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Delirium prevention in Emergency

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https://www.readbyqxmd.com/read/28250481/comparison-of-oral-dexmedetomidine-versus-oral-midazolam-as-premedication-to-prevent-emergence-agitation-after-sevoflurane-anaesthesia-in-paediatric-patients
#1
M Kavya Prabhu, Sripada G Mehandale
BACKGROUND AND AIMS: Sevoflurane is the most often used inhalational agent in paediatric anaesthesia, but emergence agitation (EA) remains a major concern. Oral midazolam and parenteral dexmedetomidine are known to be effective in controlling EA. We attempted to elucidate whether oral dexmedetomidine is better than midazolam in controlling EA. METHODS: Prospective double-blinded study involving ninety patients aged 1-10 years, undergoing elective surgeries of <2 h of expected duration under sevoflurane general anaesthesia, randomised to receive either midazolam (Group A) or dexmedetomidine (Group B) as oral premedication was carried out to record level of sedation before induction, haemodynamic parameters and recovery time...
February 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28146459/smartphone-based-behavioural-intervention-alleviates-children-s-anxiety-during-anaesthesia-induction-a-randomised-controlled-trial
#2
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
https://www.readbyqxmd.com/read/28130755/prevention-and-therapy-of-pediatric-emergence-delirium-a-national-survey
#3
Christopher Huett, Torsten Baehner, Felix Erdfelder, Claudia Hoehne, Christian Bode, Andreas Hoeft, Richard K Ellerkmann
INTRODUCTION: Although pediatric emergence delirium (ED) is common, preventive and therapeutic pharmacological treatment is the matter of an international controversial discussion and evidence on different options is partially vague. OBJECTIVE: We therefore examined clinical routine in prevention strategies and postoperative therapy of ED with respect to clinical experience in pediatric anesthesia. METHODS: A web-based survey was developed investigating routine management (prevention and treatment) of ED, facility structure, and patient population...
April 2017: Paediatric Drugs
https://www.readbyqxmd.com/read/28068834/design-considerations-of-a-randomized-controlled-trial-of-sedation-level-during-hip-fracture-repair-surgery-a-strategy-to-reduce-the-incidence-of-postoperative-delirium-in-elderly-patients
#4
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
https://www.readbyqxmd.com/read/27872590/test-retest-reliability-of-a-serious-game-for-delirium-screening-in-the-emergency-department
#5
Tiffany Tong, Mark Chignell, Mary C Tierney, Jacques S Lee
Introduction: Cognitive screening in settings such as emergency departments (ED) is frequently carried out using paper-and-pencil tests that require administration by trained staff. These assessments often compete with other clinical duties and thus may not be routinely administered in these busy settings. Literature has shown that the presence of cognitive impairments such as dementia and delirium are often missed in older ED patients. Failure to recognize delirium can have devastating consequences including increased mortality (Kakuma et al...
2016: Frontiers in Aging Neuroscience
https://www.readbyqxmd.com/read/27830713/efficacy-and-acceptability-of-different-auxiliary-drugs-in-pediatric-sevoflurane-anesthesia-a-network-meta-analysis-of-mixed-treatment-comparisons
#6
Wuchao Wang, Panchuan Huang, Weiwei Gao, Fangli Cao, Mingling Yi, Liyong Chen, Xiaoli Guo
Emergence agitation preventive medicine should be combined with pediatric anesthesia because of the high frequency of emergence agitation. However, it is challenging to determine the most appropriate medication that can be introduced into pediatric anesthesia for the sake of emergence agitation prevention. We reviewed and retrieved the data from PubMed and Embase. Various medications were assessed based on several endpoints including Emergence agitation outcomes (EA), postoperative nausea and vomiting (PONV), the number of patients who required analgesic (RA), pediatric anesthesia emergence delirium (PAED), the extubation time, the emergency time and the duration of post-anesthesia care unit (PACU) stay...
November 10, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27798810/emergence-delirium-in-pediatric-anesthesia
#7
REVIEW
Arthura D Moore, Doralina L Anghelescu
Emergence delirium (ED) is a complex of perceptual disturbances and psychomotor agitation that occurs most commonly in preschool-aged children in the early postanesthetic period. The incidence of ED varies between 10 and 80% in children and is perceived as a troublesome clinical situation by 42% of pediatric anesthesiologists. Although these events are often short lived, they increase the risk of self-injury and delayed discharge, require additional nursing staff and can increase medical care costs, all of which are causes for concern...
February 2017: Paediatric Drugs
https://www.readbyqxmd.com/read/27677382/improving-ghb-withdrawal-with-baclofen-study-protocol-for-a-feasibility-study-for-a-randomised-controlled-trial
#8
Anne Lingford-Hughes, Yash Patel, Owen Bowden-Jones, Mike J Crawford, Paul I Dargan, Fabiana Gordon, Steve Parrott, Tim Weaver, David M Wood
BACKGROUND: GHB (gamma-hydroxybutyrate) and its pro-drugs GBL (gamma-butyrolactone) and 1,4-butanediol (1,4-BD) are central nervous system depressants whose street names include 'G' and 'liquid ecstasy'. They are used recreationally predominately for their stimulant and pro-sexual effects or for sedation to help with sleep and/or to 'come down' after using stimulant recreational drugs. Although overall population prevalence is low (0.1 %), in some groups such as men who have sex with men, GHB/GBL use may reach 20 %...
September 27, 2016: Trials
https://www.readbyqxmd.com/read/27635747/effectiveness-of-preoperative-intranasal-dexmedetomidine-compared-with-oral-midazolam-for-the-prevention-of-emergence-delirium-in-pediatric-patients-undergoing-general-anesthesia-a-systematic-review-protocol
#9
Laura S Bonanno, Stephanie Pierce, Jennifer Badeaux, James J FitzSimons
This review aims to identify the effectiveness of preoperative intranasal dexmedetomidine compared with oral midazolam for the prevention of emergence delirium in pediatric patients undergoing general anesthesia.
August 2016: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/27621236/preventing-delirium-in-dementia-managing-risk-factors
#10
REVIEW
Andrew H Ford
Delirium is a common, disabling medical condition that is associated with numerous adverse outcomes. A number of inter-related factors, including pre-existing cognitive impairment, usually contribute to the development of delirium in a particular susceptible individual. Non-pharmacological approaches to prevention typically target multiple risk factors in a systematic manner (multicomponent interventions). There is generally good evidence that multicomponent interventions reduce the incidence of delirium in hospital populations but there are limited data in people with dementia and those living in the community...
October 2016: Maturitas
https://www.readbyqxmd.com/read/27596941/nurses-and-physicians-perceptions-of-confusion-assessment-method-for-the-intensive-care-unit-for-delirium-detection-focus-group-study
#11
Marie Oxenbøll-Collet, Ingrid Egerod, Vibeke Christensen, Jeannette Jensen, Thordis Thomsen
BACKGROUND: Delirium in the intensive care unit (ICU) has received more attention in the past decade. Early detection, prevention and treatment of delirium are important, and the most commonly used tool for delirium assessment is the Confusion Assessment Method for the ICU (CAM-ICU). AIM: The aim of this study was to identify nurses' and physicians' perceived professional barriers to using the CAM-ICU in Danish ICUs. METHODS: This study uses a qualitative explorative multicentre design using focus groups and a semi-structured interview guide...
September 5, 2016: Nursing in Critical Care
https://www.readbyqxmd.com/read/27555179/efficacy-of-premedication-with-intranasal-dexmedetomidine-on-inhalational-induction-and-postoperative-emergence-agitation-in-pediatric-undergoing-cataract-surgery-with-sevoflurane
#12
RANDOMIZED CONTROLLED TRIAL
Yiquan Lin, Ying Chen, Jingxia Huang, Hongbin Chen, Weihua Shen, Wenjun Guo, Qianru Chen, Hongfeng Ling, Xiaoliang Gan
STUDY OBJECTIVES: This study aimed to test the hypothesis that premedication with a single dose of intranasal dexmedetomidine (DEX) could not only reduce preoperative anxiety but also minimize the emergence agitation in children undergoing cataract surgery with sevoflurane anesthesia. DESIGN: Single-blinded, randomized, placebo-controlled clinical comparison study. SETTING: Academic medical center. PATIENTS: Ninety American Society of Anesthesiologists physical status 1 and 2 children scheduled for cataract surgery...
September 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27549604/benzodiazepine-misuse-in-the-elderly-risk-factors-consequences-and-management
#13
REVIEW
Guillaume Airagnes, Antoine Pelissolo, Mélanie Lavallée, Martine Flament, Frédéric Limosin
Benzodiazepine (BZD) inappropriate use (i.e., misuse and overuse) is a worldwide public health problem. Despite current knowledge about increased sensitivity to side effects in the elderly, that should lead to more caution, only a third of BZD prescriptions in this age group are considered appropriate. The most frequent inadequate situations are excessive duration and/or dosage of a medical prescription or self-medication, especially in a context where it would be contraindicated, e.g., long-acting BZD in the elderly...
October 2016: Current Psychiatry Reports
https://www.readbyqxmd.com/read/27459411/the-geriatric-day-hospital-preliminary-data-on-an-innovative-model-of-care-in-brazil-for-older-adults-at-risk-of-hospitalization
#14
Márlon J R Aliberti, Claudia K Suemoto, Sileno Q Fortes-Filho, Juliana A Melo, Carolina B Trindade, Juliana Y T Kasai, Marcelo Altona, Daniel Apolinario, Wilson Jacob-Filho
Older adults have a greater risk of experiencing functional decline and iatrogenic complications during hospitalization than younger individuals. Geriatric day hospitals (GDHs) have been implemented mainly for rehabilitation. The goal of the current study was to expand the GDH spectrum of care to prevent hospital admissions in this population. This study details an innovative model of GDH care that offers short-term, nonrehabilitative treatment to older adults who have experienced an acute event, those with a decompensated chronic disease, or those in need of a minor procedure that would be unattainable in a regular outpatient setting...
October 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27431505/examining-the-hospital-elder-life-program-in-a-rehabilitation-setting-a-pilot-feasibility-study
#15
Kelsey Huson, Paul Stolee, Nancy Pearce, Corrie Bradfield, George A Heckman
BACKGROUND: The Hospital Elder Life Program (HELP) has been shown to effectively prevent delirium and functional decline in older patients in acute care, but has not been examined in a rehabilitation setting. This pilot study examined potential successes and implementation factors of the HELP in a post-acute rehabilitation hospital setting. METHODS: A mixed methods (quantitative and qualitative) evaluation, incorporating a repeated measures design, was used. A total of 100 patients were enrolled; 58 on the pilot intervention unit and 42 on a usual care unit...
2016: BMC Geriatrics
https://www.readbyqxmd.com/read/27282296/understanding-cognition-in-older-patients-with-cancer
#16
REVIEW
Meghan Karuturi, Melisa L Wong, Tina Hsu, Gretchen G Kimmick, Stuart M Lichtman, Holly M Holmes, Sharon K Inouye, William Dale, Kah P Loh, Mary I Whitehead, Allison Magnuson, Arti Hurria, Michelle C Janelsins, Supriya Mohile
Cancer and neurocognitive disorders, such as dementia and delirium, are common and serious diseases in the elderly that are accompanied by high degree of morbidity and mortality. Furthermore, evidence supports the under-diagnosis of both dementia and delirium in older adults. Complex questions exist regarding the interaction of dementia and delirium with cancer, beginning with guidelines on how best measure disease severity, the optimal screening test for either disorder, the appropriate level of intervention in the setting of abnormal findings, and strategies aimed at preventing the development or progression of either process...
July 2016: Journal of Geriatric Oncology
https://www.readbyqxmd.com/read/27188116/-effective-dexmedetomidine-administration-for-the-prevention-of-emergence-agitation-and-postoperative-delirium-in-patients-with-a-history-of-postoperative-delirium
#17
Takanobu Fujisawa, Nobuyasu Komasawa, Atsushi Fujiwara, Haruki Kido, Toshiaki Minami
We successfully performed intraoperative dexmedetomidine (DEX) administration for the prevention of emergence agitation or postoperative delirium after lung resection in four patients (71.3 ± 5.7 year old, 3 males and 1 female) with a past history of postoperative delirium. DEX was started at 0.35-0.45 μg x kg(-1) x hr(-1) continuously without loading. The average time from DEX initiation to extubation was 141.3 ± 94.4 minutes. No patient had emergence agitation, and DEX administration was continued until the following morning with monitoring in all patients without any symptoms of delirium...
April 2016: Masui. the Japanese Journal of Anesthesiology
https://www.readbyqxmd.com/read/27178256/-antibiomania-think-of-the-manic-syndrome-secondary-to-antibiotic-therapy
#18
T Legendre, C Boudebesse, C Henry, B Etain
INTRODUCTION: Antibiomania is characterized by the emergence of a manic episode in reaction to antibiotics. Although relatively uncommon, this kind of side effect is observed in a growing number of cases and mostly occurs in patients who do not have a history of bipolar disorder. Several dozen cases have been reported showing the onset of manic symptoms after taking antibiotics. The antibiotic most frequently involved is clarithromycin. CLINICAL CASE: We report the case of a 61-year-old patient who presented a manic episode after taking an antibiotic combination to treat Helicobacter pylori...
May 10, 2016: L'Encéphale
https://www.readbyqxmd.com/read/27109177/correlates-of-cognitive-functioning-in-independent-elderly-patients-discharged-home-from-the-emergency-department-after-a-minor-injury
#19
Marie-Christine Ouellet, Marie-Josée Sirois, Simon Beaulieu-Bonneau, Marie-Ève Gagné, Jacques Morin, Jeffrey Perry, Raoul Daoust, Laura Wilding, Véronique Provencher, Stéphanie Camden, Nadine Allain-Boulé, Marcel Émond
BACKGROUND: The objective of this study was to explore correlates of cognitive functioning of older adults visiting the emergency department (ED) after a minor injury. METHODS: These results are derived from a large prospective study in three Canadian EDs. Participants were aged ≥ 65 years and independent in basic activities of daily living, visiting the ED for minor injuries and discharged home within 48 hours (those with known dementia, confusion, and delirium were excluded)...
August 2016: International Psychogeriatrics
https://www.readbyqxmd.com/read/27015177/delirium-prediction-based-on-hospital-information-delphi-in-general-surgery-patients
#20
Min Young Kim, Ui Jun Park, Hyoung Tae Kim, Won Hyun Cho
To develop a simple and accurate delirium prediction score that would allow identification of individuals with a high probability of postoperative delirium on the basis of preoperative and immediate postoperative data.Postoperative delirium, although transient, is associated with adverse outcomes after surgery. However, there has been no appropriate tool to predict postoperative delirium.This was a prospective observational single-center study, which consisted of the development of the DELirium Prediction based on Hospital Information (Delphi) score (n = 561) and its validation (n = 533)...
March 2016: Medicine (Baltimore)
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