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Cognitive Effects After Epidural vs General Anesthesia-Reply

Pamela Williams-Russo, MD, MPH; Nigel E. Sharrock, MBChB; Mary E. Charlson, MD
JAMA. 1995;274(19):1510. doi:10.1001/jama.1995.03530190024028.
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In Reply.  —Dr Witt raises several important issues that we took into account during the original design of our study protocol. The first issue concerns systematic differences in medications given in conjunction with the anesthetic agents in both the operative and immediate postoperative periods that could potentially affect outcome. These medications included intraoperative sedatives and postoperative analgesics. The types, routes, and quantities of these medications were systematically different between the epidural and general anesthesia groups. Thus, these other medications were cointerventions that were associated with the type of anesthesia received.We did not attempt to equalize the use of these adjunctive medications between the two anesthesia protocols for several reasons. First, we preferred to emulate customary clinical practices to ensure the generalizability of the results rather than strive for a "cleaner" comparison of the anesthetic agents alone. The use of intravenous midazolam and fentanyl for sedation is common during epidural


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