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Agitated delirium

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https://www.readbyqxmd.com/read/28810649/effect-of-dexmedetomidine-combined-with-sufentanil-on-preventing-emergence-agitation-in-children-receiving-sevoflurane-anesthesia-for-cleft-palate-repair-surgery
#1
Ke Luo, Jun-Mei Xu, Lin Cao, Ju Gao
The aim of the present study was to observe whether dexmedetomidine (DEX) combined with sufentanil decreased emergence agitation (EA) in children receiving sevoflurane anesthesia for cleft palate repair surgery. Children undergoing elective cleft palate repair surgery were randomly allocated into the DEX + sufentanil group (group DS; n=50) and the normal saline + fentanyl group (group SF; n=50). Patients in group DS were treated with 0.5 µg/kg DEX prior to induction of anesthesia, whereas patients in group SF received an equal volume of normal saline...
August 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28800801/behavioral-emergencies-special-considerations-in-the-geriatric-psychiatric-patient
#2
REVIEW
Awais Aftab, Asim A Shah
This article reviews psychiatric considerations and common psychiatric emergencies in the elderly. The elderly are vulnerable to medication side-effects because of pharmacokinetic changes from aging, and require lower doses and slower titration. They are a high-risk group for suicide, with more serious intent, fewer warning signs, and more lethality. Prompt diagnosis and treatment of delirium in emergency settings is essential, given association with worse outcomes when undiagnosed. Pharmacologic options with demonstrable efficacy for agitation in dementia are limited to antipsychotics, which are, however, associated with an increased risk of mortality; behavioral interventions are universally recommended as first-line measures...
September 2017: Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28772221/perioperative-prediction-of-agitated-hyperactive-delirium-after-cardiac-surgery-in-adults-the-development-of-a-practical-scorecard
#3
Hani N Mufti, Gregory M Hirsch
BACKGROUND: Delirium is a temporary mental disorder that occurs frequently among hospitalized patients. In this study we sought to develop a user-friendly scorecard based on perioperative features to identify patients at risk of developing agitated delirium after cardiac surgery. METHODS: Retrospective analysis was performed on adult patients undergoing cardiac surgery in a single center. A parsimonious predictive model was created, with subsequent internal validation...
July 27, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28733841/analgosedation-of-adult-patients-with-elevated-intracranial-pressure-survey-of-current-clinical-practice-in-austria
#4
Guenther Herzer, Claudia Mirth, Udo M Illievich, Wolfgang G Voelckel, Helmut Trimmel
BACKGROUND: Analgesia and sedation are key items in intensive care. Recently published S3 guidelines specifically address treatment of patients with elevated intracranial pressure. METHODS: The Austrian Society of Anesthesiology, Resuscitation and Intensive Care Medicine carried out an online survey of neurointensive care units in Austria in order to evaluate the current state of practice in the areas of analgosedation and delirium management in this high-risk patient group...
July 21, 2017: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/28725569/psychiatric-adult-onset-of-urea-cycle-disorders-a-case-series
#5
Adrien Bigot, Paul Brunault, Christian Lavigne, François Feillet, Sylvie Odent, Elsa Kaphan, Christel Thauvin, Vanessa Leguy, Pierre Broué, Michel C Tchan, François Maillot
Adult onset urea cycle disorders (UCD) may present with psychiatric symptoms, occasionally as the initial presentation. We aimed to describe the characteristics of patients presenting with a psychiatric adult-onset of UCDs, to discuss which signs could suggest this diagnosis in such a situation, and to determine which tests should be conducted. A survey of psychiatric symptoms occurring in teenagers or adults with UCD was conducted in 2010 among clinicians involved in the French society for the study of inborn errors of metabolism (SFEIM)...
September 2017: Molecular Genetics and Metabolism Reports
https://www.readbyqxmd.com/read/28708753/effectiveness-of-preoperative-intranasal-dexmedetomidine-compared-with-oral-midazolam-for-the-prevention-of-emergence-delirium-in-the-pediatric-patient-undergoing-general-anesthesia-a-systematic-review
#6
James FitzSimons, Laura S Bonanno, Stephanie Pierce, Jennifer Badeaux
BACKGROUND: Emergence delirium is defined as a cognitive disturbance during emergence from general anesthesia resulting in hallucinations, delusions and confusion manifested by agitation, restlessness, involuntary physical movement and extreme flailing in bed. Postoperative emergence delirium develops in 12% to 18% of all children undergoing general anesthesia for surgery. This post-anesthetic phenomenon changes cognitive and psychomotor behavior, and puts pediatric patients and health care personnel at risk of injury...
July 2017: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/28698343/protocol-for-an-observational-study-of-delirium-in-the-post-anaesthesia-care-unit-pacu-as-a-potential-predictor-of-subsequent-postoperative-delirium
#7
Victoria Cui, Catherine M Tedeschi, Vanessa L Kronzer, Sherry L McKinnon, Michael S Avidan
INTRODUCTION: Postoperative delirium can be a serious consequence of major surgery, associated with longer hospital stays, readmission, cognitive and functional deterioration and mortality. Delirium is an acute, reversible disorder characterised by fluctuating course, inattention, disorganised thinking and altered level of consciousness. Delirium occurring in the hours immediately following anaesthesia and delirium occurring in the postoperative period of 1-5 days have been described as distinct clinical entities...
July 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28697572/delayed-recall-and-working-memory-mmse-domains-predict-delirium-following-cardiac-surgery
#8
Catherine C Price, Cynthia Garvan, Loren P Hizel, Marcos G Lopez, Frederic T Billings
BACKGROUND: Reduced preoperative cognition is a risk factor for postoperative delirium. The significance for type of preoperative cognitive deficit, however, has yet to be explored and could provide important insights into mechanisms and prediction of delirium. OBJECTIVE: Our goal was to determine if certain cognitive domains from the general cognitive screener, the Mini-Mental State Exam (MMSE), predict delirium after cardiac surgery. METHODS: Patients completed a preoperative MMSE prior to undergoing elective cardiac surgery...
2017: Journal of Alzheimer's Disease: JAD
https://www.readbyqxmd.com/read/28668987/a-case-of-fatal-idiosyncratic-reaction-to-the-designer-drug-3-4-methylenedioxypyrovalerone-mdpv-and-review-of-the-literature
#9
Brigitte Desharnais, Yann Dazé, Laura M Huppertz, Pascal Mireault, Cameron D Skinner
The stimulant designer drug 3,4-methylenedioxypyrovalerone (MDPV) was first synthesized by Boehringer Ingelheim in 1969 and introduced on the black market in 2006. Only a small number of fatal intoxication cases have been reported in the literature, all with significant blood MDPV concentrations. In this report, we describe one fatality attributed to an idiosyncratic reaction to MDPV. The victim displayed agitation, violent behavior and delirium followed by cardiac arrest. Hyperthermia was observed at the hospital...
July 1, 2017: Forensic Science, Medicine, and Pathology
https://www.readbyqxmd.com/read/28668927/delirium-after-transcatheter-aortic-valve-replacement
#10
Jennifer L Giuseffi, Nyal E Borges, Leanne M Boehm, Li Wang, John A McPherson, Joseph L Fredi, Rashid M Ahmad, E Wesley Ely, Pratik P Pandharipande
BACKGROUND: Postoperative delirium is associated with increased mortality. Patients undergoing transcatheter aortic valve replacement are at risk for delirium because of comorbid conditions. OBJECTIVE: To compare the incidence, odds, and mortality implications of delirium between patients undergoing transcatheter replacement and patients undergoing surgical replacement. METHODS: The Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit were used to assess arousal level and delirium prospectively in all patients with severe aortic stenosis who had transcatheter or surgical aortic valve replacement at an academic medical center...
July 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/28659208/-intoxication-with-new-psychoactive-substances-drug-unknown-but-complications-are-still-treatable
#11
M N Boersma, J J Nugteren-van Lonkhuyzen, E M van Maarseveen, H A H Kaasjager, A J H P van Riel, D Dekker
Abuse of new psychoactive substances (NPS) and the number of patients presenting to the ER with intoxication are increasing. Treatment may at first sight seem complicated because of limited knowledge of the substance involved, but should be based on a general supportive approach recognising the relatively predictable spectrum of symptoms caused by adrenergic, serotonergic and dopaminergic stimulation. In this article, we discuss the vital elements of this approach and possible complications of NPS intoxication...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28623497/-psychiatric-emergencies
#12
F Schneider, S Weber-Papen
Psychiatric emergencies present a frequent and interdisciplinary challenge. Clinical diagnosis and management are complicated by the acuity, and the patient's compliance is often limited by the illness. Psychiatric emergencies include states of acute agitation, suicidality, delirium, stupor, and drug-induced emergencies. Sometimes interventions such as conversational contact, responding empathically to patients, or "talking down" are sufficient. If pharmacotherapy is necessary, benzodiazepines and antipsychotic drugs are the primary agents of choice...
July 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/28572112/delirium-in-children-identification-prevention-and-management
#13
Amanda Bettencourt, Jodi E Mullen
Delirium in children is an often underrecognized but serious complication of hospitalization. Delirium in this age group has been described as behaviors such as refractory agitation and restlessness, visual or auditory hallucinations, children being "not themselves," and a lethargic state. Often, children with delirium are at risk for harming themselves by dislodging tubes, falling, or refusing care. Pediatric nurses must recognize and intervene to prevent and treat delirium in hospitalized children because the delirium may be an indicator of worsening clinical status and is associated with high mortality and morbidity in children of all ages and with posttraumatic stress disorder...
June 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28572103/interprofessional-team-s-perception-of-care-delivery-after-implementation-of-a-pediatric-pain-and-sedation-protocol
#14
Sandra L Staveski, May Wu, Tiffany M Tesoro, Stephen J Roth, Michael J Cisco
BACKGROUND: Pain and agitation are common experiences of patients in pediatric cardiac intensive care units. Variability in assessments by health care providers, communication, and treatment of pain and agitation creates challenges in management of pain and sedation. OBJECTIVES: To develop guidelines for assessment and treatment of pain, agitation, and delirium in the pediatric cardiac intensive unit in an academic children's hospital and to document the effects of implementation of the guidelines on the interprofessional team's perception of care delivery and team function...
June 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28569132/a-pilot-study-of-the-use-of-dexmedetomidine-for-the-control-of-delirium-by-reducing-the-serum-concentrations-of-brain-derived-neurotrophic-factor-neuron-specific-enolase-and-s100b-in-polytrauma-patients
#15
Yong Li, Zhi-Xin Yu, Mu-Sen Ji, Jun Yan, Yan Cai, Jing Liu, Hong-Feng Yang, Zhao-Chen Jin
BACKGROUND: Delirium is very common among patients with polytrauma, although no suitable means exist to feasibly reduce the incidence and duration of delirium in these patients. Recent reports have suggested that continuous intravenous (IV) infusions of dexmedetomidine, rather than benzodiazepine, be administered for sedation to reduce the duration of delirium in this population. However, serum neuron-specific enolase (NSE), S100 calcium binding protein B (S100B), and brain-derived neurotrophic factor (BDNF) levels have not yet been investigated in polytrauma patients who received sedation with dexmedetomidine rather than other conventional sedatives...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28559128/performance-of-the-modified-richmond-agitation-sedation-scale-in-identifying-delirium-in-older-emergency-department-patients
#16
Florian F Grossmann, Wolfgang Hasemann, Reto W Kressig, Roland Bingisser, Christian H Nickel
BACKGROUND: Delirium in older emergency department (ED) patients is associated with severe negative patient outcomes and its detection is challenging for ED clinicians. ED clinicians need easy tools for delirium detection. We aimed to test the performance criteria of the modified Richmond Agitation Sedation Scale (mRASS) in identifying delirium in older ED patients. METHODS: The mRASS was applied to a sample of consecutive ED patients aged 65 or older by specially trained nurses during an 11-day period in November 2015...
May 22, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28558630/leukopenia-associated-with-risperidone-treatment
#17
Matthew Morrison, Autumn Schultz, Deborah L Sanchez, Maria C Catalano, Glenn Catalano
Risperidone is an atypical antipsychotic agent that was originally approved by the United States Food and Drug Adminstration for the treatment of schizophrenia. There are many side effects that are frequently associated with the use of risperidone. These include weight gain, anxiety, extra-pyramidal side effects, and elevated prolactin levels. More infrequently, the use of risperidone has been linked to leukopenia. We will now present the case of a 66-year-old gentleman who developed leukopenia after the initiation of risperidone to control agitation due to delirium...
May 30, 2017: Current Drug Safety
https://www.readbyqxmd.com/read/28547318/a-systematic-review-of-alpha-2-agonists-for-sedation-in-mechanically-ventilated-neurocritical-care-patients
#18
Alexandre Tran, Henrietta Blinder, Brian Hutton, Shane W English
The use of sedative medications is commonplace in intensive care units (ICUs) and an invaluable clinical tool for the intensive care physician. Sedation for critically ill, mechanically ventilated patients provides an opportunity to reduce anxiety, discomfort as well as ventilator intolerance and dyssynchrony. Alpha-2 agonists in particular have become increasingly popular for use in the neurocritical care population due to their proposed effectiveness in facilitating examinations and procedures as well as reducing the need for adjunctive agents...
May 25, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28523268/the-sedative-effect-of-propranolol-on-critically-ill-patients-a-case-series
#19
Junji Shiotsuka, Andrew Steel, James Downar
INTRODUCTION: Recent studies have examined the effectiveness of alpha-2 adrenergic agonists for controlling delirium and agitation. Propranolol, a non-selective beta-adrenergic antagonist with good penetration of the blood-brain barrier, has not been investigated for this purpose. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all patients who were prescribed propranolol in our Medical Surgical ICU from January 1, 2010, to December 31, 2013...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28506099/propofol-based-palliative-sedation-to-treat-antipsychotic-resistant-agitated-delirium
#20
Alfredo Covarrubias-Gómez, Maria López Collada-Estrada
Delirium is a common problem in terminally ill patients that is associated with significant distress and, hence, considered a palliative care emergency. The three subtypes of delirium are hyperactive, hypoactive, and mixed, depending on the level of psychomotor activity and arousal disturbance. When agitated delirium becomes refractory in the setting of imminent dying, the agitation may be so severe that palliative sedation (PS) is required. Palliative sedation involves the administration of sedative medications with the purpose of reducing level of consciousness for patients with refractory suffering in the setting of a terminal illness...
May 16, 2017: Journal of Pain & Palliative Care Pharmacotherapy
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