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Perioperative cognitive

Sylvia Bereknyei Merrell, David M Gaba, Aalok V Agarwala, Jeffrey B Cooper, Andrea L Nevedal, Steven M Asch, Steven K Howard, Sara N Goldhaber-Fiebert
BACKGROUND: An emergency manual (EM) is a set of evidence-based crisis checklists, or cognitive aids, that can improve team performance. EMs are used in other safety-critical industries, and health care simulation studies have shown their efficacy, but use in clinical settings is nascent. A case study was conducted on the use of an EM during one intraoperative crisis, which entailed the assessment of the impact of the EM's use on teamwork and patient care and the identification of lessons for effectively using EMs during future clinical crises...
August 2018: Joint Commission Journal on Quality and Patient Safety
Sue Wilkinson
Patients should be at the heart of everything we do. The aim should always be to achieve healthcare outcomes by involving patients fully in their own care, with decisions made in partnership with clinicians, rather than by clinicians alone: 'no decision about me, without me' (DH 2012). This article details a plan of care for an 18 year old male patient with a moderate level of learning disability who was scheduled for a tonsillectomy at a local NHS trust hospital. It focuses on the management of the patient's anxiety, nausea and pain...
July 31, 2018: Journal of Perioperative Practice
Dimitris Dimitriou, Alexander Antoniadis, Andreas Flury, Martin Liebhauser, Naeder Helmy
BACKGROUND: Hip osteoarthritis is a leading cause of functional decline and disability in the elderly. Although patients older than 80 years could significantly benefit from an elective total hip arthroplasty (THA), they pose a significant challenge to both anesthesiologist and arthroplasty surgeon. The purpose of this study was to report the clinical outcomes, complication rate, mortality, and quality-adjusted life year (QALY) of THA in patients who already exceeded the average life expectancy...
July 11, 2018: Journal of Arthroplasty
Sakura Kinjo, Eunjung Lim, Maria Victoria Magsaysay, Laura P Sands, Jacqueline M Leung
BACKGROUND: Volatile Anaesthetics (VAs) may be associated with postoperative delirium (POD). However, to date, the effects of VAs on POD are not completely understood. The objective of this study was to investigate the incidence of POD in different VA groups. METHODS: A secondary analysis was conducted using a database created from prospective cohort studies in patients who underwent elective major noncardiac surgery. Patients who received general anaesthesia with desflurane, isoflurane, or sevoflurane were included in the study...
July 27, 2018: Acta Anaesthesiologica Scandinavica
M D Luca La Colla, R M D Schroeder
Quadratus Lumborum (QL) block has been successfully used for different abdominal procedures in the past. Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized mainly by autonomic instability, motor impairment, and cognitive dysfunction. We report a case of a patient with MSA with a history of multiple episodes of unplanned admissions following outpatient minor surgical procedures under general anesthesia scheduled to undergo open inguinal hernia repair. In our patient, QL block was successfully used for surgical anesthesia and it resulted in hemodynamic stability and an opioid-free perioperative course...
2018: Case Reports in Anesthesiology
A Heidenreich
The limits of cancer surgery in uro-oncology are characterized by a carefully weighed risk of surgical feasibility and oncological necessity. The limits of uro-oncological cancer surgery do not represent fixed dogmas but ideally these more or less cognitive boundaries move based on new scientific findings, improved imaging modalities, optimized surgical techniques and perioperative care. The limits of cancer surgery are defined by patient-specific parameters, the biological aggressiveness of the tumor itself, the skills and expertise of the surgeon, and adequate perioperative care of the patient...
July 24, 2018: Der Urologe. Ausg. A
Parineeta Thapa, Pramote Euasobhon
Chronic postsurgical pain (CPSP) is an unwanted adverse event in any operation. It leads to functional limitations and psychological trauma for patients, and leaves the operative team with feelings of failure and humiliation. Therefore, it is crucial that preventive strategies for CPSP are considered in high-risk operations. Various techniques have been implemented to reduce the risk with variable success. Identifying the risk factors for each patient and applying a timely preventive strategy may help patients avoid the distress of chronic pain...
July 2018: Korean Journal of Pain
Wei-Liang Zhang, Yong-Liang Chi, Lian-Zhu Wang, Hui Liu, Lu-Xi Zhao, Fan Su
Postoperative cognitive dysfunction (POCD) is one of the major complications in patients who have undergone surgeries. Reduction of surgery-induced inflammation and perioperative stress responses may prevent the development of POCD. As recent experimental data have suggested, Shenmai and Shenfu injections, two ginseng containing formulations, may improve cognition. We designed this study using aged rats as an experimental model to determine the effect of combined perioperative Shenmai injection and Shenfu injection in preventing the development of POCD and exploring the underlying mechanism of this intervention...
2018: American Journal of Chinese Medicine
Angela Builes-Aguilar, Jose L Diaz-Gomez, Federico Bilotta
PURPOSE OF REVIEW: We summarize the latest evidence in neuroanesthesia and neurocritical care (NCC) training. In addition, we describe the newer advancements that clinical educators face in these subspecialties. Lastly, we highlight educational approaches that may lead to an enhanced learning experience and development of necessary skills for neurosciences trainees. RECENT FINDINGS: Current neuroanesthesia and NCC training requires acquisition of specific skills for increasing complex surgical cases, specialized neurosurgical practice and new perioperative technologies...
July 9, 2018: Current Opinion in Anaesthesiology
Marko Mrkobrada, Matthew T V Chan, David Cowan, Jessica Spence, Douglas Campbell, Chew Yin Wang, David Torres, German Malaga, Robert D Sanders, Carl Brown, Alben Sigamani, Wojciech Szczeklik, Adam Andrew Dmytriw, Ronit Agid, Eric E Smith, Michael D Hill, Manas Sharma, Mukul Sharma, Scott Tsai, Arun Mensinkai, Demetrios J Sahlas, Gordon Guyatt, Shirley Pettit, Ingrid Copland, William K K Wu, Simon C H Yu, Tony Gin, Pui San Loh, Norlisah Ramli, Yee Lein Siow, Timothy G Short, Ellen Waymouth, Jonathan Kumar, Monidipa Dasgupta, John M Murkin, Maite Fuentes, Victor Ortiz-Soriano, Heidi Lindroth, Sara Simpson, Daniel Sessler, P J Devereaux
OBJECTIVES: Covert stroke after non-cardiac surgery may have substantial impact on duration and quality of life. In non-surgical patients, covert stroke is more common than overt stroke and is associated with an increased risk of cognitive decline and dementia. Little is known about covert stroke after non-cardiac surgery.NeuroVISION is a multicentre, international, prospective cohort study that will characterise the association between perioperative acute covert stroke and postoperative cognitive function...
July 6, 2018: BMJ Open
Mimi Wu, Yongxin Liang, Zhao Dai, Shiduan Wang
STUDY OBJECTIVE: To evaluate the efficiency of dexmedetomidine on the incidence of delirium in patients after cardiac surgery. DESIGN: Meta-analysis of randomized controlled trials. SETTING: Operating room and Intensive Care Unit (ICU). PATIENTS: Ten trials with a total of 1387 patients undergoing cardiac surgery met the inclusion criteria. INTERVENTION: Randomized controlled trials (RCTs) comparing the effect of dexmedetomidine versus non-treatment of dexmedetomidine (normal saline (NS), propofol and other anesthetic drugs) on delirium in patients undergoing cardiac surgery were retrieved from PubMed/Medline, Embase, the Cochrane Library and Web of science...
June 27, 2018: Journal of Clinical Anesthesia
Florian Bernard, Jean-Michel Lemée, Ghislaine Aubin, Aram Ter Minassian, Philippe Menei
BACKGROUND: In awake craniotomy, it is possible to temporarily inactivate regions of the brain using direct electrical stimulation, while the patient performs neuropsychological tasks. If the patient shows decreased performance in a given task, the neurosurgeon will not remove these regions, so as to maintain all brain functions. OBJECTIVE: The objective of our study was to describe our experience of using a virtual reality (VR) social network during awake craniotomy and discuss its future applications for perioperative mapping of nonverbal language, empathy, and theory of mind...
June 26, 2018: Journal of Medical Internet Research
N J N Harper, T M Cook, T Garcez, D N Lucas, M Thomas, H Kemp, K-L Kong, S Marinho, S Karanam, K Ferguson, J Hitchman, H Torevell, A Warner, W Egner, S Nasser, N McGuire, M Bellamy, K Floss, L Farmer, S Farooque
BACKGROUND: Anaphylaxis during anaesthesia is a serious complication for patients and anaesthetists. There is little published information on management and outcomes of perioperative anaphylaxis in the UK. METHODS: The 6th National Audit Project of the Royal College of Anaesthetists (NAP6) collected and reviewed 266 reports of Grade 3-5 anaphylaxis from all UK NHS hospitals over 1 yr. Quality of management was assessed against published guidelines. RESULTS: Appropriately senior anaesthetists resuscitated all patients...
July 2018: British Journal of Anaesthesia
Bodil Ivarsson, Ami Hommel, Magnus Sandberg, Desirée Sjöstrand, Anders Johansson
BACKGROUND: Hip fractures are described to have a significant impact on patients' well-being and different fast-track concepts could result in a reduction of the patient's psychological and emotional reactions before pre- and intrahospital care. AIMS AND OBJECTIVES: This study aimed to elucidate perceived situations of significance experienced by patients with hip fracture during the prehospital- and in-hospital care. DESIGN: The study used a qualitative approach using a critical incident technique (CIT), 14 patients with hip fractures were included...
August 2018: International Journal of Orthopaedic and Trauma Nursing
Lisbeth A Evered, Brendan S Silbert
Postoperative cognitive dysfunction (POCD) is an objectively measured decline in cognition postoperatively compared with preoperative function. POCD has been considered in the anesthetic and surgical literature in isolation of cognitive decline which is common in the elderly within the community and where it is labeled as mild cognitive impairment, neurocognitive disorder, or dementia. This narrative review seeks to place POCD in the broad context of cognitive decline in the general population. Cognitive change after anesthesia and surgery was described over 100 years ago, initially as delirium and dementia...
August 2018: Anesthesia and Analgesia
Csenge Szeverenyi, Zoltan Kekecs, Alisa Johnson, Gary Elkins, Zoltan Csernatony, Katalin Varga
The present study aims to assess the effectiveness of psychosocial techniques to decrease postoperative pain and improve perioperative clinical care in orthopedic surgery. A systematic review and meta-analysis was performed to evaluate the effects of psychosocial methods among adults undergoing orthopedic surgeries. The systematic review included both randomized and non-randomized trials, but only randomized controlled clinical trials (RCTs) were included in the meta-analysis. Key outcomes were postoperative pain, analgesic requirement, perioperative anxiety, quality of life, and recovery...
May 24, 2018: Journal of Pain: Official Journal of the American Pain Society
B Frilling, W von Renteln-Kruse, A Rösler, F-C Rieß
BACKGROUND: Despite substantial progress in interventional cardiology, there are still many geriatric patients who require cardiac surgery. Estimation of the operative risk is therefore of great importance. OBJECTIVE: The prognostic value of the geriatric assessment for estimation of the operative risk was evaluated. MATERIAL AND METHODS: Between 2008 and 2009 a geriatric assessment was carried out on 500 patients before an urgent or elective cardiac surgery intervention...
June 2018: Zeitschrift Für Gerontologie und Geriatrie
Simone Gurlit, Henriette Möllmann
BACKGROUND: As more aged patients are surgically treated in hospitals without specialized geriatric care, patients at risk for perioperative complications must be identified and treatment must be adapted. The aim was the use of the Identification of Seniors at Risk (ISAR) as a screening tool for the identification of high-risk patients, who need specialized perioperative care. The study presented investigated the use of ISAR screening not only as recommended in the emergency room but also in validation tests as a new option in elective surgery...
June 2018: Zeitschrift Für Gerontologie und Geriatrie
L Wang, Y Chang, S A Kennedy, P J Hong, N Chow, R J Couban, R E McCabe, P J Bieling, J W Busse
BACKGROUND: Persistent post-surgical pain affects 10-80% of individuals after common operations, and is more common among patients with psychological factors such as depression, anxiety, or catastrophising. METHODS: We conducted a systematic review and meta-analysis of randomised, controlled trials to evaluate the efficacy of perioperative psychotherapy for persistent post-surgical pain and physical impairment. Paired independent reviewers identified studies, extracted data, and assessed risk of bias...
June 2018: British Journal of Anaesthesia
Audrey Chun
Because of age, increased rates of multimorbidity, polypharmacy, functional changes, and cognitive impairment, older adults are at higher risk for perioperative complications. Identifying modifiable risk factors and educating patients and families about what to expect can improve surgical outcomes and satisfaction. Comprehensive preoperative evaluation assesses these potential factors and should include recommendations for risk reduction. The optimal preoperative evaluation for older adults should address medical conditions and other areas pertinent to the care of older adults including assessments of cognition, capacity, delirium risk, function, frailty, nutrition, medications, and treatment preferences...
August 2018: Otolaryngologic Clinics of North America
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