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Agitated delirium

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https://www.readbyqxmd.com/read/29287876/effect-of-preoperative-visiting-operation-room-on-emergence-agitation-in-preschool-children-under-sevoflurane-anesthesia
#1
Qiaosheng Zhong, Xianfeng Qu, Chuanhua Xu
BACKGROUND: Emergence agitation (EA) is a common complication in children during recovery from sevoflurane anesthesia with an high incidence. The main objective of this study was to compare the effects of preoperative visiting operation room (PVOR) to administration of propofol at the end of anesthesia on EA in preschool children under sevoflurane anesthesia. METHODS: Sixty-nine preschool children aged from 3 to 6 years scheduled for tonsillectomy under sevoflurane anesthesia were randomly allocated to one of the three groups to receive either PVOR (Group PV), routine preoperative visit (Group RV) or routine preoperative visit plus propofol (Group RP), 23 patients were included in each group...
January 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29224711/-risk-factors-associated-with-anesthesia-emergence-delirium-in-children-undergoing-outpatient-surgery
#2
Ana Carolina Tavares Paes Barreto, Ana Carolina Rangel da Rocha Paschoal, Carolina Barbosa Farias, Paulo Sérgio Gomes Nogueira Borges, Rebeca Gonelli Albanez da Cunha Andrade, Flávia Augusta de Orange
INTRODUCTION: Anesthesia emergence delirium (AED) is a self-limiting clinical phenomenon very common in children. Although pathophysiology is still uncertain, some factors seem to be involved, such as rapid awakening in an unknown environment, agitation during anesthetic induction, preoperative anxiety, environmental disorders, use of preanesthetic medication, use of inhalational anesthetics, and postoperative pain. OBJECTIVE: To determine the prevalence and risk factors associated with AED in children undergoing outpatient surgery...
December 7, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29213507/sundown-syndrome-and-symptoms-of-anxiety-and-depression-in-hospitalized-elderly
#3
Marcello Weynes Barros Silva, Rilva Lopes Sousa-Muñoz, Heitor Cabral Frade, Priscilla Alencar Fernandes, Andrêssa de Oliveira Magalhães
Sundown syndrome is characterized by the sudden appearance of neuropsychiatric symptoms such as agitation, confusion and anxiety in a chronologic fashion, usually during late afternoon or early evening. Objective: To evaluate the prevalence of sundown syndrome in university hospital wards and its relationship with anxiety/depression symptoms, cognitive decline, and clinical and demographic variables. Methods: We evaluated 70 patients admitted to the Lauro Wanderley University Hospital (HULW), João Pessoa-PB, Brazil...
April 2017: Dementia & Neuropsychologia
https://www.readbyqxmd.com/read/29196585/feasibility-of-a-nurse-managed-pain-agitation-and-delirium-protocol-in-the-surgical-intensive-care-unit
#4
Alan Rozycki, Andrew S Jarrell, Rachel M Kruer, Samantha Young, Pedro A Mendez-Tellez
BACKGROUND: Society of Critical Care Medicine guidelines recommend the use of pain, agitation, and delirium protocols in the intensive care unit. The feasibility of nurse management of such protocols in the surgical intensive care unit has not been well assessed. OBJECTIVES: To evaluate the percentage of adherent medication interventions for patients assessed by using a pain, sedation, and delirium protocol. METHODS: Data on all adult patients admitted to a surgical intensive care unit from January 2013 through September 2013 who were assessed at least once by using a pain, sedation, and delirium protocol were retrospectively reviewed...
December 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/29194171/improving-the-accuracy-of-delirium-assessments-in-neuroscience-patients-scaling-a-quality-improvement-program-to-improve-nurses-skill-compliance-and-accuracy-in-the-use-of-the-confusion-assessment-method-in-the-intensive-care-unit-tool
#5
Justin DiLibero, Susan DeSanto-Madeya, Rachael Dottery, Lauren Sullivan, Sharon C O'Donoghue
BACKGROUND: Delirium affects up to 80% of critically ill patients; however, many cases of delirium go unrecognized because of inaccurate assessments. The effectiveness of interventions to improve assessment accuracy among the general population has been established, but assessments among neuroscience patients are uniquely complicated due to the presence of structural neurologic changes. OBJECTIVES: The purposes of this quality improvement project were to improve the accuracy of nurse's delirium assessments among neuroscience patients and to determine the comparative effectiveness of the intervention between medical and neuroscience patients...
January 2018: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/29174758/a-proactive-approach-to-high-risk-delirium-patients-undergoing-total-joint-arthroplasty
#6
Andres F Duque, Zachary D Post, Fabio R Orozco, Rex W Lutz, Alvin C Ong
BACKGROUND: Delirium is a common complication among elderly patients undergoing total joint arthroplasty (TJA). Its incidence has been reported from 4% to 53%. The Centers for Medicare and Medicaid Services consider delirium following TJA a "never-event." The purpose of this study is to evaluate a simple perioperative protocol used to identify delirium risk patients and prevent its incidence following TJA. METHODS: Our group developed a protocol to identify and prevent delirium in patients undergoing TJA...
November 13, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29173782/new-psychoactive-substances-in-pediatric-patients
#7
REVIEW
Brandon J Warrick, Anita Paula Tataru, Roy Gerona
New psychoactive substances (NPS), namely cannabinoids, cathinones, and opioids, have surged in popularity among school-age children, resulting in serious morbidity and mortality globally. In the last decade, there has been a rapid evolution of NPS resulting in hundreds of new compounds. Little to no evidence for humans is available on most compounds. The clinical presentations of patients intoxicated with cannabinoids and cathinones are highly variable but most commonly present with a sympathomimetic toxidrome, for example, agitation, delirium, and tachycardia...
December 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/29167040/delirium-in-the-intensive-care-setting-and-the-richmond-agitation-and-sedation-scale-rass-drowsiness-increases-the-risk-and-is-subthreshold-for-delirium
#8
Soenke Boettger, David Garcia Nuñez, Rafael Meyer, André Richter, Susana Franco Fernandez, Alain Rudiger, Maria Schubert, Josef Jenewein
INTRODUCTION: Sedation is a core concept in the intensive care setting, however, the impact of sedation on delirium has not yet been studied to date. METHODS: In this prospective cohort study, 225 patients with Richmond Agitation and Sedation (RASS) scores of -1 - drowsiness and 0 - alert- and calmness were assessed with the Delirium Rating Scale-Revised 1998 (DRS-R-98) and DSM-IV-TR-determined diagnosis of delirium assessing drowsiness versus alertness. RESULTS: By itself, drowsiness increased the odds for developing delirium eightfold (OR 7...
December 2017: Journal of Psychosomatic Research
https://www.readbyqxmd.com/read/29166854/a-single-dose-of-dezocine-suppresses-emergence-agitation-in-preschool-children-anesthetized-with-sevoflurane-remifentanil
#9
Li-Jun An, Yang Zhang, Zheng Su, Xian-Long Zhang, Hai-Lin Liu, Zhi-Jie Zhang, Jian-Lin Hu, Shi-Tong Li
BACKGROUND: Emergence agitation (EA) is a common phenomenon in preschool children during emergence from general anesthesia. This study evaluated the safety and efficacy of dezocine for emergence agitation in preschool children anesthetized with sevoflurane-remifentanil. METHODS: A total of 100 preschool children, scheduled for elective laparoscopic repair of an inguinal hernia by high ligation of the hernia sac under sevoflurane-remifentanil anesthesia were randomized into two groups: Group C (n = 50) received Ringer's lactate 10 mL and Group D received Ringer's lactate 10 mL containing dezocine 0...
November 22, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/29137682/cefepime-induced-neurotoxicity-a-systematic-review
#10
Lauren E Payne, David J Gagnon, Richard R Riker, David B Seder, Elizabeth K Glisic, Jane G Morris, Gilles L Fraser
BACKGROUND: Cefepime is a widely used antibiotic with neurotoxicity attributed to its ability to cross the blood-brain barrier and exhibit concentration-dependent ϒ-aminobutyric acid (GABA) antagonism. Neurotoxic symptoms include depressed consciousness, encephalopathy, aphasia, myoclonus, seizures, and coma. Data suggest that up to 15% of ICU patients treated with cefepime may experience these adverse effects. Risk factors include renal dysfunction, excessive dosing, preexisting brain injury, and elevated serum cefepime concentrations...
November 14, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29136716/-the-impact-of-goal-directed-analgesia-on-mechanical-ventilated-patients-s-outcomes-in-intensive-care-unit-a-clinical-observational-study
#11
Q D Li, X Y Wan, Y L Zhang, S W Li, L L Han, W W Li, H Y Shi
To investigate the impact of goal directed analgesia on the outcome of patients with mechanical ventilation in intensive care unit.A total of 126 patients who needed mechanical ventilation were recruited.With a method of before and after paired comparison, they were divided into two group: (1) analgesia with empirical administration or control group; (2) goal directed analgesia based on critical-care pain observation tool (CPOT). Compared with the control group, after goal directed analgesia was applied, the consumption of midazolam significantly dropped from (368...
November 1, 2017: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/29136301/ketamine-for-the-acute-management-of-excited-delirium-and-agitation-in-the-prehospital-setting
#12
REVIEW
Lauren M Linder, Clint A Ross, Kyle A Weant
Traditional first-line therapy in the prehospital setting for the acutely agitated patient includes an antipsychotic in combination with a benzodiazepine. Recently, interest has grown regarding the use of ketamine in the prehospital setting as an attempt to overcome the limitations of the traditional medications and provide a more safe and effective therapy. This review provides an overview of the pharmacology of ketamine, evaluates the literature regarding ketamine use for prehospital agitation, and proposes an algorithm that may be used within the prehospital setting...
January 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29110954/effect-of-motor-subtypes-of-delirium-in-the-intensive-care-unit-on-fast-track-failure-after-cardiac-surgery
#13
Anna Lee, Jing Lan Mu, Chun Hung Chiu, Tony Gin, Malcolm John Underwood, Gavin Matthew Joynt
OBJECTIVE: The purpose of the study was to evaluate the association between motor subtypes of postoperative delirium in the intensive care unit and fast-track failure (a composite outcome of prolonged stay in the intensive care unit >48 hours, intensive care unit readmission, and 30-day mortality) after cardiac surgery. METHODS: This was a secondary analysis of a prospective cohort study of 600 consecutive adults undergoing cardiac surgery at a university hospital in Hong Kong (July 2013 to July 2015)...
September 30, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29105206/risk-factors-for-psychological-and-psychosomatic-symptoms-among-children-with-malignancies
#14
Kenichi Maeda, Daisuke Hasegawa, Kevin Y Urayama, Shinichi Tsujimoto, Yuriko Azami, Miwa Ozawa, Atsushi Manabe
AIM: With increasing survival rates in paediatric malignancies, the quality-of-life of children during hospitalisation should be given more attention. We aimed to identify factors associated with psychological and psychosomatic symptoms (PPS) that required medication among children hospitalised for treatment of malignancies. METHODS: We retrospectively analysed data of 190 patients aged 2-18 years old. They were diagnosed with malignant diseases and admitted for treatment at St...
November 3, 2017: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/29100197/using-simulated-family-presence-to-decrease-agitation-in-older-hospitalized-delirious-patients-a-randomized-controlled-trial
#15
Christine M Waszynski, Kerry A Milner, Ilene Staff, Sheila L Molony
BACKGROUND: Simulated family presence has been shown to be an effective nonpharmacological intervention to reduce agitation in persons with dementia in nursing homes. Hyperactive or mixed delirium is a common and serious complication experienced by hospitalized patients, a key feature of which is agitation. Effective nonpharmacological interventions to manage delirium are needed. OBJECTIVES: To examine the effect of simulated family presence through pre-recorded video messages on the agitation level of hospitalized, delirious, acutely agitated patients...
October 7, 2017: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/29045280/sedation-practice-in-extracorporeal-membrane-oxygenation-treated-patients-with-acute-respiratory-distress-syndrome-a-retrospective-study
#16
Julian deBacker, Erik Tamberg, Laveena Munshi, Lisa Burry, Eddy Fan, Sangeeta Mehta
Our objective was to characterize sedation management in adult patients with severe respiratory distress syndrome (ARDS) treated with venovenous extracorporeal membrane oxygenation (VV-ECMO). We conducted a retrospective chart review of these patients treated at Toronto General Hospital between January 2012 and October 2015. Medications administered (sedative, analgesic, paralytic, and antipsychotic), sedation depth (Sedation Agitation Scale [SAS] score) delirium assessments, and mobilization were recorded daily...
October 18, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29044304/delirium-in-a-latin-american-intensive-care-unit-a-prospective-cohort-study-of-mechanically-ventilated-patients
#17
Patricia Mesa, Ignacio José Previgliano, Sonia Altez, Silvina Favretto, María Orellano, Cinthya Lecor, Ana Soca, Ely Wesley
OBJECTIVE: To establish the prevalence of delirium in a general intensive care unit and to identify associated factors, clinical expression and the influence on outcomes. METHODS: This was a prospective cohort study in a medical surgical intensive care unit. The Richmond Agitation-Sedation Scale and Confusion Assessment Method for the Intensive Care Unit were used daily to identify delirium in mechanically ventilated patients. RESULTS: In this series, delirium prevalence was 80% (N = 184 delirious patients out of 230 patients)...
July 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/29037744/intoxication-from-the-novel-synthetic-cannabinoids-ab-pinaca-and-adb-pinaca-a-case-series-and-review-of-the-literature
#18
REVIEW
Patil Armenian, Michael Darracq, Jirair Gevorkyan, Shane Clark, Bryan Kaye, Nicklaus P Brandehoff
Synthetic cannabinoids (SC), are a novel class of designer drugs which emerged as a drug of abuse in the late 2000's. We report a case series of 6 patients who may have smoked a synthetic cannabinoid product in a remote wilderness setting. They presented with varying degrees of altered mental status, agitation, and seizures. Two were confirmed to have AB-PINACA, ADB-PINACA and their respective pentanoic acid metabolites in biological specimens via liquid chromatography time-of-flight mass spectrometry (LC-TOF/MS)...
October 14, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/29021727/analgesia-sedation-and-arousal-status-in-burn-patients-the-gap-between-recommendations-and-current-practices
#19
A Lavrentieva, N Depetris, I Rodini
Assessment and treatment of pain, agitation and delirium are integral parts of the management of critically ill patients. The purpose of this review is to describe how pain, delirium and agitation are managed in general intensive care units and in burn units, and to address whether management of these issues is compatible with internationally accepted recommendations. A substantial gap exists between the conception of the guidelines, clinical practice and physicians' statements regarding pain, sedation and delirium management...
June 30, 2017: Annals of Burns and Fire Disasters
https://www.readbyqxmd.com/read/28975307/effect-of-lorazepam-with-haloperidol-vs-haloperidol-alone-on-agitated-delirium-in-patients-with-advanced-cancer-receiving-palliative-care-a-randomized-clinical-trial
#20
RANDOMIZED CONTROLLED TRIAL
David Hui, Susan Frisbee-Hume, Annie Wilson, Seyedeh S Dibaj, Thuc Nguyen, Maxine De La Cruz, Paul Walker, Donna S Zhukovsky, Marvin Delgado-Guay, Marieberta Vidal, Daniel Epner, Akhila Reddy, Kimerson Tanco, Janet Williams, Stacy Hall, Diane Liu, Kenneth Hess, Sapna Amin, William Breitbart, Eduardo Bruera
Importance: The use of benzodiazepines to control agitation in delirium in the last days of life is controversial. Objective: To compare the effect of lorazepam vs placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium in the setting of advanced cancer. Design, Setting, and Participants: Single-center, double-blind, parallel-group, randomized clinical trial conducted at an acute palliative care unit at MD Anderson Cancer Center, Texas, enrolling 93 patients with advanced cancer and agitated delirium despite scheduled haloperidol from February 11, 2014, to June 30, 2016, with data collection completed in October 2016...
September 19, 2017: JAMA: the Journal of the American Medical Association
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