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Postoperative delirium

Puja Shankar, Ariel Mueller, Senthil Packiasabapathy, Doris Gasangwa, Melissa Patxot, Brian O'Gara, Shahzad Shaefi, Edward R Marcantonio, Balachundhar Subramaniam
BACKGROUND: Postoperative delirium is common in elderly cardiac surgery patients. It is multifactorial and is influenced by the patient's baseline status and the nature of the medical and surgical interventions that the patient receives. Some of these factors are potentially modifiable, including postoperative sedation and analgesia protocols. This study has been designed to evaluate the effectiveness of postoperative intravenous acetaminophen in conjunction with either dexmedetomidine or propofol in decreasing the incidence of delirium...
June 22, 2018: Trials
Ahmed A Badawy, Samaa A Kasem, Doaa Rashwan, Tarek Al Menesy, Ghada Adel, Ali M Mokhtar, Yasmin A Badawy
BACKGROUND: Short acting inhalational anesthetic (Desflurane) produces emergence agitation (EA) in pediatrics with an incidence up to 80%. The aim of the present study was to examine the role of Gabapentin oral solution in attenuating desflurane associated EA in children after strabismus surgery under general anesthesia. METHODS: Seventy patients, 2-6 years old, scheduled for strabismus surgery were randomly allocated into two groups (35 each); Control group (c): received 5 ml of oral strawberry juice (placebo) and Gabapentin group (G) received 5 mg/Kg gabapentin oral solution in 5 ml strawberry juice, 1 h before anesthesia...
June 20, 2018: BMC Anesthesiology
Sandra L Staveski, Karen Boulanger, Lee Erman, Li Lin, Christina Almgren, Chloe Journel, Stephen J Roth, Brenda Golianu
OBJECTIVES: The purpose of this pilot study was three-fold: 1) to evaluate the safety and feasibility of instituting massage therapy in the immediate postoperative period after congenital heart surgery, 2) to examine the preliminary results on effects of massage therapy versus standard of care plus three reading visits on postoperative pain and anxiety, and 3) to evaluate preliminary effects of opioid and benzodiazepine exposure in patients receiving massage therapy compared with reading controls...
June 14, 2018: Pediatric Critical Care Medicine
Kristen K MacKenzie, Angelitta M Britt-Spells, Laura P Sands, Jacqueline M Leung
BACKGROUND: Postoperative delirium complicates approximately 15 to 20% of major operations in patients at least 65 yr old and is associated with adverse outcomes and increased resource utilization. Furthermore, patients with postoperative delirium might also be at risk of developing long-term postoperative cognitive dysfunction. One potentially modifiable variable is use of intraoperative processed electroencephalogram to guide anesthesia. This systematic review and meta-analysis examines the relationship between processed electroencephalogram monitoring and postoperative delirium and cognitive dysfunction...
June 15, 2018: Anesthesiology
Tanyong Pipanmekaporn, Yodying Punjasawadwong, Manee Raksakietisak, Wimonrat Sriraj, Varinee Lekprasert, Thewarug Werawatganon
The purpose of this study is to demonstrate the characteristics, contributing factors and recommended policy changes associated with emergence delirium. Relevant data were extracted from the PAAd Thai database of 2,006 incident reports which were conducted from 1 January to 31 December 2015. Details pertinent to the patient, surgery, anaesthetic and systematic factors were reviewed independently. Seventeen incidents of emergence delirium were recorded. Emergence delirium was common in the following categories: male (70...
January 1, 2018: Journal of Perioperative Practice
Vassil Gegouskov, Georgi Manchev, Vladimir Danov, Georgi Stoitsev, Sergey Iliev
BACKGROUND: During surgery for ascending aortic dissection, the dissected ascending aorta itself has traditionally been rejected as a cannulation option. The purpose of this study is to prove that direct cannulation of the ascending aorta in patients operated for acute aortic dissection type A (AADA) is at least as effective and safe as classic femoral cannulation. METHODS AND RESULTS: Between September 2008 and January 2015, we operated on 117 patients with AADA through median sternotomy...
April 30, 2018: Heart Surgery Forum
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...
June 8, 2018: Anesthesia and Analgesia
Dian-Shi Wang, Kirusanthy Kaneshwaran, Gang Lei, Fariya Mostafa, Junhui Wang, Irene Lecker, Sinziana Avramescu, Yu-Feng Xie, Nathan K Chan, Alejandro Fernandez-Escobar, Junsung Woo, Darren Chan, Amy J Ramsey, Jeremy M Sivak, C Justin Lee, Robert P Bonin, Beverley A Orser
BACKGROUND: Postoperative delirium is associated with poor long-term outcomes and increased mortality. General anesthetic drugs may contribute to delirium because they increase cell-surface expression and function of α5 subunit-containing γ-aminobutyric acid type A receptors, an effect that persists long after the drugs have been eliminated. Dexmedetomidine, an α2 adrenergic receptor agonist, prevents delirium in patients and reduces cognitive deficits in animals. Thus, it was postulated that dexmedetomidine prevents excessive function of α5 γ-aminobutyric acid type A receptors...
June 8, 2018: Anesthesiology
Katarzyna Kotfis, Aleksandra Szylińska, Mariusz Listewnik, Marta Strzelbicka, Mirosław Brykczyński, Iwona Rotter, Maciej Żukowski
Introduction: Postoperative delirium is a common complication of cardiac surgery associated with increased mortality, morbidity, and long-term cognitive dysfunction. The aim of this study was to identify incidence and risk factors of delirium in elderly (≥65 years) and very elderly (≥80 years) patients undergoing major cardiac surgery. Materials and methods: We performed a retrospective cohort analysis of prospectively collected data from a register of the cardiac surgery department of a tertiary referral university hospital between 2014 and 2016...
2018: Clinical Interventions in Aging
Darren F Hight, Jamie Sleigh, Joel D Winders, Logan J Voss, Amy L Gaskell, Amy D Rodriguez, Paul S García
Background: Assessment of patients for delirium in the Post Anesthesia Care Unit (PACU) is confounded by the residual effects of the varied anesthetic and analgesic regimens employed during surgery and by the physiological consequences of surgery such as pain. Nevertheless, delirium diagnosed at this early stage has been associated with adverse clinical outcomes. The last decade has seen the emergence of the confusion assessment method-intensive care unit (CAM-ICU) score as a quick practical method of detecting delirium in clinical situations...
2018: Frontiers in Systems Neuroscience
N V Tsygan, R V Andreev, A S Peleshok, S V Kolomentsev, V A Yakovleva, A V Ryabtsev, M A Gumennaya, I V Litvinenko
AIM: To study risk factors, characteristics of clinical symptoms and diagnosis, and possibilities of prevention of perioperative stroke and other clinical types of cerebral dysfunction in main types of heart valve surgery. MATERIAL AND METHODS: The study included 83 patients, aged 63 (54; 70) years, undergoing heart valve surgery with cardiopulmonary bypass. RESULTS: Postoperative cerebral dysfunction was diagnosed in 37.3% of cases, including perioperative stroke in 3...
2018: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
Sandra L Staveski, Rita H Pickler, Li Lin, Richard J Shaw, Jareen Meinzen-Derr, Andrew Redington, Martha A Q Curley
OBJECTIVES: The purpose of this study was to describe how pediatric cardiac intensive care clinicians assess and manage delirium in patients following cardiac surgery. DESIGN: Descriptive self-report survey. SETTING: A web-based survey of pediatric cardiac intensive care clinicians who are members of the Pediatric Cardiac Intensive Care Society. PATIENT OR SUBJECTS: Pediatric cardiac intensive care clinicians (physicians and nurses)...
June 2018: Pediatric Critical Care Medicine
Giuseppe Bellelli, Lucio Carnevali, Maurizio Corsi, Alessandro Morandi, Antonella Zambon, Paolo Mazzola, Marianna Galeazzi, Alessandra Bonfanti, Francesca Massariello, Hajnalka Szabo, Giulia Oliveri, Justin Haas, Luca Cavalieri d'Oro, Giorgio Annoni
OBJECTIVE: Studies exploring the incidence and impact of the psychomotor subtypes of postoperative delirium (POD) on the survival of hip fracture patients are few, and results are inconsistent. We sought to assess the incidence of POD subtypes and their impact, in addition to delirium duration, on 6-month mortality in older patients after hip-fracture surgery. METHODS: This is a prospective study involving 571 individuals admitted to an Orthogeriatric Unit within a 5-year period with a diagnosis of hip fracture...
May 31, 2018: International Journal of Geriatric Psychiatry
Karin Becke, Christoph Eich, Claudia Höhne, Martin Jöhr, Andreas Machotta, Markus Schreiber, Robert Sümpelmann
Inspired by the Choosing Wisely initiative, a group of pediatric anesthesiologists representing the German Working Group on Paediatric Anaesthesia (WAKKA) coined and agreed upon 10 concise positive ("dos") or negative ("don'ts") evidence-based recommendations. (i) In infants and children with robust indications for surgical, interventional, or diagnostic procedures, anesthesia or sedation should not be avoided or delayed due to the potential neurotoxicity associated with the exposure to anesthetics...
May 30, 2018: Paediatric Anaesthesia
Shinsaku Honda, Kenichiro Furukawa, Noriyuki Nishiwaki, Keiichi Fujiya, Hayato Omori, Sanae Kaji, Rie Makuuchi, Tomoyuki Irino, Yutaka Tanizawa, Etsuro Bando, Taiichi Kawamura, Masanori Terashima
PURPOSE: The incidence of postoperative delirium is reported to range from 9 to 87%; however, no report has focused on cases of postoperative delirium in gastric cancer surgery alone. Therefore, we investigated the incidence of and risk factors for postoperative delirium after gastrectomy in patients with gastric cancer. METHODS: A total of 1037 patients who underwent surgery were included in the study. Patients were divided into two groups-those with (delirium group) or without (non-delirium group) postoperative delirium-and their backgrounds were compared...
May 30, 2018: World Journal of Surgery
K J Xie, W Zhang, J B Yuan, J Zhou, Y Y Lian, J Fang
Objective: To observe whether Ginkgo biloba extract (EGb761) can improve postoperative delirium in elderly patients. Methods: Eighty elderly patients undergoing tumor surgery at Zhejiang Cancer Hospital and complicated with postoperative delirium(POD) between June 2013 and July 2016 were randomly divided into treatment group (group A) and control group (group B) according to the random number table method. Patients in group A received ginkgo biloba extract (EGb761) drops oral treatment (3 times/d, 80 mg each time) in addition to oxygen inhalation and appeasement treatment...
May 15, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Albert Ha, Ross E Krasnow, Matthew Mossanen, Ramzy Nagle, Tammy T Hshieh, James L Rudolph, Steven L Chang
PURPOSE: Postoperative delirium (PD) is associated with poor outcomes and increased health care costs. The incidence, outcomes, and cost of delirium for major urologic cancer surgeries have not been previously characterized in a population-based analysis. MATERIALS AND METHODS: We performed a population-based, retrospective cohort study of patients with PD at 490 US hospitals between 2003 and 2013 to evaluate the incidence, outcomes, and cost of delirium after radical prostatectomy, radical nephrectomy, partial nephrectomy, and radical cystectomy (RC)...
May 22, 2018: Urologic Oncology
Qi Cheng, Fengchao Zhao, Kaijin Guo, Guochun Zha, Xin Zheng, Yong Pang
Objective: To evaluate the mid-term effectiveness of cerclage wires fixation in treating Mallory typeⅡperiprosthetic femoral fractures associated with primary hip arthroplasty. Methods: A retrospective analysis was made in the data of 14 patients (14 hips) with Mallory typeⅡ periprosthetic femoral fractures associated with primary hip arthroplasty and treated with cerclage wires fixation between January 2010 and June 2011 (fracture group). Twenty-eight patients (28 hips) without periprosthetic femoral fractures associated with primary hip arthroplasty at the same stage were chosen as control group...
November 1, 2017: Chinese Journal of Reparative and Reconstructive Surgery
Yoshikazu Matsuda, Yoshihiro Owai, Koji Kakishita, Naoyuki Nakao
Cerebral venous sinus thrombosis is sometimes fatal. We describe a case of sinus thrombosis in a 43-year-old woman presenting with generalized seizure, delirium, and a 2 week history of headache and nausea. The patient underwent mechanical thrombectomy using a novel combined approach, in which a Shouryu HR balloon catheter (Kaneka) was anchored in the right transverse sinus (TS), sigmoid sinus (SS), and superior sagittal sinus (SSS), while a Penumbra 5 MAX ACE (Penumbra) catheter was moved back and forth between the right TS, SS, and SSS...
May 24, 2018: Journal of Neurointerventional Surgery
J Steenberg, A M Møller
BACKGROUND: Fascia iliaca compartment block is used for hip fractures in order to reduce pain, the need for systemic analgesia, and prevent delirium, on this basis. This systematic review was conducted to investigate the analgesic and adverse effects of fascia iliaca block on hip fracture in adults when applied before operation. METHODS: Nine databases were searched from inception until July 2016 yielding 11 randomised and quasi-randomised controlled trials, all using loss of resistance fascia iliaca compartment block, with a total population of 1062 patients...
June 2018: British Journal of Anaesthesia
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