Postcardiotomy delirium

BACKGROUND: Delirium is an acute confusional state, associated with morbidity and mortality in diverse medically-ill populations. Delirium is recognized, through both professional competencies and instructional materials, as a core topic in consultation psychiatry. OBJECTIVE: Conduct a computational scoping review of the delirium literature to identify the overall contours of this literature and evolution of the delirium literature over time. METHODS: Algorithmic analysis of all research articles on delirium indexed in MEDLINE between 1995 and 2015 using network analysis of citation Medical Subject Headings (MeSH) tags and probabilistic topic modeling of article abstracts...

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There is increasing recognition that coronary artery bypass grafting (CABG) may be a risk factor for subtle cognitive decline although the presence and pattern of such decline has varied across studies. Cognitive deficits may present as short-term memory loss, executive dysfunction and psychomotor slowing. Although they are usually are not severe enough to meet criteria for mild cognitive impairment or vascular dementia, they lower quality of life and add to hospitalization and out-of-hospital costs. Proposed mechanisms include surgical-related trauma, genetic susceptibility (eg, apolipoprotein E4 allele), microembolization, other vascular or ischemic changes, and temperature during surgery...

BACKGROUND: Postoperative cognitive dysfunction is a clinical entity that is associated with poor outcome. We determined the effectiveness of amantadine in reducing surgery-induced cognitive impairment and the role of glial cell line-derived neurotrophic factor (GDNF) in this effect. METHODS: Four-month old male Fischer 344 rats were subjected to right carotid exposure under intravenous anesthesia. Some rats received intraperitoneal injection of 25 mg/kg/day amantadine for 3 days with the first dose at 15 min before the surgery or intracerebroventricular injection of GDNF or an anti-GDNF antibody at the end of surgery...

Delirium is a highly prevalent disease in the elderly and postoperative, cancer, and AIDS patients. However it is often misdiagnosed and mistreated. This may be partly due to the inconsistencies of the diagnosis itself. Delirium is best defined currently by an association of cognitive impairment and arousal disturbance. Three subtypes (hyperactive, hypoactive, mixed) receive a definition in the literature, but those definitions may vary from author to author according to the importance they give either to the motoric presentation of the delirium or to the arousal disturbance...

The brain controls the heart directly through the sympathetic and parasympathetic branches of the autonomic nervous system, which consists of multi-synaptic pathways from myocardial cells back to peripheral ganglionic neurons and further to central preganglionic and premotor neurons. Cardiac function can be profoundly altered by the reflex activation of cardiac autonomic nerves in response to inputs from baro-, chemo-, nasopharyngeal and other receptors as well as by central autonomic commands, including those associated with stress, physical activity, arousal and sleep...

BACKGROUND: To investigate the controlling efficacy of ondasetron and haloperidol in regard to the postcardiotomy delirium. METHODS: We included in this prospective, randomized, double-blinded study 80 patients who developed delirium after heart surgery with the application of heart lung-machine. The patients were divided into two, equally-sized groups, which on detection of delirium received ondasetron 8 mg iv or haloperidol 5 mg iv respectively. The statistical analysis compared the baseline and demographic characteristics of the two groups (age, gender, comorbidities, years of education, type of surgery etc...

AIMS: More than 20% of patients of 65 years or older may develop a delirium after cardiac surgery. Patients with delirium frequently show a disturbed 24-hr motor activity pattern, but objective and quantitative data are scarce. Our aim was to quantify motor activity patterns in elderly patients with or without a postcardiotomy delirium after elective cardiac surgery. METHODS: Wrist-actigraphy was used to quantify 24-hr motor activity patterns for a 5-day period following cardiac surgery in 79 patients of 65 years or older...

OBJECTIVE: To determine the incidence and predictors of delirium after cardiac surgery. METHOD: A prospective, observational study of postcardiotomy surgical patients was conducted during a 5 month period at the Minneapolis, MN, VAMC. RESULTS: Of the 53 patients who completed the study, 12 patients (23%) met criteria for postoperative delirium and 18 patients (34%) met criteria for postoperative subsyndromal delirium. Significant predictors of postoperative delirium included a history of cerebrovascular disease (Charlson Index item, VA CICSP), high medical comorbidity (VA morbidity risk score, Charlson Index), increased preoperative creatinine level, and an increased preoperative pain rating...

UNLABELLED: BACKGROUND AND AIM OF REVIEW: Cardiac surgery is increasingly common and relatively safe, but there are frequent reports of neuropsychiatric sequelae occurring in the postoperative period. One of the most common neuropsychiatric presentations of cardiac surgery is delirium, also called postcardiotomy delirium (PCD). Despite the vast numbers of cardiac surgeries performed today, there is a paucity of data on risk factors and management options of PCD available to the clinician...

OBJECTIVE: To evaluate the effect of the 5-HT3-receptor antagonist ondansetron in patients with postcardiotomy delirium. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Thirty-five patients who had undergone coronary artery bypass graft surgery. INTERVENTIONS: Thirty-five patients, 23 men and 12 women, who developed delirium in the intensive care unit after coronary artery bypass graft surgery were included...

This article will briefly review the clinical studies focusing on measurement of serum levels of anticholinergic activity in delirious states. Three experimental approaches have been taken. First, to identify medications currently prescribed that have subtle anticholinergic effects. The current "list" includes 48 commonly prescribed medications. Second, to associate serum anticholinergic activity with delirium in various clinical states including postcardiotomy delirium, postelectroconvulsive delirium, delirious elderly medical inpatients, and nursing home patients...

The neurotransmitter acetylcholine has been implicated in animal and human studies of delirium. This chapter will briefly review the clinical studies focussing on measurement of serum levels of anticholinergic activity in delirious states. Three approaches have been taken. First, to identify medications currently prescribed that have subtle anticholinergic effects. The current 'list' includes 48 commonly prescribed medications. Second, to associate serum anticholinergic activity with delirium in various clinical states including postcardiotomy delirium, postelectroconvulsive delirium, delirious elderly medical inpatients, and nursing home patients...

Numerous articles have been published investigating the incidence of and risk factors for delirium after cardiac surgery. Smith and Dimsdale reviewed the literature on postcardiotomy delirium in 1987 using a meta-analysis of 44 research studies. However, doubts about their methods and results caused the authors to re-examine the literature using these 44 references as well as computerized literature searches to gather research and review papers from medical journals. Delirium after cardiac surgery appeared to be ill-defined in most of these studies...

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This study investigated the relationship of incidence, degree, and duration of PCD to age of the patient, time on cardiopulmonary bypass, mean arterial pressure on bypass, ICU time, and body temperature postoperatively. The study sample consisted of 50 open-heart surgery patients. The delirium assessment was made each evening for 7 days after operation. Manifestations of delirium were experienced by 72% of the sample. Incidence of PCD was related to blood pressure on bypass, age, and temperature on the third postoperative day...

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This report details the implantation of a total artificial heart into a human being who survived for 112 days. Included are the criteria for candidate selection, the preoperative psychiatric evaluation, and the description of operative and postoperative complications in the context of the research subject's mental status over the period of his survival. Postmortem pathologic findings are reviewed. We summarize pertinent literature, including disordered behavior, postcardiotomy, and neuropsychiatric syndromes in hepatic, renal, and cardiac transplant patients...