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Delirium in Emergency room

Débora O Cumino, Joaquim E Vieira, Luciana C Lima, Livia P Stievano, Raquel A P Silva, Ligia A S T Mathias
BACKGROUND: Preoperative anxiety negatively influences children's anaesthetic and surgical experience, and results in postoperative complications, such as emergence delirium and behavioural changes. Nonpharmacological management using alternative therapies that alleviate psychological stress can be as important as pharmacological ones in reducing children's anxiety. Nevertheless, their validity as an effective anxiety-reducing strategy in children remains controversial. OBJECTIVE(S): To verify whether nonpharmacological strategies, that is, leaflet and distraction with smartphone application presented to parents/guardians and children, respectively, were effective in preventing children's anxiety during anaesthesia induction...
March 2017: European Journal of Anaesthesiology
Tianjing Li, L Susan Wieland, Esther Oh, Karin J Neufeld, Nae-Yuh Wang, Kay Dickersin, Frederick E Sieber
Background Delirium is an acute change in mental status characterized by sudden onset, fluctuating course, inattention, disorganized thinking, and abnormal level of consciousness. The objective of the randomized controlled trial "A STrategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients" (STRIDE) is to assess the effectiveness of light versus heavy sedation on delirium and other outcomes in elderly patients undergoing hip fracture repair surgery. Our goal is to describe the design considerations and lessons learned in planning and implementing the STRIDE trial...
January 1, 2017: Clinical Trials: Journal of the Society for Clinical Trials
Tulun Ozturk, Arzu Acıkel, Ozge Yılmaz, Ismet Topçu, Eralp Çevıkkalp, Hasan Yuksel
STUDY OBJECTIVE: To determine the effects of low-dose ketamine and propofol on cough during emergence and the recovery period when administered at emergence in children undergoing fiberoptic bronchoscopy for bronchoalveolar lavage (FOBL) with sevoflurane-remifentanil anesthesia. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Operating room, postoperative recovery area. PATIENTS: Sixty-eight children aged 1 to 8 years old undergoing elective diagnostic FOBL...
December 2016: Journal of Clinical Anesthesia
Toshiro Kobayashi, Hiroshi Kurazumi, Hidenori Gohra, Seiichi Shibasaki, Yuko Kudo, Naoko Yamauchi, Takashi Tamura, Michio Shigedomi
Fast-track surgery has been widely implemented and allows such immediate extubation as in the operating room(OR). We retrospectively investigated the effect of routine ultra-fast-track(UFT) surgery extubating in the OR in patients undergoing cardiovascular operations. Among 333 consecutive patients, 224 (67.3%)were extubated in the OR. Five patients were re-intubated, but none were because of heart or respiratory failure. Independent predictors for failure of OR extubation were preoperative renal failure, pre-existent cerebrovascular disease, emergency surgery, and prolonged operation and/or cardiopulmonary bypass times...
November 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Martin G Cole, Jane McCusker, Robert Bailey, Michael Bonnycastle, Shek Fung, Antonio Ciampi, Eric Belzile
BACKGROUND: the implications of partial and no recovery from delirium after hospital discharge are not clear. We sought to explore whether partial and no recovery from delirium among recently discharged patients predicted increased adverse events (emergency room visits, hospitalisations, death) during the subsequent 3 months. METHOD: prospective study of recovery from delirium in older hospital inpatients. The Confusion Assessment Method was used to diagnose delirium in hospital and determine recovery status after discharge (T0)...
September 8, 2016: Age and Ageing
M F Emons, J P Bae, B J Hoogwerf, S L Kindermann, R J Taylor, B H Nathanson
OBJECTIVE: Hypoglycemia is a serious complication of diabetes treatment. This retrospective observational study characterized hypoglycemia-related hospital emergency room (ER) and inpatient (in-pt) admissions and identified risk factors for 30-day all-cause and hypoglycemia-related readmission. RESEARCH DESIGN AND METHODS: 4476 hypoglycemia-related ER and in-pt encounters with discharge dates from 1/1/2009 to 3/31/2014 were identified in a large, multicenter electronic health record database...
2016: BMJ Open Diabetes Research & Care
Joseph A Giovannitti
PURPOSE OF REVIEW: Anesthesia for dentistry is commonly performed outside the operating room. The combination of a shared airway between surgeon and anesthetist, the variety of open airway techniques, and the out-of-operating room setting often results in anxiety and avoidance of dental cases among anesthesia personnel. This review attempts to demystify dental treatment and facilitate the anesthesia provider in providing effective sedation of dental procedures performed in the nonoperating room setting...
August 2016: Current Opinion in Anaesthesiology
L Munk, G Andersen, A M Møller
BACKGROUND: Emergence delirium (ED) after general anaesthesia (GA) is a well-known phenomenon, yet the risk factors are still unclear. The aims of this study were to determine the incidence and independent predictors of ED and secondly to determine to which degree ED has any relevant, clinical consequences to medical staff as well as to patients. METHOD: This prospective, observational cohort study assessed adult patients emerging from GA in the operating room, using the Richmond Agitation-Sedation Scale (RASS)...
September 2016: Acta Anaesthesiologica Scandinavica
Liting Ji, Xiaoping Zhang, Hui Fan, Mei Han, Haitao Yang, Lihua Tang, Yan Shao, Yunping Lan, Dongbai Li
OBJECTIVE: There is no existing standard format for preoperative anesthesia education. The drawMD APP is an visible preoperative education tool. The aim of this study was to evaluate the effects of drawMD APP on pre-operative anesthesia education. METHODS: The parents were randomized to receive drawMD APP-aided pre-operative anesthesia education or standard verbal education. Parental anxiety was measured before education (T0) and immediately after education (T1), and after operation (T4)...
February 2016: Patient Education and Counseling
Jeff Gadsden, Alicia Warlick
Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform...
2015: Local and Regional Anesthesia
Amir Vahedian Azimi, Abbas Ebadi, Fazlollah Ahmadi, Soheil Saadat
BACKGROUND: Prolonged hospitalization in the intensive care unit (ICU) can impose long-term psychological effects on patients. One of the most significant psychological effects from prolonged hospitalization is delirium. OBJECTIVES: The aim of this study was to assess the effect of prolonged hospitalization of patients and subsequent delirium in the intensive care unit. PATIENTS AND METHODS: This conventional content analysis study was conducted in the General Intensive Care Unit of the Shariati Hospital of Tehran University of Medical Sciences, from the beginning of 2013 to 2014...
May 2015: Trauma Monthly
Kristen M Bailey, Sally J Bird, Patrick J McGrath, Jill E Chorney
BACKGROUND: The purpose of this study is to compare the effectiveness of a brief preparation intervention for parental presence during induction of anesthesia (PPIA preparation) with a PPIA with standard preparation (PPIA standard). METHODS: Ninety-three children, aged 2 to 10 years, undergoing elective surgery at a children's hospital participated together with their parents. Parents were randomly assigned to receive either PPIA preparation or PPIA standard before their children's induction of anesthesia...
October 2015: Anesthesia and Analgesia
Paola R Fuentes, Javier Webar, Carla Matus, Cristián Vergara, Michelle Herrera, Elizabeth M Barthel, Jorge S Vega
Illness presentation in the elderly may be entirely non-specific, with fatigue, loss of function or the presence of geriatric syndromes. We report a 90 years old male consulting in the emergency room for delirium that persisted throughout hospitalization without finding a cause. During the course of hospitalization mild fever appeared and a left knee swelling became apparent. A synovial fluid aspiration showed a leukocyte count of 360 per field with 60% polymorphonuclear cells. The culture was negative. With a presumptive diagnosis of pseudogout, cochicine and celecoxib were started with remission of the confusional state...
April 2015: Revista Médica de Chile
Hyuckgoo Kim, Sung Mee Jung, Hwarim Yu, Sang-Jin Park
BACKGROUND: The anxiolytic efficacy of video watching, in the absence of parents, during the mask induction of anesthesia in young children with high separation anxiety has not been clearly established. We performed this study to determine whether the effect of video distraction on alleviating preoperative anxiety is independent of parental presence and whether a combination of both interventions is more effective than either single intervention in alleviating preoperative anxiety and postoperative behavioral disturbance in preschool children...
September 2015: Anesthesia and Analgesia
E Card, P Pandharipande, C Tomes, C Lee, J Wood, D Nelson, A Graves, A Shintani, E W Ely, C Hughes
BACKGROUND: Emergence from anaesthesia is often accompanied by signs of delirium, including fluctuating mental status and inattention. The evolution of these signs of delirium requires investigation since delirium in the post-anaesthesia care unit (PACU) may be associated with worse outcomes. METHODS: Adult patients emerging from anaesthesia were assessed for agitated emergence in the operating room using the Richmond Agitation-Sedation Scale (RASS). The Confusion Assessment Method for the Intensive Care Unit was then used to evaluate delirium signs at PACU admission and during PACU stay at 30 min, 1 h, and discharge...
September 2015: British Journal of Anaesthesia
Albert Diefenbacher
In German speaking countries, during the last decades, we can see a growing, though albeit small, integration of psychiatry and psychosomatics into (somatic) medicine. This article outlines the importance of the growing number of elderly patients in medical care as a vantage point for c-l-psychiatrists to play a pro-active role in implementing adequate structures and processes for diagnostics and treatment of this patient group. It is argued that delirium (in dementia) can and should be regarded as a paradigm for a biopsychosocial disorder sui generis...
2015: Neuropsychiatrie: Klinik, Diagnostik, Therapie und Rehabilitation
Fermín García-Gollarte, José Baleriola-Júlvez, Isabel Ferrero-López, Álvaro Cuenllas-Díaz, Alfonso J Cruz-Jentoft
OBJECTIVE: Inappropriate drug prescription is a common problem in people living in nursing homes and is linked to adverse health outcomes. This study assessed the effect of an educational intervention directed to nursing home physicians in reducing inappropriate prescription and improving health outcomes and resource utilization. DESIGN: Prospective, randomized, multicenter study. SETTING: A private organization of nursing homes in Spain. PARTICIPANTS: Sixty nursing home physicians caring for approximately 3900 nursing home residents in 37 centers were randomized to receive an educational intervention (30) or as a control group (30)...
December 2014: Journal of the American Medical Directors Association
Gilles Naeije, Chantal Depondt, Claire Meeus, Keziah Korpak, Thierry Pepersack, Benjamin Legros
INTRODUCTION: Delirium is a leading cause of hospitalization and morbidity in elderly persons. Nonconvulsive status epilepticus (NCSE) and delirium share many risk factors. We tested the hypothesis that NCSE plays an important role in delirium by performing continuous EEG (cEEG) monitoring in elderly patients with delirium of any cause. MATERIAL AND METHODS: Patients over 65 years old presenting with delirium in the emergency room were prospectively included and underwent either routine 20-minute EEG or cEEG within 24h after admission...
July 2014: Epilepsy & Behavior: E&B
Sherry Tang, Priyanka Patel, Jagdish Khubchandani, George T Grossberg
Background. The growing geriatric population in the United States (US) has prompted better understanding of treatment of the elderly in the hospital and emergency room (ER) settings. This study examines factors influencing the disposition of psychogeriatric patients after their initial presentation in the ER. Methods. Data was collected on patients 65 years of age or older arriving at the ER of a large urban hospital in the USA (January 2009-December 2010). Results. Of the total subjects (n = 95) included in the study, majority were females (66...
2014: ISRN Psychiatry
A Pickard, P Davies, K Birnie, R Beringer
Undergoing general anaesthesia is distressing for children, with up to two-thirds demonstrating abnormal behaviours after their procedure, such as emergence delirium (ED) and post-hospitalization behaviour change. The aim of this systematic review was to determine the effect of intraoperative i.v. α₂-adrenergic agonists on postoperative behaviour in children. We included published full-text reports of randomized controlled trials involving children who received i.v. clonidine or dexmedetomidine after induction of general anaesthesia, who were assessed for postoperative behavioural disturbance...
June 2014: British Journal of Anaesthesia
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