Recovery After Upper Extrimety Surgery

The goal of this randomized clinical trial is to determine whether Bispectral Index (BIS)-guided general anesthesia improves postoperative cognitive recovery and overall quality of recovery in adults undergoing elective hand or arm surgery. The main questions it aims to answer are: Does BIS-guided anesthesia improve postoperative cognitive recovery compared with general anesthesia guided by routine clinical signs? Does BIS-guided anesthesia improve overall postoperative recovery, as measured by the Postoperative Quality of Recovery Scale (PQRS)? Researchers will compare patients receiving BIS-guided general anesthesia with patients receiving clinically guided general anesthesia, in which the BIS monitor records data but the displayed values are concealed from the anesthesia team, to determine whether BIS-guided anesthetic management improves postoperative recovery. An additional comparison group will consist of patients undergoing surgery under intravenous regional anesthesia without general anesthesia. Participants will: undergo elective hand or arm surgery; receive either BIS-guided or clinically guided general anesthesia, or intravenous regional anesthesia without general anesthesia; complete PQRS assessments before surgery and at multiple postoperative time points, including follow-up for up to three months.

Inclusion Criteria: * Age 65 years or older. * Scheduled to undergo hand or arm surgery using either intravenous regional anesthesia or general anesthesia. * Able to understand the study information and provide informed consent. * Able to complete the Postoperative Quality of Recovery Scale assessments and cognitive tests. Exclusion Criteria: * Inability to complete the recovery or cognitive assessments. * Deafness or hearing impairment that prevented completion of the assessments. * Bispectral Index monitoring could not be applied or used because of technical or surgical reasons. * Expected duration of surgery of less than 30 minutes or more than 4 hours. * Allergy to nuts or soybeans in participants scheduled to receive general anesthesia. * Pregnancy. * Substance abuse.