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Perioperative cognitive

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OBJECTIVERecurrent meningiomas are primarily managed with radiation therapy or repeat resection. Surgical morbidity after reoperation for recurrent meningiomas is poorly understood. Thus, the objective of this study was to report surgical outcomes after reoperation for recurrent non-skull base meningiomas.METHODSA retrospective review of patients was performed. Inclusion criteria were patients with recurrent meningioma who had prior resection and supratentorial non-skull base location. Univariate and multivariate logistic regression and recursive partitioning analysis were used to identify risk factors for surgical complications...
November 1, 2018: Journal of Neurosurgery
Anna Clebone, Kim M Strupp, Gina Whitney, Michael R Anderson, Jeffrey Hottle, James Fehr, Myron Yaster, Laura E Schleelein, Barbara K Burian, Jorge A Galvez, Justin L Lockman, David Polaner, Natalie R Barnett, Michael J Keane, Shashikanth Manikappa, Stephen Gleich, Robert S Greenberg, Ariel Vincent, Sarah L Oswald, Red Starks, Scott Licata
When life-threatening, critical events occur in the operating room, the fast-paced, high-distraction atmosphere often leaves little time to think or deliberate about management options. Success depends on applying a team approach to quickly implement well-rehearsed, systematic, evidence-based assessment and treatment protocols. Mobile devices offer resources for readily accessible, easily updatable information that can be invaluable during perioperative critical events. We developed a mobile device version of the Society for Pediatric Anesthesia 26 Pediatric Crisis paper checklists-the Pedi Crisis 2...
December 11, 2018: Anesthesia and Analgesia
Brian O'Gara, Edward R Marcantonio, Alvaro Pascual-Leone, Shahzad Shaefi, Ariel Mueller, Valerie Banner-Goodspeed, Daniel Talmor, Balachundhar Subramaniam
BACKGROUND: Delirium is associated with a significantly increased risk of postoperative morbidity and mortality. Furthermore, delirium has been associated with an increased risk of prolonged cognitive deficits and accelerated long-term cognitive decline. To date, experimental interventions for delirium have mainly focused on alternative pharmacologic and behavioral strategies in the postoperative period. Few studies have examined whether proactive strategies started before surgery can prevent delirium or reduce its sequelae...
December 11, 2018: Trials
Robert E Freundlich, Sara E Nelson, Yuxuan Qiu, Jesse M Ehrenfeld, Warren S Sandberg, Jonathan P Wanderer
The prevention and treatment of hypothermia is an important part of routine anesthesia care. Avoidance of perioperative hypothermia was introduced as a quality metric in 2010. We sought to assess the integrity of the perioperative hypothermia metric in routine care at a single large center. Perioperative temperatures from all anesthetics of at least 60 min duration between January 2012 and 2017 were eligible for inclusion in analysis. Temperatures were displayed graphically, assessed for normality, and analyzed using paired comparisons...
December 8, 2018: Journal of Clinical Monitoring and Computing
S V Tumanyan, A V Shepelenko, S A Chekmezova
The aim of the study was to evaluate the impact of various variants of multimodal anesthesia on the cognitive functions of elderly patients after surgical interventions on pelvic organs, the development of preventive measures for POCD. MATERIAL AND METHODS: A study was conducted in 76 elderly patients aged 62 to 84 years with an increased risk of developing POCD. Of these, 46 women and 30 men. Patients were divided into two groups, depending on the type of anesthesia. The 1st group consisted of 37 patients who had low-flow anesthesia with sevoflurane combined with epidural analgesia...
2018: Khirurgiia
Petros Tzimas, Evangelia Samara, Anastasios Petrou, Anastasios Korompilias, Athanasios Chalkias, Georgios Papadopoulos
BACKGROUND: Hip fracture is common and morbid in elderly patients. Postoperative cognitive dysfunction (POCD) is also very common in these subjects undergoing surgery with an incidence which exceeds 40% in some reports. To date, the evidence is ambiguous as to whether anesthetic technique may affect the patients' outcome as far as postoperative cognitive function is concerned. OBJECTIVE: The aim of this study was to compare the effect of general and subarachnoid (spinal) anesthesia on the development of POCD up to 30 days after surgery in elderly patients undergoing hip fracture surgery...
December 2018: Injury
Robert A Whittington, László Virág, Maud Gratuze, Hilana Lewkowitz-Shpuntoff, Mehdi Cheheltanan, Franck Petry, Isabelle Poitras, Françoise Morin, Emmanuel Planel
Preclinical studies have shown that anesthesia might accelerate the clinical progression of Alzheimer's disease (AD) and can have an impact on tau pathology, a hallmark of AD. Although benzodiazepines have been suggested to increase the risk of incident dementia, their impact on tau pathology in vivo is unknown. We thus examined the impact of midazolam, a benzodiazepine that is often administered perioperatively as an anxiolytic, on tau hyperphosphorylation in nontransgenic and in hTau mice, the latter a model of AD-like tau pathology...
November 8, 2018: Neurobiology of Aging
Susanne Koch, Claudia Spies
PURPOSE OF REVIEW: To summarize recent recommendations on intraoperative electroencephalogram (EEG) neuromonitoring in the elderly aimed at the prevention of postoperative delirium and long-term neurocognitive decline. We discuss recent perioperative EEG investigations relating to aging and cognitive dysfunction, and their implications on intraoperative EEG neuromonitoring in elderly patients. RECENT FINDINGS: The incidence of postoperative delirium in elderly can be reduced by monitoring depth of anesthesia, using an index number (0-100) derived from processed frontal EEG readings...
November 29, 2018: Current Opinion in Anaesthesiology
Simon T Schaefer, Stephan Koenigsperger, Cynthia Olotu, Thomas Saller
PURPOSE OF REVIEW: Neurocognitive dysfunction after surgery is highly relevant in the elderly. The multifactorial manner of this syndrome has made it hard to define an ideal biomarker to predict individual risk and assess diagnosis and severity of delirium [postoperative delirium (POD)] and subsequent postoperative cognitive decline (POCD). This review summarizes recent literature on blood biomarkers for POD/POCD. RECENT FINDINGS: Markers for delirium have been searched for in the cerebrospinal fluid to examine the pathologic cascade...
November 29, 2018: Current Opinion in Anaesthesiology
Takahisa Ogawa, Takuya Aoki, Shinichi Shirasawa
BACKGROUND: Hip fracture constitutes a high-mortality injury in elderly patients. In addition, caregiver burden is also a relevant issue, as patients after hip fracture surgery lose ambulation and require support in the perioperative period and after discharge. Early surgery is recommended to improve mortality. However the positive effect of early surgery on the short-term postoperative ambulatory function is unknown. The objective of this study was to determine whether a shorter waiting time for hip fracture surgery improves short-term postoperative mobility in elderly patients...
November 28, 2018: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Michel E van Genderen, J H Vlake
Innovative technologies, such as virtual reality (VR), augmented reality (AR) and mixed reality (MR) are no longer only interesting for a niche of gamers but are increasingly being applied within healthcare. Possible applications for VR in care vary from exposure therapy for PTSD and anxiety disorders to aiding in cognitive and physical rehabilitation. VR has also acquired an important role in medical education. AR/MR are used predominantly within surgery, for instance for perioperative projection of patient information, holographic images and scans...
November 26, 2018: Nederlands Tijdschrift Voor Geneeskunde
Paris Payton, Jeffrey E Shook
Surgical treatment of the elderly can be a very difficult and complex endeavor. Appropriate and thorough evaluation of this group of patients is essential to identify surgical candidates who may be at increased risk for developing age-related problems, such as cognitive impairment or postoperative delirium. Involvement of family members and ancillary caregivers is ideal. In order to optimize surgical results, communication of goals of surgery and expectations of patients in order to achieve these goals is paramount...
January 2019: Clinics in Podiatric Medicine and Surgery
Tania Giovannetti, Catherine C Price, Molly Fanning, Steven Messé, Sarah J Ratcliffe, Abigail Lyon, Scott E Kasner, Gregory Seidel, Joseph E Bavaria, Wilson Y Szeto, W Clarke Hargrove, Michael A Acker, Thomas F Floyd
BACKGROUND: Aortic valve replacement (AVR) for calcific aortic stenosis is associated with high rates of perioperative stroke and "silent" cerebral infarcts on diffusion-weighted magnetic resonance imaging (MRI), but cognitive outcomes in elderly AVR patients compared with individuals with cardiac disease who do not undergo surgery are uncertain. METHODS: One hundred ninety AVR patients (mean age=76±6y) and 198 non-surgical participants with cardiovascular disease (mean age=74±6y) completed comprehensive cognitive testing at baseline (pre-surgery), and 4-6 weeks and 1-year postoperatively...
November 10, 2018: Annals of Thoracic Surgery
Heberto Suarez-Roca, Rebecca Y Klinger, Mihai V Podgoreanu, Ru-Rong Ji, Martin I Sigurdsson, Nathan Waldron, Joseph P Mathew, William Maixner
Baroreceptors are mechanosensitive elements of the peripheral nervous system that maintain homeostasis by coordinating physiologic responses to external and internal stimuli. While it is recognized that carotid and cardiopulmonary baroreceptor reflexes modulate autonomic output to mitigate excessive fluctuations in arterial blood pressure and to maintain intravascular volume, increasing evidence suggests that baroreflex pathways also project to key regions of the central nervous system that regulate somatosensory, somatomotor, and central nervous system arousal...
November 5, 2018: Anesthesiology
Xuejiang Du, Jianshe Yu, Weidong Mi
INTRODUCTION: Cognitive dysfunction after surgery, a common clinical manifestation of postoperative psychonosema. It usually occurs after heart surgery, hip replacement, mandibular fractures, and other major operations. Dexmedetomidine can exert sedative, analgesic, anxiolytic effect, inhibits the sympathetic activity, maintains hemodynamic balance, helps reduce the amount of anesthetic agents, and relatively slightly depresses respiration. Preoperative administration of dexmedetomidine for sedation has been reported to reduce the incidence of acute postoperative delirium...
October 2018: Medicine (Baltimore)
Rui Tao, Xiao-Wen Wang, Liang-Jun Pang, Jun Cheng, Yong-Mei Wang, Guo-Qing Gao, Yu Liu, Chao Wang
BACKGROUND: Postoperative delirium is a prevalent and disabling mental disorder in patients undergoing on-pump cardiac surgery. There is some evidence that the use of pharmacological interventions may reduce the risk of developing of postoperative delirium. Therefore, the aim of this meta-analysis was to determine the effect of pharmacologic agents for the prevention postoperative delirium after cardiac surgery. METHODS: Randomized controlled trials (RCTs) were identified through a systematic literature search of electronic databases and article references up to October 2016...
October 2018: Medicine (Baltimore)
Franchesca Arias, Alberto C Bursian, Joshua W Sappenfield, Catherine E Price
BACKGROUND Delirium is a well-established clinical phenomenon that remains largely underdiagnosed. In light of its association with diminished postoperative outcomes, recent efforts involve implementing preventive strategies and fostering early detection. This report highlights how multidisciplinary interventions can inform risk for delirium and the challenges that accompany identifying at-risk patients. CASE REPORT A 75-year-old male with a history of postoperative cognitive complications including delirium and mild cognitive impairment...
November 6, 2018: American Journal of Case Reports
Karen M O'Connell, Reneé L Garbark, Kelly Cavanaugh Nader
PURPOSE: This study's purpose was to determine the prevalence of lateral violence in a military facility and the effect of cognitive rehearsal training on its occurrence. DESIGN: A preintervention/postintervention study was conducted. METHODS: A quantitative exploration of nurses' perceptions of lateral violence occurrence within a military setting and the effect of an intervention was planned using the Negative Acts Questionnaire-Revised...
October 29, 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
Scheherazade Le, Allen L Ho, Robert S Fisher, Kai J Miller, Jaimie M Henderson, Gerald A Grant, Kimford J Meador, Casey H Halpern
BACKGROUND: Laser interstitial thermal therapy (LITT) is a minimally invasive alternative with less cognitive risks compared with traditional surgery for focal drug-resistant epilepsy. OBJECTIVE: We describe seizure outcomes and complications after LITT in our cohort with intractable mesial temporal lobe epilepsy (MTLE). MATERIAL AND METHODS: We prospectively tracked Stanford's MTLE cases treated with LITT from October 2014 to October 2017...
October 25, 2018: Epilepsy & Behavior: E&B
Yaeesh Sardiwalla, Gail Eskes, Andre Bernard, Ronald B George, Michael Schmidt
PURPOSE: Postoperative cognitive dysfunction is difficult to predict and diagnose, and can have severe consequences in the long term. The purpose of our study was to examine the feasibility of using a computerised test battery, the Dalhousie Computerized Assessment Battery in the perioperative clinic to detect cognitive changes after surgery. METHODS: Fifty patients were recruited for this study. Patients completed the Dalhousie Computerized Assessment Battery and tests of general cognition, mood and pain at baseline and at three months postoperatively...
October 29, 2018: Journal of Perioperative Practice
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