ... & Li, Z. (2021). Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery: a prospective cohort clinical trial.EBioMedicine,70.)
| Evaluation Framework Grid |
Questions |
Evaluation |
| The academic perspective |
Was there a clearly formulated hypothesis? |
Yes |
| Was the research method appropriate? |
Yes |
| Is the sample size appropriate? |
Yes |
| Methods - are quality control measures used? |
Yes |
| Conclusions -are they justified? |
Yes |
| The practitioner perspective |
Is there any obvious application that could lead to an improvement in patient care? |
Yes |
| Does the research have relevance to everyday patient care? |
Yes |
| The management perspective |
Does the article suggest how any resulting evidence could be disseminated? |
Yes |
| Would the application of the research have a positive or negative economic impact? |
No |
| The strategic perspective |
Does the research explain the underlying reasons for events? |
Yes |
| Will the research assist in the delivery of national NHS (or other healthcare systems) strategies? |
Yes |
(Source: Self-developed)
| Strengths |
Limitations |
| Prospective cohort design Collection of the data without the biases |
Limitation in the external validity it does not make the proper outcome of the results. |
| Sufficient size of the sample The cohort of 138 members is helpful in making the research in the various groups without biases |
Lacking the long-term effect This does not allow to find the long-term effect of the medication |
| Comprehensive outcome assessment This helps in making the proper understanding of the result |
Potential selection bias The result are dependent on the specific group |
SN:Strength-The study involves the Prospective cohort design which involves the collection of some data in real-time and lowers the recall of the biased mentality. This type of design is appropriate for examining the associations and comparing results among different groups. The sufficient size of the sample is the strength of the paper. The cohort of 138 members is helpful in making the research in the various groups and helps to get the idea or effect of it in the maximum number of people.Weakness-Limitation in the external validity does not make the proper outcome of the research. The research is based on the temporary effect. Lacking the long-term effect does not allow us to find the long-term effect of the medication
Paper Three
Article 3: Meuret, P., Bouvet, L., Villet, B., Hafez, M., Allaouchiche, B., & Boselli, E. (2018). Hypobaric unilateral spinal anaesthesia versus general anaesthesia in elderly patients undergoing hip fracture surgical repair: a prospective randomised open trial. Turkish Journal of Anaesthesiology and Reanimation, 46(2), 121. doi: 10.5152/TJAR.2018.90699
| Evaluation Framework Grid |
Questions |
Evaluation |
| The academic perspective |
Was there a clearly formulated hypothesis? |
No |
| Was the research method appropriate? |
Yes |
| Is the sample size appropriate? |
Yes |
| Methods - what quality control measures were used? |
Yes |
| Conclusions -are they justified? |
Yes |
| The practitioner perspective |
Is there any obvious application that could lead to an improvement in patient care? |
Yes |
| Does the research have relevance to everyday patient care? |
Yes |
| The management perspective |
Does the article suggest how any resulting evidence could be disseminated? |
No |
| Would the application of the research have a positive or negative economic impact? |
Yes |
| The strategic perspective |
Does the research explain the underlying reasons for events? |
Yes |
| Will the research assist in the delivery of national NHS (or other healthcare systems) strategies? |
Yes |
(Source: Self-developed)
| Strengths |
Limitations |
| Prospective randomized trial: this study is based on this open trial method which is a better version than the observational research works |
Small sample size: the sample size of the study is comparatively small in size. It is problematic because for larger groups the values can be different. |
| Patient population: Elderly patients with hip fracture issues are part of this study and those people are going through other tests as well. These data help in the usage of anaesthesia for each person. |
Single-centre study: this study is based on a single centre that can cause biasedness and limitless for the project. |
| Objective primary endpoint: this has been used in the study to observe severe hypotension in patients which provides the quantitative data. |
Follow-up for the short term: this study focuses on the immediate outcomes which may manipulate the authentication of data. |
SN: Elderly patients with hip fracture issues are part of this study and those people are going through other tests as well. These data help in the usage of anaesthesia for each person. Single-centre study: this study is based on a single centre that can cause biasedness and limitless for the project.
Comparison
| Similarities |
Differences |
| Comparison between used techniques:Each and every study was compared based on the different types of techniques of using anaesthesia. These techniques can be either usage of spinal anaesthesia or usage of general anaesthesia. This can lead to different kinds of outcomes. |
Relevant Research Questions:even though there are multiple similarities visible in these papers, these papers differ in the matter of raising questions which are relevant to the topic. |
| Prospective for design: All of chosen and selected three studies have3 used the mentioned prospective designs. This can include techniques of data collection methods in real-time and also can have the ability to minimize bias. |
Intervention and outcomes:The required interventions and the possible results are measured in each of these three studies different in nature. |
Relevance to the research question:
- The chosen first journal and the third journal are directly addressing the research questions, which is doing a comparison between spinal anaesthesia and general anaesthesia in orthopaedic patients who are aged.
- The first study deals with the effects of PEEP titration while performing spinal surgery. However, the third study deals with a comparison of the hemodynamic effects of HUSA while doing hip fracture surgery.
- In the second journal, the research questions were not directly addressed and it also explored the effect of anaesthesia on the rhythm of melatonin, patterns of sleep, and also with postoperative delirium.
SN: The above slide gives comparison of three studies.
Ethical And Research Governance
- In the United Kingdom, the institute named “National Institute for Health Research (NIHR)” eagerly funds researchers to do research on the healthcare sector.
- This helps people to get the required facilities and technology which are needed for the purpose of research studies.
- This provides a proper research framework for the researchers to perform their studies.
- The researchers need to follow those guidelines while performing the research.
SN: The above slide demonstrates ethical and research governance
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Conclusion
- This study is dealing with the usage of anaesthesia of different kinds.
- The study has mentioned different types of anaesthesia and their respective roles in elderly patients. The overall background of the research topic has been discussed here.
- This study only took samples from the population who are suffering from orthopaedic issues.
- The study also included points related to ethical values and governance of research projects.
- Log sheets have been included for each chosen paper to understand the papers properly and to select the relevant papers.
SN: The study has given a detailed comparison among the three papers which were the chosen ones. There are many similarities and differences present in this part of the research project.
Impact On Operating Department Practice
- The field of research is ever-changing and improving the research scopes for the researchers.
- The researchers need to use updated methods and technology to perform their research project so that the research work can be related.
- The importance of both usages of different types of anaesthesia needs to be mentioned here. Their risk factors and benefits are also part of this project in relation to orthopaedic issues.
- Research projects need to do further study so that they can provide varied results.
SN: There are no such significant differences for the evidence to be shown, the staff members should be there to create awareness. This will help the SSI which was there for the FAW and can be easily available and vigilant in theatre.
References
Provided journals
- Qian, M., Yang, F., Zhao, L., Shen, J., & Xie, Y. (2021). Individualized positive end-expiratory pressure titration on respiration and circulation in elderly patients undergoing spinal surgery in prone position under general anesthesia.American Journal of Translational Research,13(12), 13835. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8748121/
- Meuret, P., Bouvet, L., Villet, B., Hafez, M., Allaouchiche, B., & Boselli, E. (2018). Hypobaric unilateral spinal anaesthesia versus general anaesthesia in elderly patients undergoing hip fracture surgical repair: a prospective randomised open trial.Turkish Journal of Anaesthesiology and Reanimation,46(2), 121. doi:10.5152/TJAR.2018.90699
- Song, Y., Liu, Y., Yuan, Y., Jia, X., Zhang, W., Wang, G., ... & Li, Z. (2021). Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery: a prospective cohort clinical trial.EBioMedicine,70. DOI:https://doi.org/10.1016/j.ebiom.2021.103490
- Other Journals
- Capdevila, X., Aveline, C., Delaunay, L., Bouaziz, H., Zetlaoui, P., Choquet, O., ... & Bonnet, F. (2020). Factors determining the choice of spinal versus general anesthesia in patients undergoing ambulatory surgery: results of a multicenter observational study.Advances in Therapy,37, 527-540. Doi https://doi.org/10.6084/m9.figshare.11210276
- Chen, D. X., Yang, L., Ding, L., Li, S. Y., Qi, Y. N., & Li, Q. (2019). Perioperative outcomes in geriatric patients undergoing hip fracture surgery with different anesthesia techniques: A systematic review and meta-analysis.Medicine,98(49).doi:10.1097/MD.0000000000018220
- Ehsani, R., Motlagh, S. D., Zaman, B., Kashani, S. S., & Ghodraty, M. R. (2020). Effect of general versus spinal anesthesia on postoperative delirium and early cognitive dysfunction in elderly patients.Anesthesiology and pain medicine,10(4). doi:10.5812/aapm.101815
- Maugeri, G., & Musumeci, G. (2020). Research and Publication Ethics in Journal of Functional Morphology and Kinesiology.Journal of Functional Morphology and Kinesiology,5(2), 42. DOI:10.3390/jfmk5020042
- Neuman, M. D., Feng, R., Carson, J. L., Gaskins, L. J., Dillane, D., Sessler, D. I., ... & Ellenberg, S. S. (2021). Spinal anesthesia or general anesthesia for hip surgery in older adults.New England Journal of Medicine,385(22), 2025-2035. DOI: 10.1056/NEJMoa2113514
- Oh, E. S., Leoutsakos, J. M., Rosenberg, P. B., Pletnikova, A. M., Khanuja, H. S., Sterling, R. S., ... & Neufeld, K. J. (2021). Effects of ramelteon on the prevention of postoperative delirium in older patients undergoing orthopedic surgery: the RECOVER randomized controlled trial.The American Journal of Geriatric Psychiatry,29(1), 90-100. doi:10.1016/j.jagp.2020.05.006
- Tang, L., Fang, P., Fang, Y., Lu, Y., Xu, G., & Liu, X. (2021). Comparison of effects between combined lumbar-sacral plexus block plus general anesthesia and unilateral spinal anesthesia in elderly patients undergoing hip fracture surgery: a pilot randomized controlled trial.Evidence-Based Complementary and Alternative Medicine,2021. https://doi.org/10.1155/2021/6685497
- Weibel, S., Rücker, G., Eberhart, L. H., Pace, N. L., Hartl, H. M., Jordan, O. L., Mayer, D., Riemer, M., Schaefer, M. S., Raj, D., Backhaus, I., Helf, A., Schlesinger, T., Kienbaum, P., & Kranke, P. (2020). Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta-analysis.The Cochrane database of systematic reviews,10(10), CD012859. https://doi.org/10.1002/14651858.CD012859.pub2
- Wiertz, S., & Boldt, J. (2022). Evaluating models of consent in changing health research environments.Medicine, Health Care and Philosophy,25(2), 269-280. DOI:10.1007/s11019-022-10074-3
- Yuan, Y., Song, Y., Wang, G., Jia, Y., Zhou, Y., Mi, X., ... & Li, Z. (2021). Protocol: Effects of general versus regional anaesthesia on circadian melatonin rhythm and its association with postoperative delirium in elderly patients undergoing hip fracture surgery: study protocol for a prospective cohort clinical trial.BMJ Open,11(2). doi:10.1136/bmjopen-2020-043720
