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Postoperative delirium

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https://www.readbyqxmd.com/read/29661417/postoperative-delirium-in-total-knee-and-hip-arthroplasty-patients-a-study-of-perioperative-modifiable-risk-factors
#1
S M Weinstein, L Poultsides, L R Baaklini, E E Mörwald, C Cozowicz, J N Saleh, M B Arrington, J Poeran, N Zubizarreta, S G Memtsoudis
BACKGROUND: Postoperative delirium continues to pose major clinical difficulties. While unmodifiable factors (e.g. age and comorbidity burden) are commonly studied risk factors for delirium, the role of modifiable factors, such as anaesthesia type and commonly used perioperative medications, remains understudied. This study aims to evaluate the role of modifiable factors for delirium after hip and knee arthroplasties. METHODS: We performed a retrospective study of 41 766 patients who underwent hip or knee arthroplasties between 2005 and 2014 at a single institution...
May 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29656802/impact-on-the-brain-of-the-inflammatory-response-to-surgery
#2
Sarah Saxena, Mervyn Maze
The brain is both the orchestrator as well as the target of the innate immune system's response to the aseptic trauma of surgery. When trauma-induced inflammation is not appropriately regulated persistent neuro-inflammation interferes with the synaptic plasticity that underlies the learning and memory aspects of cognition. The complications that ensue, include postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) at two poles of a constellation that is now termed perioperative neurocognitive disorders...
April 12, 2018: La Presse Médicale
https://www.readbyqxmd.com/read/29650354/risk-factors-for-postoperative-delirium-in-patients-undergoing-free-flap-reconstruction-for-oral-cancer
#3
T Makiguchi, S Yokoo, J Kurihara
The aim of this study was to investigate risk factors for postoperative delirium in patients undergoing free flap reconstruction for defects after oral cancer resection. This was a non-randomized, retrospective cohort study involving 102 patients who underwent oral cancer resection and free flap reconstruction. Data were collected from the medical records. Postoperative delirium occurred in 34 patients (33.3%), of whom 27 were male and seven were female. High preoperative total protein and albumin, diabetes mellitus, history of smoking, use of hypnotics or antipsychotics, time until getting out of bed after surgery, and postoperative insomnia were significantly related to delirium in the univariate analysis (P<0...
April 10, 2018: International Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29630129/a-meta-analysis-of-pharmacological-neuroprotection-in-noncardiac-surgery-focus-on-statins-lidocaine-ketamine-and-magnesium-sulfate
#4
Z-W Zeng, Y-N Zhang, W-X Lin, W-Q Zhang, R Luo
OBJECTIVE: Non-cardiac surgery is associated with perioperative cerebral complications (delirium, postoperative cognition dysfunction, stroke). While rare, these complications can lead to disabilities and deaths. Information is ambiguous as to whether pharmacological preoperative treatment exerts neuroprotection. We wished to systematically assess potential modulation by statins, lidocaine, ketamine or magnesium sulfate of the relative risk of cerebral complications in noncardiac surgery...
March 2018: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/29628826/dexmedetomidine-vs-morphine-and-midazolam-in-the-prevention-and-treatment-of-delirium-after-adult-cardiac-surgery-a-randomized-double-blinded-clinical-trial
#5
Tamer M Abdel Azeem, Nahed E Yosif, Adel M Alansary, Ibrahim Mamdouh Esmat, Ahmed K Mohamed
Background: The aim of this clinical study was to evaluate the efficacy of neurobehavioral, hemodynamics and sedative characteristics of dexmedetomidine compared with morphine and midazolam-based regimen after cardiac surgery at equivalent levels of sedation and analgesia in improving clinically relevant outcomes such as delirium. Methods: Sixty patients were randomly allocated into one of two equal groups: group A = 30 patients received dexmedetomidine infusion (0...
April 2018: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29623158/undiagnosed-partial-ornithine-transcarbamylase-deficiency-presenting-postoperatively-as-agitated-delirium
#6
E D Goldstein, R Cannistraro, P S Atwal, J F Meschia
Partial ornithine transcarbamylase deficiency (pOTCD), an enzymatic defect within the urea cycle, is an increasingly recognized etiology for hyperammonemia of unclear source following a stressor within female adults. Here we present a case of newly diagnosed pOTCD following a systemic stressor and prolonged hospitalization course. From a neurological perspective, prompt recognition provided the patient with a swift and near complete recovery. We briefly review the pertinent literature pertaining to this genetically based condition including historical context and current therapeutic approaches...
April 2018: Neurohospitalist
https://www.readbyqxmd.com/read/29621031/neurocognitive-function-after-cardiac-surgery-from-phenotypes-to-mechanisms
#7
Miles Berger, Niccolò Terrando, S Kendall Smith, Jeffrey N Browndyke, Mark F Newman, Joseph P Mathew
For half a century, it has been known that some patients experience neurocognitive dysfunction after cardiac surgery; however, defining its incidence, course, and causes remains challenging and controversial. Various terms have been used to describe neurocognitive dysfunction at different times after cardiac surgery, ranging from "postoperative delirium" to "postoperative cognitive dysfunction or decline." Delirium is a clinical diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)...
April 5, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29615969/postoperative-delirium-learning-and-anesthetic-neurotoxicity-some-perspectives-and-directions
#8
W Alan C Mutch, Renée M El-Gabalawy, M Ruth Graham
Evidence of anesthetic neurotoxicity is unequivocal when studied in animal models. These findings have translated poorly to the clinical domain when equated to postoperative delirium (POD) in adults and postoperative cognitive dysfunction (POCD) in either children or the elderly. In this perspective, we examine various reasons for the differences between animal modeling of neurotoxicity and the clinical situation of POD and POCD and make suggestions as to potential directions for ongoing research. We hypothesize that the animal anesthetic neurotoxicity models are limited, in part, due to failed scaling correction of physiological time...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29610916/should-this-patient-receive-prophylactic-medication-to-prevent-delirium-grand-rounds-discussion-from-beth-israel-deaconess-medical-center
#9
Anjala V Tess, Melissa L P Mattison, Joshua R Leo, Eileen E Reynolds
In 2015, the American Geriatrics Society released recommendations for prevention and management of postoperative delirium, based on a systematic literature review and evaluation of nonpharmacologic and pharmacologic approaches by an expert panel. The guidelines recommend an interdisciplinary focus on nonpharmacologic measures (reorientation, medication management, early mobility, nutrition, and gastointestinal motility) for prevention and consideration of this strategy for acute management. They also recommend optimizing nonopioid medication as a means to manage pain and avoiding benzodiazepines other than to treat substance withdrawal...
April 3, 2018: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29589415/perioperative-hyperglycaemia-and-neurocognitive-outcome-after-surgery-a-systematic-review
#10
Jeroen Hermanides, Ega Qeva, Benedikt Preckel, Federico Bilotta
BACKGROUND: Preliminary evidence suggest a possible relationship between perioperative hyperglycaemia, postoperative delirium (POD) or cognitive dysfunction (POCD). We aim to present the available clinical evidence related to chronic (i.e. Diabetes Mellitus) or acute perioperative hyperglycaemia as risk factors for POD/POCD. METHODS: A literature search of EMBASE (via Ovid, 1974-present) online medical database and MEDLINE (via PubMed or Ovid, 1946-present) was performed...
March 27, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29580683/mandibular-reconstruction-with-free-fibula-flaps-in-the-elderly-a-retrospective-evaluation
#11
Y Sugiura, S Sarukawa, J Hayasaka, H Kamochi, T Noguchi, Y Mori
The purpose of this study was to evaluate surgical outcomes in elderly patients who had undergone free fibula flap transfer for malignant head and neck tumours. A retrospective chart review was performed to identify patients who had undergone free fibula flap transfer for mandibular reconstruction after malignant tumour resection at Jichi Medical University Hospital between May 2009 and April 2015. Enrolled patients were divided into an elderly group (≥80years old) and a younger group (<80years old). Seventeen patients met the inclusion criteria and were included in the elderly group...
March 23, 2018: International Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29576120/pattern-of-perioperative-gabapentinoid-use-and-risk-for-postoperative-naloxone-administration
#12
A Deljou, S J Hedrick, E R Portner, D R Schroeder, W M Hooten, J Sprung, T N Weingarten
BACKGROUND: Single preoperative gabapentinoid (gabapentin and pregabalin) administration has been associated with respiratory depression during Phase I anaesthesia recovery. In this study, we assess for associations between chronic (home) use and perioperative administration (preoperative and postoperative) of gabapentinoids, and risk for severe over-sedation or respiratory depression as inferred from the use of naloxone. METHODS: From 2011 to 2016, we identified patients undergoing general anaesthesia discharged to standard postoperative wards and administered naloxone within 48 h of surgery in a single centre...
April 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29570715/preoperative-statins-are-associated-with-a-reduced-risk-of-postoperative-delirium-following-vascular-surgery
#13
Dae-Sang Lee, Mi Yeon Lee, Chi-Min Park, Dong-Ik Kim, Young-Wook Kim, Yang-Jin Park
Delirium is a common complication of vascular surgery. The protective effect of preoperative statins on delirium after vascular surgery is controversial. The authors hypothesized that preoperative statin administration would decrease the incidence of delirium after vascular surgery. From May 2010 to May 2015, 1,132 patients underwent vascular surgery. Postoperative delirium was diagnosed from patients' medical records. The incidence of delirium was 11.5%. The preoperative statin exposure was not associated with reduced delirium in the univariate analysis...
2018: PloS One
https://www.readbyqxmd.com/read/29567515/in-hospital-complication-rate-following-microendoscopic-versus-open-lumbar-laminectomy-a-propensity-score-matched-analysis
#14
Takeshi Oichi, Yasushi Oshima, Hirotaka Chikuda, Junichi Ohya, Hiroki Matsui, Kiyohide Fushimi, Sakae Tanaka, Hideo Yasunaga
BACKGROUND CONTEXT: The incidence of postoperative complications after microendoscopic laminectomy (MEL) has not been compared with that of open laminectomy in a large study, so it is not clear whether MEL is a safer procedure. PURPOSE: To compare postoperative morbidity and mortality following lumbar laminectomy between patients treated with MEL and open laminectomy. STUDY DESIGN: Retrospective cohort study with propensity score-matched analysis...
March 19, 2018: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/29562395/-dexmedetomidine-combined-with-ropivacaine-for-continuous-femoral-nerve-block-improved-postoperative-sleep-quality-in-elderly-patients-after-total-knee-arthroplasty
#15
X L Wang, J Wang, D L Mu, D X Wang
Objective: To investigate the effect of dexmedetomidine adding to ropivacaine for continuous femoral nerve block on the improvement of postoperative sleep quality in elderly patients after total knee arthroplasty. Methods: One hundred and sixty patients aged 60 years or older in Jishuitan Hospital scheduled for single total knee arthroplasty between Nov. 2016 and Jun. 2017 were recruited. All patients received spinal anesthesia and were randomized to receive either combined ropivacaine and dexmedetomidine (0...
March 13, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29557378/neuroprotective-effect-of-bispectral-index-guided-fast-track-anesthesia-using-sevoflurane-combined-with-dexmedetomidine-for-intracranial-aneurysm-embolization
#16
Chao-Liang Tang, Juan Li, Zhe-Tao Zhang, Bo Zhao, Shu-Dong Wang, Hua-Ming Zhang, Si Shi, Yang Zhang, Zhong-Yuan Xia
Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controlled clinical trials with which to verify this hypothesis are lacking. In total, 120 patients who underwent embolization of an intracranial aneurysm were recruited from Anhui Provincial Hospital and Renmin Hospital of Wuhan University of China and randomly allocated to two groups. After intraoperative administration of 2% to 3% sevoflurane inhalation, one group of patients received pump-controlled intravenous injection of 1...
February 2018: Neural Regeneration Research
https://www.readbyqxmd.com/read/29553500/a-mouse-model-of-orthopedic-surgery-to-study-postoperative-cognitive-dysfunction-and-tissue-regeneration
#17
Chao Xiong, Zhiquan Zhang, Gurpreet S Baht, Niccolo Terrando
Surgery is commonly used to improve and maintain quality of life. Unfortunately, in vulnerable patients such as the elderly, complications may occur and significantly diminish the outcome. Indeed, after routine orthopedic surgery to repair a fracture, as many as 50% of elderly patients suffer from neurologic complications like delirium. Also, the capacity to heal and regenerate tissue after surgery decreases with age, and can impact the quality of fracture repair and even osseous integration of implants. Thus, a better understanding of mechanisms that drive these age-dependent changes could provide strategic targets to minimize risk for such complications and optimize outcomes...
February 27, 2018: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/29551203/impact-of-timing-and-duration-of-postoperative-delirium-a-retrospective-observational-study
#18
Hannah Lee, Jae-Woo Ju, Seung-Young Oh, Jeongsoo Kim, Chul Woo Jung, Ho Geol Ryu
BACKGROUND: Recent reports suggest that not all critically ill patients with delirium share the same consequences. The outcomes of surgical intensive care unit patients with postoperative delirium were evaluated depending on the onset and duration of delirium. METHODS: A total of 527 patients who were admitted from the operating theater and cared for in the surgical intensive care unit for >24 hours were evaluated for delirium using the Confusion Assessment Method for intensive care unit, 3 times a day...
March 15, 2018: Surgery
https://www.readbyqxmd.com/read/29550773/ability-of-postoperative-delirium-to-predict-intermediate-term-postoperative-cognitive-function-in-patients-undergoing-elective-surgery-at-an-academic-medical-centre-protocol-for-a-prospective-cohort-study
#19
Amrita Aranake-Chrisinger, Jenny Zhao Cheng, Maxwell R Muench, Rose Tang, Angela Mickle, Hannah Maybrier, Nan Lin, Troy Wildes, Eric Lenze, Michael Simon Avidan
INTRODUCTION: Postoperative delirium (POD) is a common complication in elderly patients, characterised by a fluctuating course of altered consciousness, disordered thinking and inattention. Preliminary research has linked POD with persistent cognitive impairment and decreased quality of life. However, these findings maybe confounded by patient comorbidities, postoperative complications and frailty. Our objective is to determine whether POD is an independent risk factor for persistent impairments in attention and executive function after elective surgery...
March 17, 2018: BMJ Open
https://www.readbyqxmd.com/read/29549829/the-effect-of-the-timing-and-dose-of-dexmedetomidine-on-postoperative-delirium-in-elderly-patients-after-laparoscopic-major-non-cardiac-surgery-a-double-blind-randomized-controlled-study
#20
Cheol Lee, Cheol Hyeong Lee, Gilho Lee, Jongmyeong Lee, Jihyo Hwang
STUDY OBJECTIVE: There were few clinical data dosing and timing regimen for preventing postoperative delirium. The present study aimed to investigate the effect of the timing and dose of dexmedetomidine on postoperative delirium in elderly patients after laparoscopic major non-cardiac surgery. PATIENTS AND INTERVENTIONS: A total of 354 patients >65 years of age undergoing laparoscopic major non-cardiac surgery under general anesthesia received a dexmedetomidine 1 μg/kg bolus followed by 0...
March 14, 2018: Journal of Clinical Anesthesia
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