1
|
Aldana EM, Pérez de Arriba N, Valverde JL, Aldecoa C, Fábregas N, Fernández-Candil JL. National survey on perioperative cognitive dysfunction. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024:S2341-1929(24)00122-7. [PMID: 38972351 DOI: 10.1016/j.redare.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/29/2023] [Accepted: 02/15/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Perioperative cognitive dysfunction (PCD) is a very prevalent clinical syndrome due to the progressive aging of the surgical population.The aim of our study is to evaluate the clinical practice of Spanish anesthesiologists surveyed regarding this entity. MATERIAL AND METHODS Prospective online survey conducted by the Neurosciences Section and distributed by SEDAR. RESULTS 544 responses were obtained, with a participation rate of 17%. 54.4% of respondents never make a preoperative assessment of cognitive impairment, only 7.5% always do it. 79.6% lack an intraoperative management protocol for the patient at risk of PCD. In the anesthetic planning, only 23.3% of the patients was kept in mind. Eighty-nine percent considered regional anesthesia with or without sedation preferable to general anesthesia for the prevention of PCD. 88.8% considered benzodiazepines to present a high risk of PCD. 71.7% considered that anesthetic depth monitoring could prevent postoperative cognitive deficit. Routine evaluation of postoperative delirium is low, only 14%. More than 80% recognize that PCD is underdiagnosed. CONCLUSIONS Among Spanish anesthesiologists surveyed, PCD is still a little known and underappreciated entity. It is necessary to raise awareness of the need to detect risk factors for PCD, as well as postoperative assessment and diagnosis. Therefore, the development of guidelines and protocols and the implementation of continuing education programs in which anesthesiologists should be key members of multidisciplinary teams in charge of perioperative care are suggested.
Collapse
Affiliation(s)
- E M Aldana
- Anestesiología y Reanimación, Hospital Vithas Xanit Internacional, Benalmádena, Málaga, Spain.
| | - N Pérez de Arriba
- Anestesiología y Reanimación, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J L Valverde
- Anestesiología y Reanimación, Hospital Vithas Xanit Internacional, Benalmádena, Málaga, Spain
| | - C Aldecoa
- Anestesiología y Reanimación, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - N Fábregas
- Anestesiología y Reanimación, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
| | | |
Collapse
|
2
|
Aasheim A, Rosseland LA, Leonardsen ACL, Romundstad L. Depth of anesthesia monitoring in Norway-A web-based survey. Acta Anaesthesiol Scand 2024; 68:781-787. [PMID: 38551019 DOI: 10.1111/aas.14420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 01/16/2024] [Accepted: 03/18/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The bispectral index (BIS) monitor is the most frequently used electroencephalogram (EEG)-based depth of anesthesia (DoA) technology in Norwegian hospitals. However, there is limited knowledge regarding the extent and clinical impact of its use and how anesthesiologists and nurse anesthetists use the information provided by the DoA monitors in their clinical practice. METHODS This cross-sectional survey on the use of DoA monitors in Norway used a web-based questionnaire distributed to anesthesia personnel in all hospitals in Norway. Participation was voluntary and anonymized, and the web form could not track IP sources or respondents' locations. RESULTS Three hundred and ninety-one nurse anesthetists (n = 324) and anesthesiologists (n = 67) responded. Among the EEG-based DoA monitoring tools, BIS was most often used to observe and assess patients' DoA (98%). Raw EEG waveform analysis (10%), EEG-spectrogram (9%), and suppression rate (10%) were seldom used. Twenty-seven percent of the anesthesia personnel were able to recognize a burst suppression pattern on EEG and its significance. Fifty-eight percent of the respondents considered clinical observations more reliable than BIS. Almost all respondents reported adjusting anesthetic dosage based on the BIS index values (80%). However, the anesthetic dose was more often increased (90%) because of high BIS index values than lowered (55%) because of low BIS index values. CONCLUSION Despite our respondents' extensive use of DoA monitoring, the anesthesia personnel in our survey did not use all the information and the potential to guide the titration of anesthetics the DoA monitors provide. Thus, anesthesia personnel could generally benefit from increased knowledge of how EEG-based DoA monitoring can be used to assess and determine individual patients' need for anesthetic medication.
Collapse
Affiliation(s)
- Anders Aasheim
- Department of Research and Development, Division of Emergencies and Critical care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ann-Chatrin Linqvist Leonardsen
- Department of Nursing, Health and Bioengineering, University of Southeastern Norway, Fredrikstad, Norway
- Department of Anesthesia, Østfold Hospital Trust, Kalnes, Norway
| | - Luis Romundstad
- Department of Anesthesia and Intensive Care medicine, Division of Emergencies and Critical care, Oslo University Hospital, Oslo, Norway
- Lovisenberg Diaconal University College, Oslo, Norway
| |
Collapse
|
3
|
Hu L, Kang S, Peng Q, An E, Lu J, Yang H, Zhou H, Zhang B. Knowledge, attitudes, and practice toward postoperative cognitive dysfunction among anesthesiologists in China: a cross-sectional study. BMC MEDICAL EDUCATION 2024; 24:359. [PMID: 38561709 PMCID: PMC10986038 DOI: 10.1186/s12909-024-05358-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND To investigate the knowledge, attitudes, and practice (KAP) toward postoperative cognitive dysfunction (POCD) among anesthesiologists in China. METHODS This cross-sectional study was conducted nationwide among Chinese anesthesiologists between December 2022 and January 2023. The demographic information and KAP scores of the respondents were collected using a web-based questionnaire. The mean KAP dimension scores ≥ 60% were considered good. RESULTS This study enrolled 1032 anesthesiologists (51.2% male). The mean total scores of knowledge, positive attitude, and positive practice were 9.3 ± 1.2 (max 12), 34.8 ± 3.3 (max 40), and 30.6 ± 6.7 (max 40), respectively. The knowledge items with correctness scores < 60% were "the anesthetic drugs that tend to cause POCD" (23.3%) and "Treatment of POCD" (40.3%). Multivariable analysis showed that ≥ 40 years old, master's degree or above, intermediate professional title (i.e., attending physician), senior professional title (i.e., chief physician), and working in tertiary hospitals were independently associated with adequate knowledge. Multivariable analysis showed that the attitude scores, middle professional title, and ≥ 16 years of experience were independently associated with good practice. CONCLUSIONS These results suggest that Chinese anesthesiologists have good knowledge, favorable attitudes, and good practice toward POCD. Still, some points remain to be improved (e.g., the drugs causing POCD and managing POCD) and should be emphasized in training and continuing education. TRIAL REGISTRATION ChiCTR2200066749.
Collapse
Affiliation(s)
- Li Hu
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Shuai Kang
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Qiaoyi Peng
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Erdan An
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jian Lu
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hao Yang
- Department of Anesthesiology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Hongmei Zhou
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China.
| | - Bin Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China.
| |
Collapse
|
4
|
Khaled M, Youssef N, Choi S, Uppal V, Chui J, Marcucci M, Madden K, Shanthanna H. Preoperative assessment of postoperative delirium: a cross-sectional study of patients and anesthesiologists in Canada. Can J Anaesth 2023; 70:1600-1610. [PMID: 37606836 DOI: 10.1007/s12630-023-02537-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 08/23/2023] Open
Abstract
PURPOSE We sought to evaluate 1) patient- and anesthesiologist-reported rates of postoperative delirium (POD) risk discussion during preoperative meetings, 2) patients' and anesthesiologists' ratings of the importance of POD, and 3) predictors of patient-reported discussion of POD risk during preoperative meetings. METHODS In this multicentre two-part cross-sectional survey study, patients ≥ 65 yr scheduled to undergo elective noncardiac surgery completed a five-minute survey after preoperative anesthesia consultation. Patients were asked about their perception of POD importance, and whether they discussed or were assessed for POD risk. Anesthesiologists were surveyed using self-administered surveys circulated via institutional email lists. Anesthesiologists were asked about the frequency of POD risk assessment and discussion in older adults, tools used, and perception of POD-screening barriers. RESULTS Four hundred and twelve (of 510 approached) patients (50% male; mean age, 73 yr) and 267 anesthesiologists (of 1,205 invited via e-mail) participated in this study conducted in five Canadian hospitals. Postoperative delirium screening and discussion was reported by 88/412 (22%) patients and 229/267 (86%) anesthesiologists. Postoperative delirium was rated as "somewhat-extremely" important by 64% of patients. A previous history of delirium, higher education, the number of daily medications, and longer surgical duration were associated with POD discussion. On average, anesthesiologists rated the importance of POD at 8/10, and 42% ranked "patient risk factors" as the top reason prompting discussion. CONCLUSION The combined evaluation of patients' and anesthesiologists' perspectives provides valuable information on preoperative POD screening and risk assessment, and highlights areas for improvement in the current practice. Most factors we identified to be associated with higher odds of POD discussion are recognized risk factors of POD.
Collapse
Affiliation(s)
- Maram Khaled
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Perioperative and Surgery Research Program, Population Health Research Institute, Hamilton, ON, Canada
| | - Nayer Youssef
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Stephen Choi
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Vishal Uppal
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jason Chui
- Department of Anesthesia & Perioperative Medicine, Western University, London, ON, Canada
| | - Maura Marcucci
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Perioperative and Surgery Research Program, Population Health Research Institute, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kim Madden
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Harsha Shanthanna
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
- St Joseph's Healthcare Hamilton, McMaster University, 50 Charlton Ave. E, Hamilton, ON, L8N 4A8, Canada.
| |
Collapse
|
5
|
Ormonde C, Igwe EO, Nealon J, O'Shaughnessy P, Traynor V. Delirium education and post-anaesthetics care unit nurses' knowledge on recognising and managing delirium in older patients. Aging Clin Exp Res 2023; 35:995-1003. [PMID: 37014618 PMCID: PMC10149476 DOI: 10.1007/s40520-023-02390-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/10/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Postoperative delirium (POD) is a major complication following a surgical procedure. There is evidence that improving knowledge about POD could enhance POD care and patient outcomes. AIM The study aimed to evaluate whether the amount of delirium education among registered nurses working in post-anaesthetics care units (PACU) impacts on their self-reported confidence and competence in recognising and managing delirium as well as prior knowledge on factors that influence the risk of delirium onset for older people. METHOD The current study utilised an online survey on delirium care practice among registered nurses in PACUs. The survey consisted of 27 items. There were questions about confidence and competence in delirium care, knowledge about delirium risk factors, and ranked responses to two case scenario questions to evaluate the application of POD care. There were also demographic questions, including previous experience with delirium care education. RESULTS A total of 336 responses were generated from registered nurses working in PACU. Our findings found substantial variability among the respondents about their delirium care education. The amount of delirium education did not influence the PACU registered nurses' confidence or competence in delirium care. In addition, previous education did not have an impact on their knowledge about delirium risk factors. DISCUSSION AND CONCLUSION These findings suggested that the quantity of prior education about delirium did not improve the confidence, competence, knowledge, or case scenario questions of PACU registered nurses. Thus, delirium care education needs to be transformed to ensure it has a positive effect on delirium care clinical practice by registered nurses in PACU.
Collapse
Affiliation(s)
- Callum Ormonde
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Ezinne O Igwe
- Faculty of Science, Medicine and Health, School of Nursing, University of Wollongong, Wollongong, NSW, 2522, Australia.
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, NSW, Australia.
| | - Jessica Nealon
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, NSW, Australia
| | - Pauline O'Shaughnessy
- School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Victoria Traynor
- Faculty of Science, Medicine and Health, School of Nursing, University of Wollongong, Wollongong, NSW, 2522, Australia
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong, NSW, Australia
| |
Collapse
|
6
|
Zhao J, Wang WB, Ding H, Fu HJ, Jiang YA. Prevention of Dexmedetomidine on Postoperative Delirium and Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Thoracoscopic Lobectomy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:5263021. [PMID: 36276865 PMCID: PMC9586721 DOI: 10.1155/2022/5263021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/22/2022] [Accepted: 09/17/2022] [Indexed: 11/18/2022]
Abstract
Objective To investigate the effect of dexmedetomidine on postoperative cognitive function and delirium in elderly patients undergoing thoracoscopic lobectomy. Methods 109 elderly patients (age is more than 65 years) who underwent thoracoscopic lobectomy in our hospital from June 2020 to Feb 2022 were randomly divided into the dexmedetomidine (DEX) group (n = 54) and the control group (n = 55). The patients in the experimental group were given dexmedetomidine by intravenous pump, intravenous pump 0.5 μg/kg within 10 minutes, and maintained the speed of 0.5 μg/(kg. h) to 30 min before the operation was ended. The control group was given the same amount of normal saline. Delirium assessment-severity (CAM-S) assessment and Mini-Cog were used to assess the severity levels of POD and POCD 24 h before, 6 hours after, one day after the operation, three days after the operation, and 1 week after the operation. Serum TNF-αα and NSE levels were assessed by using enzyme-linked immunosorbent assay. NRS pain marks were assessed in the DEX group at postanesthesia care unit (PACU) and 24 postoperation. Surgical pierhysmographic index (SPI) evaluation was performed at five time points. Results The Mini-Cog scores in the DEX group were markedly enhanced compared with those in the saline group 6 and 24 hours after the operation. The SPI values in the DEX group were markedly reduced within 2 min after intubation and at surgical sutures. Moreover, the CAM scores in the DEX group were markedly reduced 24 hours after the operation. Tumor necrosis factor-α (TNF-α) and neuron-specific enolase (NSE) levels were significantly decreased in the DEX group at T1∼T3. Conclusion The use of dexmedetomidine in the thoracoscopic lobectomy in elderly patients could reduce the occurrence and severity of postoperative cognitive dysfunction and delirium.
Collapse
Affiliation(s)
- Jing Zhao
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, China
| | - Wei-Bo Wang
- Department of Anesthesiology, Shaanxi Provincial Pucheng Country Hospital, Weinan 715500, Shaanxi, China
| | - Hui Ding
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, China
| | - Hua-Jun Fu
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, China
| | - Yan-An Jiang
- Department of Anesthesiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, China
| |
Collapse
|
7
|
Jildenstål P, Bäckström A, Hedman K, Warrén-Stomberg M. Spectral edge frequency during general anaesthesia: A narrative literature review. J Int Med Res 2022; 50:3000605221118682. [PMID: 35971317 PMCID: PMC9386875 DOI: 10.1177/03000605221118682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Previous studies have attempted to determine the depth of anaesthesia with different anaesthetic agents using electroencephalogram (EEG) measurements with variable success. Measuring depth of anaesthesia is confounded by the complexity of the EEG and the fact that different agents create different pattens. A narrative review was undertaken to examine the available research evidence on the effect and reliability of spectral edge frequency (SEF) for assessing the depth of anaesthesia in adult patients under general anaesthesia. A systematic search of the PubMed®, Scopus®, CINAHL and Cochrane databases identified six randomized controlled trials and five observational studies. The findings of these studies suggest that SEF varies according to the anaesthetic drugs used. Remifentanil and age are two factors that can affect SEF, while other opioids and benzodiazepine (administered separately) seem to have no effect. No patients experienced intraoperative awareness. However, this does not indicate that SEF can provide full protection against it and the number of articles in which intraoperative awareness was studied was too small to afford any certainty. None of the studies demonstrated a reliable SEF interval associated with adequate general anaesthesia. SEF must be adapted to the anaesthetic drug used, the patient’s age and state while under general anaesthesia.
Collapse
Affiliation(s)
- Pether Jildenstål
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden.,Department of Anaesthesia and Intensive Care, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden.,Department of Anaesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, Goteborg, Sweden.,Department of Anaesthesiology and Intensive Care, Örebro University Hospital and School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of medicine & Health Sciences, Lund University, Lund, Sweden
| | - Amanda Bäckström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Klara Hedman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Margareta Warrén-Stomberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| |
Collapse
|
8
|
Zastrow I, Tohsche P, Loewen T, Vogt B, Feige M, Behnke M, Wolff A, Kiefmann R, Olotu C. Comparison of the '4-item assessment test' and 'nursing delirium screening scale' delirium screening tools on non-intensive care unit wards: A prospective mixed-method approach. Eur J Anaesthesiol 2021; 38:957-965. [PMID: 33606422 DOI: 10.1097/eja.0000000000001470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In elderly patients following surgery, postoperative delirium (POD) is the most frequent complication and is associated with negative outcomes. The 2017 European Society of Anaesthesiology guideline on POD aims to improve patient care by implementing structured delirium prevention, diagnosis and treatment. However, these recommendations, especially systematic delirium screening, are still incompletely adopted in clinical practice. The aim of this study was to evaluate the feasibility and acceptance of validated delirium screening tools and to identify barriers to their implementation on nonintensive care unit wards. METHODS Screening rates, as well as practicability, acceptance and the interprofessional handling of positive results, were assessed for each group. Screening rates were calculated as a percentage of the total potential testing episodes completed (up to 15 per patient). Patients were considered eligible when aged 65 years and above. Barriers and motivating factors were assessed in a mixed method approach by utilising questionnaires and focus group discussions. INTERVENTION In a 3-month phase, a guideline-compliant screening protocol involving screening for POD three times daily for 5 days following surgery was introduced in five wards: both the 4-item assessment test (4AT) and the nursing delirium screening scale (NuDESC) were used. Before commencing the study and again after 6 weeks, medical staff of the respective wards underwent a 45 min training session. RESULTS Of a total of 3183 potential testing episodes, 999 (31.4%) were completed, with more NuDESC observational tests (43%) than 4AT bedside tests completed (20%). The 4AT was considered more difficult to integrate into daily working routines, it took longer to administer, and nurses felt uncomfortable conducting the screening (53 vs. 13%). Screening results indicating delirium were often not discussed within the team (47%), and nurses felt that often such results were not taken seriously by physicians (54%). CONCLUSION The observational NuDESC showed a higher completion rate than the bedside 4AT, although overall testing rates were low. The necessary time needed to conduct the screening, the negative reactions by patients, insufficient team communication and a lack of initiation of any therapy were identified as major barriers in the implementation of the guideline-compliant screening protocol. For all staff, further education and awareness of the importance of POD diagnosis and treatment might improve the screening rates. The NuDesc received better results concerning acceptance, practicability and introduction into daily work routine, leading to higher screening rates compared with the 4AT. The latter instrument, which was intended to be used rather selectively or when POD is suspected, might therefore not be suitable for guideline-compliant regular and repeated screening for POD.
Collapse
Affiliation(s)
- Inke Zastrow
- From the Department of Patient and Care Management (IZ, BV, MF), Department of Intensive Care Medicine (PT, AW) and Department of Anaesthesiology (TL, MB, RK, CO), Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre, Hamburg, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Ringblom J, Proczkowska M, Korhonen L, Wåhlin I. Experiences of paediatric emergence delirium - from parents' and a child's perspective. Scand J Caring Sci 2021; 36:1104-1112. [PMID: 34156116 DOI: 10.1111/scs.13011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 05/11/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergence delirium is a complex behaviour of perceptual disturbances that may occur after general anaesthesia in children. These children often exhibit delusions, confusion, restlessness and involuntary physical activity. They cry and are almost impossible to console. Research has mainly focused on comparing different medication agents in the occurrence of and dealing with emergence delirium. However, less is known about parents' experiences of emergence delirium during the recovery process, and there is hardly any research concerning the children's experiences. AIMS The primary aim of this study was to describe parents' experiences and reflections during their child's emergence delirium behaviour when recovering from anaesthesia. A secondary aim was to describe children's experiences of having been in this condition. METHOD A qualitative research approach with thematic analysis was applied. The study was conducted at two county hospitals in southern Sweden. A total of 16 parents and one child were interviewed. RESULTS Watching their child demonstrate emergence delirium made parents feel as if they were encountering an incomprehensible scenario. They experienced fear and insecurity and had feelings of powerlessness and guilt. Information and previous experience turned out to offer relief, and being seen by the healthcare staff when they, in their vulnerability, failed to reach or console their child, gave hope and energy. The child confirmed the unexpected and uncontrolled behaviour described by parents. She clearly remembered being 'wild' and out of control. CONCLUSION Emergence delirium must be extensively considered in children undergoing general anaesthesia. It is of great importance for healthcare staff to be aware of the parental difficulties it may cause and what is experienced as relieving, such as receiving information and staff members being available, responsive and supportive during the wake-up period.
Collapse
Affiliation(s)
- Jenny Ringblom
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Departments of Anesthesiology and Intensive Care, Region Kalmar County, Kalmar, Sweden
| | - Marie Proczkowska
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Laura Korhonen
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of child and adolescent psychiatry, Linköping University, Linköping, Sweden
| | - Ingrid Wåhlin
- School of Health and Caring Sciences, Linnaeus University, Växjö, Kalmar, Sweden.,Research Section, Region Kalmar County, Kalmar, Sweden
| |
Collapse
|
10
|
Igwe EO. A survey about postoperative delirium in older patients among nurses and anaesthetists: implications for future practice and policy. J Res Nurs 2021; 26:341-351. [PMID: 35251260 PMCID: PMC8894989 DOI: 10.1177/1744987120949893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Postoperative delirium is a major complication associated with anaesthesia and surgery, more commonly seen in older people. AIMS The aims of this study were to explore the knowledge and understanding of anaesthetists and nurses involved in anaesthesia through their responses to two case scenarios of postoperative delirium experienced by older people. METHODS A 30-item online survey was sent to 500 potential respondents. RESULTS Two hundred and twenty-six practitioners from Australia, New Zealand and Scotland responded. Most had no workplace protocols for anaesthesia planning in older people. There was substantial variability in practice in relation to postoperative delirium screening, detection, prevention and management. CONCLUSIONS Improvements in education and awareness, together with a more coherent approach, for example, as recommended in the European Society of Anaesthesiology Guidelines, could help to reduce the impact of postoperative delirium in older people. This should be combined with ongoing research into perioperative optimisation of detection, prevention and management of postoperative delirium.
Collapse
Affiliation(s)
- Ezinne O Igwe
- Ezinne O Igwe, School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, NSW 2522, Australia.
| |
Collapse
|
11
|
Choi S, Jerath A, Jones P, Avramescu S, Djaiani G, Syed S, Saha T, Kaustov L, Kiss A, D'Aragon F, Hedlin P, Rajamohan R, Couture EJ, Singh A, Mapplebeck JC, Wong S, Orser BA. Cognitive Outcomes after DEXmedetomidine sedation in cardiac surgery: CODEX randomised controlled trial protocol. BMJ Open 2021; 11:e046851. [PMID: 33849856 PMCID: PMC8051371 DOI: 10.1136/bmjopen-2020-046851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Older patients undergoing cardiac surgery carry the highest risk for developing major postoperative neurocognitive disorder (postoperative NCD or P-NCD) with up to 25% incidence 3 months after surgery. P-NCD is associated with significant morbidity, mortality, loss of independence, premature retirement and increased healthcare costs. This multicentre randomised trial is investigating the efficacy of postoperative dexmedetomidine sedation in reducing the incidence of major P-NCD after cardiac surgery compared with standard protocols. CODEX will be the largest interventional trial with major P-NCD as the primary outcome. METHODS AND ANALYSIS CODEX is recruiting patients ≥60 years old, undergoing elective cardiac surgery and without pre-existing major cognitive dysfunction or dementia. Eligible participants are randomised to receive postoperative dexmedetomidine or standard institutional sedation protocols in the intensive care unit. Baseline preoperative cognitive function is assessed with the computer-based Cogstate Brief Battery. The primary outcome, major P-NCD, 3 months after surgery is defined as a decrease in cognitive function ≥1.96 SD below age-matched, non-operative controls. Secondary outcomes include delirium, major P-NCD at 6/12 months, depressive symptoms, mild P-NCD and quality of surgical recovery at 3/6/12 months. The specific diagnostic criteria used in this protocol are consistent with the recommendations for clinical assessment and management of NCD from the Nomenclature Consensus Working Group on perioperative cognitive changes. Intention-to-treat analysis will compare major P-NCD at 3 months between study groups. ETHICS AND DISSEMINATION CODEX was approved by Sunnybrook Health Sciences Centre Research Ethics Board (REB) (Project ID 1743). This will be the first multicentre, randomised controlled trial to assess the efficacy of a pharmacological intervention to reduce the incidence of major P-NCD after cardiac surgery in patients ≥60 years old. Dissemination of the study results will include briefings of key findings and interpretation, conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT04289142.
Collapse
Affiliation(s)
- Stephen Choi
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Angela Jerath
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Philip Jones
- Department of Anesthsia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
| | - Sinziana Avramescu
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, Humber River Hospital, Toronto, Ontario, Canada
| | - George Djaiani
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Summer Syed
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Tarit Saha
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Lilia Kaustov
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alex Kiss
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Frédérick D'Aragon
- Départment d'anesthésiologie, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Peter Hedlin
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Raja Rajamohan
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Etienne J Couture
- Department of Anesthesiology and Cardiac Surgical Intensive Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Amara Singh
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Josiane Cs Mapplebeck
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sophia Wong
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Beverley Anne Orser
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
12
|
MacLullich AM, Shenkin SD, Goodacre S, Godfrey M, Hanley J, Stíobhairt A, Lavender E, Boyd J, Stephen J, Weir C, MacRaild A, Steven J, Black P, Diernberger K, Hall P, Tieges Z, Fox C, Anand A, Young J, Siddiqi N, Gray A. The 4 'A's test for detecting delirium in acute medical patients: a diagnostic accuracy study. Health Technol Assess 2020; 23:1-194. [PMID: 31397263 DOI: 10.3310/hta23400] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Delirium is a common and serious neuropsychiatric syndrome, usually triggered by illness or drugs. It remains underdetected. One reason for this is a lack of brief, pragmatic assessment tools. The 4 'A's test (Arousal, Attention, Abbreviated Mental Test - 4, Acute change) (4AT) is a screening tool designed for routine use. This project evaluated its usability, diagnostic accuracy and cost. METHODS Phase 1 - the usability of the 4AT in routine practice was measured with two surveys and two qualitative studies of health-care professionals, and a review of current clinical use of the 4AT as well as its presence in guidelines and reports. Phase 2 - the 4AT's diagnostic accuracy was assessed in newly admitted acute medical patients aged ≥ 70 years. Its performance was compared with that of the Confusion Assessment Method (CAM; a longer screening tool). The performance of individual 4AT test items was related to cognitive status, length of stay, new institutionalisation, mortality at 12 weeks and outcomes. The method used was a prospective, double-blind diagnostic test accuracy study in emergency departments or in acute general medical wards in three UK sites. Each patient underwent a reference standard delirium assessment and was also randomised to receive an assessment with either the 4AT (n = 421) or the CAM (n = 420). A health economics analysis was also conducted. RESULTS Phase 1 found evidence that delirium awareness is increasing, but also that there is a need for education on delirium in general and on the 4AT in particular. Most users reported that the 4AT was useful, and it was in widespread use both in the UK and beyond. No changes to the 4AT were considered necessary. Phase 2 involved 785 individuals who had data for analysis; their mean age was 81.4 (standard deviation 6.4) years, 45% were male, 99% were white and 9% had a known dementia diagnosis. The 4AT (n = 392) had an area under the receiver operating characteristic curve of 0.90. A positive 4AT score (> 3) had a specificity of 95% [95% confidence interval (CI) 92% to 97%] and a sensitivity of 76% (95% CI 61% to 87%) for reference standard delirium. The CAM (n = 382) had a specificity of 100% (95% CI 98% to 100%) and a sensitivity of 40% (95% CI 26% to 57%) in the subset of participants whom it was possible to assess using this. Patients with positive 4AT scores had longer lengths of stay (median 5 days, interquartile range 2.0-14.0 days) than did those with negative 4AT scores (median 2 days, interquartile range 1.0-6.0 days), and they had a higher 12-week mortality rate (16.1% and 9.2%, respectively). The estimated 12-week costs of an initial inpatient stay for patients with delirium were more than double the costs of an inpatient stay for patients without delirium (e.g. in Scotland, £7559, 95% CI £7362 to £7755, vs. £4215, 95% CI £4175 to £4254). The estimated cost of false-positive cases was £4653, of false-negative cases was £8956, and of a missed diagnosis was £2067. LIMITATIONS Patients were aged ≥ 70 years and were assessed soon after they were admitted, limiting generalisability. The treatment of patients in accordance with reference standard diagnosis limited the ability to assess comparative cost-effectiveness. CONCLUSIONS These findings support the use of the 4AT as a rapid delirium assessment instrument. The 4AT has acceptable diagnostic accuracy for acute older patients aged > 70 years. FUTURE WORK Further research should address the real-world implementation of delirium assessment. The 4AT should be tested in other populations. TRIAL REGISTRATION Current Controlled Trials ISRCTN53388093. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 40. See the NIHR Journals Library website for further project information. The funder specified that any new delirium assessment tool should be compared against the CAM, but had no other role in the study design or conduct of the study.
Collapse
Affiliation(s)
| | - Susan D Shenkin
- Geriatric Medicine, Division of Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Steve Goodacre
- Emergency Medicine, University of Sheffield, Sheffield, UK
| | - Mary Godfrey
- Health and Social Care, Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Janet Hanley
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Antaine Stíobhairt
- Geriatric Medicine, Division of Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Elizabeth Lavender
- Health and Social Care, Leeds Institute of Health Sciences, School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Julia Boyd
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Jacqueline Stephen
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK.,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Christopher Weir
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK.,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Allan MacRaild
- Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
| | - Jill Steven
- Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
| | - Polly Black
- Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
| | - Katharina Diernberger
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
| | - Peter Hall
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Zoë Tieges
- Geriatric Medicine, Division of Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Christopher Fox
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Atul Anand
- Geriatric Medicine, Division of Health Sciences, University of Edinburgh, Edinburgh, UK
| | - John Young
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Najma Siddiqi
- Psychiatry, University of York, York.,Hull York Medical School, York, UK.,Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Alasdair Gray
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Emergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK
| |
Collapse
|
13
|
Tire Y, Aydoğan E, Sargın M, Kozanhan B. Assessment of Postoperative Cognitive Dysfunction: Results From a Survey of Turkish Anaesthesiologists. Turk J Anaesthesiol Reanim 2020; 48:300-307. [PMID: 32864645 PMCID: PMC7434352 DOI: 10.5152/tjar.2019.36699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/10/2019] [Indexed: 11/22/2022] Open
Abstract
Objective Postoperative cognitive dysfunction (POCD) is one of the most common complications in elderly surgical patients. We conducted a survey study to evaluate the perspectives of Turkish anaesthesiologists on postoperative cognitive disorders. Methods We conducted a prospective online survey with questions and answers were recorded either in a Likert scale from 1 to 5 (completely disagree to completely agree) or as yes/no/do not know types of answers. Potential participants were contacted through an e-mail that included a brief introductory note, instructions, a link to the survey and the authors' contact information. Results We analysed 129 surveys (9.9% of total potential respondents). The majority believed that the risk of cognitive side effects should be considered when choosing the type of anaesthesia (87.6%) and that preoperative cognitive function should be routinely assessed (74.4%). When caring for an agitated and confused patient postoperatively, 56.6%, protocols to screen and manage postoperative cognitive disorders were rarely used. Nearly all respondents believe that postoperative delirium and POCD are neglected areas in anaesthesiology. Conclusion Overall, participants perceive postoperative cognitive disorders as important adverse outcomes following surgery and anaesthesia. They are aware of the main risk factors for their development but may lack information on the prevention and management postoperatively.
Collapse
Affiliation(s)
- Yasin Tire
- Department of Anaesthesiology and Reanimation, University of Health Science, Konya Training and Research Hospital, Konya, Turkey
| | - Eyüp Aydoğan
- Department of Anaesthesiology and Reanimation, University of Health Science, Konya Training and Research Hospital, Konya, Turkey
| | - Mehmet Sargın
- Department of Anaesthesiology and Reanimation, Selçuk University School of Medicine, Konya, Turkey
| | - Betül Kozanhan
- Department of Anaesthesiology and Reanimation, University of Health Science, Konya Training and Research Hospital, Konya, Turkey
| |
Collapse
|
14
|
Delp S, Mei W, Spies CD, Neuner B, Aldecoa C, Bettelli G, Bilotta F, Sanders RD, Kramer S, Weiss B. Clinical practice in the management of postoperative delirium by Chinese anesthesiologists: a cross-sectional survey designed by the European Society of Anaesthesiology. J Int Med Res 2020; 48:300060520927207. [PMID: 32493149 PMCID: PMC7273774 DOI: 10.1177/0300060520927207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/27/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE In this survey, we assessed the current clinical management of postoperative delirium (POD) among Chinese anesthesiologists, after publishing the European POD guideline. METHODS We administered an electronic survey, designed according to the European POD guideline. The survey was completed using mobile devices. RESULTS In total, 1,514 respondents from China participated in the survey. Overall, 74.4% of participants reported that delirium is very important. More than 95% of participants stated that they routinely assessed POD. In total, 61.4% screened for POD using clinical observation and 37.6% used a delirium screening tool. Although the depth of anesthesia (a POD risk factor) was monitored, electroencephalogram monitoring was unavailable to 30.6% of respondents. Regarding treatment, only 24.1% of respondents used a standard algorithm; 58.5% used individualized treatment. CONCLUSION Our survey showed that there are high awareness levels among Chinese anesthesiologists regarding the importance of POD. However, routine assessment and monitoring of all patients, including perioperative anesthesia depth monitoring, and a treatment algorithm need to be implemented on a larger scale. According to the results, efforts should be made to improve the knowledge of POD among Chinese anesthesiologists.
Collapse
Affiliation(s)
- Simon Delp
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - Wei Mei
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Claudia D. Spies
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - Bruno Neuner
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - César Aldecoa
- Department of Anesthesiology, Facultad de Medicina de Valladolid, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Gabriella Bettelli
- Department of Geriatric Surgery; Department of Anaesthesia, Analgesia and Intensive Care, Italian National Research Centres on Aging/IRCCS, Ancona, Italy
| | - Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, ‘Sapienza’ University of Rome, Rome, Italy
| | - Robert D. Sanders
- Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Sylvia Kramer
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - Bjoern Weiss
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| |
Collapse
|
15
|
Bilotta F, Weiss B, Neuner B, Kramer S, Aldecoa C, Bettelli G, Sanders RD, Delp SM, Spies CD. Routine management of postoperative delirium outside the ICU: Results of an international survey among anaesthesiologists. Acta Anaesthesiol Scand 2020; 64:494-500. [PMID: 31883373 DOI: 10.1111/aas.13535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/18/2019] [Accepted: 12/16/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Postoperative delirium (POD) is a severe brain dysfunction. Although data indicate a high relevance, no survey has investigated the routine practice to monitor delirium outside the ICU setting after surgery. Prior to publishing of the new European Society of Anaesthesiology (ESA) guidelines on POD, an international survey was conducted to assess current practice. METHODS European Society of Anaesthesiology-endorsed online survey; Trial Registration: NCT-identifier: 02513537. RESULTS In total, 566 respondents from 62 countries accessed, and 564 (99.6%) completed the survey (completion rate). Overall, 385 (68%) of the respondents reported that delirium is either "very relevant" or "relevant" for their daily clinical practice. In all, 38 (7%) of the respondents routinely monitor for delirium in >50% of all patients. Asked on the monitoring time point, more than half (n = 308, 55%) indicated to screen before or at recovery room discharge, 235 (42%) up to the first postoperative day, 143 (25%) up to 3 days, and 77 (14%) up to 5 postoperative days. Although there is a lack of long-term monitoring, nearly all respondents (n = 530, 94%) reported to treat delirium. Availability of EEG/EMG-based monitoring to assess the depth of anaesthesia was high in the study group (n = 547, 97%) and was used by more than one-third of the respondents to reduce risk of burst suppression (n = 189, 34%). CONCLUSION Although delirium is perceived as a relevant condition among anaesthesiologists, there is a high demand for implementing monitoring strategies after publishing of the POD Guideline. The survey shows that tools necessary for POD Guideline implementation are available in the centres represented by the respondents.
Collapse
Affiliation(s)
- Federico Bilotta
- Department of Anesthesiology Critical Care and Pain Medicine, "Sapienza" University of Rome Rome Italy
| | - Bjoern Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Bruno Neuner
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Sylvia Kramer
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - César Aldecoa
- Department of Anaesthesiology & Intensive Care Hospital Universitario Rio Hortega Valladolid Spain
| | - Gabriella Bettelli
- Department of Geriatric Surgery Italian National Research Centres on Aging/IRCCS Ancona Italy
- Department of Anaesthesia, Analgesia and Intensive Care Italian National Research Centres on Aging/IRCCS Ancona Italy
| | | | - Simon M. Delp
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Claudia D. Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| |
Collapse
|
16
|
Sturm H, Wildermuth R, Stolz R, Bertram L, Eschweiler GW, Thomas C, Rapp M, Joos S. Diverging Awareness of Postoperative Delirium and Cognitive Dysfunction in German Health Care Providers. Clin Interv Aging 2019; 14:2125-2135. [PMID: 31849456 PMCID: PMC6910093 DOI: 10.2147/cia.s230800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Postoperative cognitive dysfunction (POCD) appears in up to 30% of patients suffering from postoperative delirium (POD). Both are associated with higher mortality and postoperative complications, prolonged hospital stays, and increased costs. Multi-modal models with pre-admission risk reduction counselling, perioperative monitoring, and training of multidisciplinary patient care providers have been shown to decrease the prevalence of both. The aim of our study is to understand how far those measures are known and implemented in routine care and to detect potential gaps in the current practice regarding risk communication and information flow between involved caregivers for patients at risk for POD/POCD. PATIENTS AND METHODS As part of a multicenter study, seven semi-structured focus group (FG) discussions with nurses and physicians from tertiary care hospitals (surgery, anesthesiology, and orthopedics, n=31) and general practitioners (GPs) in private practice (n=7) were performed. Transcribed discussions were analyzed using qualitative content analysis. RESULTS POD is present above all in the daily work of nurses, whereas physicians do not perceive it as a relevant problem. Physicians report that no regular risk assessment or risk communication was performed prior to elective surgery. Information about POD often gets lost during hand-offs and is not regularly reported in discharge letters. Thus, persisting cognitive dysfunction is often missed. The importance of standardized documentation and continuous education concerning risks, screening, and treatment was emphasized. The often-suggested pre-OP medication adjustment was seen as less important; in contrast, avoiding withdrawal was regarded as far more important. CONCLUSION Altogether, it seems that standards and available best practice concepts are rarely implemented. In contrast to physicians, nurses are highly aware of delirium and ask for standardized procedures and more responsibility. Therefore, raising awareness regarding risks, screening tools, and effective preventive measures for POD/POCD seems an urgent goal. Nurses should have a central role in coordination and care of POD to prevent the risk for POCD.
Collapse
Affiliation(s)
- H Sturm
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - R Wildermuth
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - R Stolz
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - L Bertram
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - GW Eschweiler
- Geriatric Center, University Hospital Tübingen, Tübingen72076, Germany
| | - C Thomas
- Department of Old Age Psychiatry and Psychotherapy, Klinikum Stuttgart, Stuttgart, Germany
| | - M Rapp
- Department of Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - S Joos
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| |
Collapse
|
17
|
Knowledge, opinions and clinical practice regarding postoperative delirium in older patients: A survey of nurses and anaesthetists. J Clin Anesth 2019; 57:108-109. [PMID: 30965270 DOI: 10.1016/j.jclinane.2019.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/14/2019] [Accepted: 04/02/2019] [Indexed: 11/24/2022]
|
18
|
Postoperative cognitive dysfunction and the possible underlying neurodegenerative effect of anaesthesia. Int J Neurosci 2019; 129:729-737. [DOI: 10.1080/00207454.2018.1561451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
19
|
Susano MJ, Vasconcelos L, Lemos T, Amorim P, Abelha FJ. Adverse postoperative cognitive disorders: a national survey of portuguese anesthesiologists. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 30049480 PMCID: PMC9391822 DOI: 10.1016/j.bjane.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background and objectives Postoperative delirium and postoperative cognitive dysfunction are some of the most common complications in older surgical patients and are associated with adverse outcomes. The aim of this study was to evaluate portuguese anesthesiologists’ perspectives and knowledge about adverse postoperative cognitive disorders, and routine clinical practice when caring for older surgical patients. Methods We used a prospective online survey with questions using a Likert scale from 1 to 5 (completely disagree to completely agree), or yes/no/don’t know answer types. Potential participants were portuguese anesthesiologists working in hospitals affiliated with the portuguese national health system and private hospitals. Results We analyzed 234 surveys (17.7% of total potential respondents). The majority believed that the risk of cognitive side effects should be considered when choosing the type of anesthesia (87.6%) and that preoperative cognitive function should be routinely assessed (78.6%). When caring for an agitated and confused patient postoperatively, 62.4% would first administer an analgesic and 11.1% an anxiolytic. Protocols to screen and manage postoperative cognitive disorders are rarely used. Nearly all respondents believe that postoperative delirium and postoperative cognitive dysfunction are neglected areas in anesthesiology. Conclusions Overall, participants perceive postoperative cognitive disorders as important adverse outcomes following surgery and anesthesia are aware of the main risk factors for their development but may lack information on prevention and management of postoperative delirium. The majority of hospitals do not have protocols regarding preoperative cognitive assessment, diagnosis, management or follow-up of patients with delirium and postoperative cognitive dysfunction.
Collapse
Affiliation(s)
- Maria J Susano
- Centro Hospitalar do Porto, Departamento de Anestesiologia, Porto, Portugal; Centro Hospitalar do Porto, Centro de Investigação Clínica em Anestesiologia, Departamento de Anestesiologia, Porto, Portugal.
| | | | - Tiago Lemos
- Centro Hospitalar do Porto, Departamento de Anestesiologia, Porto, Portugal
| | - Pedro Amorim
- Centro Hospitalar do Porto, Departamento de Anestesiologia, Porto, Portugal; Centro Hospitalar do Porto, Centro de Investigação Clínica em Anestesiologia, Departamento de Anestesiologia, Porto, Portugal
| | - Fernando J Abelha
- Universidade do Porto, Faculdade de Medicina, Centro Hospitalar de São João, Departamento de Anestesiologia e de Cirurgia e Fisiologia, Porto, Portugal
| |
Collapse
|
20
|
Zhang J, Gao J, Guo G, Li S, Zhan G, Xie Z, Yang C, Luo A. Anesthesia and surgery induce delirium-like behavior in susceptible mice: the role of oxidative stress. Am J Transl Res 2018; 10:2435-2444. [PMID: 30210682 PMCID: PMC6129548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
Anesthesia and surgery (A + S) are risk factors for patients to develop postoperative delirium (POD). However, the pathogenesis of POD remains largely to be determined. We employed battery of behavioral tests including open-filed test (OFT), elevated plus maze test (EPMT) and buried food test (BFT) to investigate the role of oxidative stress in the development of POD and to explore the therapeutic target for POD in mice after A + S (simple laparotomy under 1.4% isoflurane anesthesia). We initially found that 6 hours after A + S, mice failed to alter the behavioral changes in OFT and the adenosine triphosphate (ATP) level in hippocampus. After hierarchical cluster analysis, however, there was a significant change in the behavior tests between POD unsusceptible (non-POD) and susceptible (POD-like) mice. Interestingly, cyclosporine A, an inhibitor of mitochondrial permeability transition pore (mPTP) opening, exerted pharmacologically beneficial effects on symptoms, decreased reactive oxygen species (ROS) and ATP, and increased superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) levels in the hippocampus of POD-like mice. These findings suggest that abnormally activated oxidative stress might be involved in the underlying mechanisms of POD. Novel therapeutic agents targeting inhibition of oxidative stress would provide an available strategy for POD treatment.
Collapse
Affiliation(s)
- Jie Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Jie Gao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Guojun Guo
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Shan Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Gaofeng Zhan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Zhongcong Xie
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical SchoolCharlestown, MA, US
| | - Chun Yang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| | - Ailin Luo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, China
| |
Collapse
|
21
|
Susano MJ, Vasconcelos L, Lemos T, Amorim P, Abelha FJ. [Adverse postoperative cognitive disorders: a national survey of portuguese anesthesiologists]. Rev Bras Anestesiol 2018; 68:472-483. [PMID: 30049480 DOI: 10.1016/j.bjan.2018.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/27/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Postoperative delirium and postoperative cognitive dysfunction are some of the most common complications in older surgical patients and are associated with adverse outcomes. The aim of this study was to evaluate portuguese anesthesiologists' perspectives and knowledge about adverse postoperative cognitive disorders, and routine clinical practice when caring for older surgical patients. METHODS We used a prospective online survey with questions using a Likert scale from 1 to 5 (completely disagree to completely agree), or yes/no/don't know answer types. Potential participants were portuguese anesthesiologists working in hospitals affiliated with the portuguese national health system and private hospitals. RESULTS We analyzed 234 surveys (17.7% of total potential respondents). The majority believed that the risk of cognitive side effects should be considered when choosing the type of anesthesia (87.6%) and that preoperative cognitive function should be routinely assessed (78.6%). When caring for an agitated and confused patient postoperatively, 62.4% would first administer an analgesic and 11.1% an anxiolytic. Protocols to screen and manage postoperative cognitive disorders are rarely used. Nearly all respondents believe that postoperative delirium and postoperative cognitive dysfunction are neglected areas in anesthesiology. CONCLUSIONS Overall, participants perceive postoperative cognitive disorders as important adverse outcomes following surgery and anesthesia are aware of the main risk factors for their development but may lack information on prevention and management of postoperative delirium. The majority of hospitals do not have protocols regarding preoperative cognitive assessment, diagnosis, management or follow-up of patients with delirium and postoperative cognitive dysfunction.
Collapse
Affiliation(s)
- Maria J Susano
- Centro Hospitalar do Porto, Departamento de Anestesiologia, Porto, Portugal; Centro Hospitalar do Porto, Centro de Investigação Clínica em Anestesiologia, Departamento de Anestesiologia, Porto, Portugal.
| | | | - Tiago Lemos
- Centro Hospitalar do Porto, Departamento de Anestesiologia, Porto, Portugal
| | - Pedro Amorim
- Centro Hospitalar do Porto, Departamento de Anestesiologia, Porto, Portugal; Centro Hospitalar do Porto, Centro de Investigação Clínica em Anestesiologia, Departamento de Anestesiologia, Porto, Portugal
| | - Fernando J Abelha
- Universidade do Porto, Faculdade de Medicina, Centro Hospitalar de São João, Departamento de Anestesiologia e de Cirurgia e Fisiologia, Porto, Portugal
| |
Collapse
|
22
|
Gao H, Zhang L, Chen Z, Liu S, Zhang Q, Zhang B. Effects of intravenous anesthetics on the phosphorylation of cAMP response element‑binding protein in hippocampal slices of adult mice. Mol Med Rep 2018; 18:627-633. [PMID: 29749444 DOI: 10.3892/mmr.2018.8939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 04/17/2018] [Indexed: 11/06/2022] Open
Abstract
cAMP response‑element binding protein (CREB) functions in hippocampal synaptic plasticity and memory formation. However, it remains unknown whether intravenous anesthetics modulate CREB. The present study aimed to examine the effects of intravenous anesthetics on CREB phosphorylation in the mouse hippocampus. CREB phosphorylation was examined in hippocampal slices with and without pharmacological or intravenous anesthetics via immunoblotting. In a dose‑response experiment, the concentrations of intravenous anesthetics ranged from 10‑9 to 10‑4 mol/l for 1 h. For the time‑response experiment, these slices were incubated with 5x10‑6 mol/l of propofol for 0, 1, 2, 5, 7, 9, 12, 15, 30 and 60 min. In order to examine whether CREB phosphorylation could be recovered following washing out the propofol, the slices were incubated in plain artificial cerebrospinal fluid at different time durations following 5 min incubation with propofol. Propofol, etomidate, ketamine and midazolam inhibited CREB phosphorylation (P<0.05) in a time‑ and dose‑dependent manner. This inhibition was reversible following the removal of propofol, and was rescued by CREB phosphorylation (P<0.05). The decrease in CREB phosphorylation revealed additive effects with 100 µM of chelerythrine and 20 µM of PD‑98059, and the etomidate‑induced decrease in CREB phosphorylation was blocked by 1 mM of NMDA. However, 0.1 µM of phorbol 12‑myristate 13‑acetate, 50 µM of U 73122, 100 µM of carbachol and 10 µM of MK801 were ineffective in the anesthetic‑induced decrease in CREB phosphorylation. Intravenous anesthetics markedly decreased CREB phosphorylation in the mouse hippocampus, which was most likely via the protein kinase C and mitogen activated protein kinase pathways. This suggests that CREB represents a target for anesthetic action in the brain.
Collapse
Affiliation(s)
- Haiying Gao
- Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Lingyu Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Zhenyi Chen
- Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Shuncui Liu
- Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Qinghong Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Bingxi Zhang
- Department of Anesthesiology, Affiliated Beijing Tongren Hospital, Capital University of Medical Science, Beijing 100000, P.R. China
| |
Collapse
|
23
|
Singh PM, Borle A, Makkar JK, Trikha A, Fish D, Sinha A. Haloperidol Versus 5-HT 3 Receptor Antagonists for Postoperative Vomiting and QTc Prolongation: A Noninferiority Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials. J Clin Pharmacol 2017; 58:131-143. [PMID: 28914976 DOI: 10.1002/jcph.999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/17/2017] [Indexed: 11/09/2022]
Abstract
Haloperidol is an antipsychotic with well-known antiemetic potential. It is underutilized for postoperative nausea vomiting due to reported corrected QT interval (QTc) prolongation. This meta-analysis evaluates its safety and efficacy as an antiemetic in the perioperative period. Trials comparing haloperidol to 5-HT3 -receptor antagonists (5-HT3 -RA) for 24 postoperative vomiting incidences published up to May 2017 were searched in the medical database. Comparisons were made for antiemetic efficiency variables (vomiting incidence, rescue antiemetic need, and patients with complete response) during early (until 6 hours) and late postoperative phases. Eight randomized controlled double-blinded trials were included in the final analysis. Twenty-four-hour vomiting incidence was similar in groups (fixed effects, P = 0.52, I2 = 0%). Trial-sequential analysis confirmed noninferiority of haloperidol over 5-HT3 -RAs (α = 5%, β = 20%, δ = 10%), with "information size" being 859 (required > 812). Pooled results did not demonstrate superiority/inferiority of 5-HT3 -RAs over haloperidol in all other antiemetic efficacy variables (early and delayed). Negligible heterogeneity was found in all the comparisons made. Pooled Mantel Haenszel odds ratio for QTc prolongation was equivalent in both groups (fixed effects, P = 0.23, I2 = 0%). The mean dose of haloperidol used was 1.34 mg, and no trial reported extrapyramidal side effects. Trial-sequential analysis showed statistical equivalence (α = 5%, β = 20%, δ = 10%), with information size being 745 (required > 591). Publication bias was unlikely (Egger test, X-intercept = 2.07, P = 0.10). We conclude that haloperidol is equivalent to the well-established 5-HT3 -RAs in preventing vomiting during the first day after surgery. The incidence of QTc prolongation with haloperidol is statistically equivalent to 5-HT3 -RAs and thus should not be the factor that discourages its use for treatment/prophylaxis of postoperative nausea vomiting.
Collapse
Affiliation(s)
- Preet Mohinder Singh
- Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Anuradha Borle
- Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Jeetinder Kaur Makkar
- Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjan Trikha
- Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - David Fish
- Division Chief for Critical Care, Department of Anesthesiology, Temple University Health System, Philadelphia, PA, USA
| | - Ashish Sinha
- Anesthesiology and Perioperative, Medicine, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, PA, USA
| |
Collapse
|
24
|
Anaesthetics and analgesics; neurocognitive effects, organ protection and cancer reoccurrence an update. Int J Surg 2016; 34:41-46. [DOI: 10.1016/j.ijsu.2016.08.235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/15/2016] [Accepted: 08/20/2016] [Indexed: 12/17/2022]
|
25
|
Gao X, Zhuang FZ, Qin SJ, Zhou L, Wang Y, Shen QF, Li M, Villarreal M, Benefield L, Gu SL, Ma TF. Dexmedetomidine protects against learning and memory impairments caused by electroconvulsive shock in depressed rats: Involvement of the NMDA receptor subunit 2B (NR2B)-ERK signaling pathway. Psychiatry Res 2016; 243:446-52. [PMID: 27455425 DOI: 10.1016/j.psychres.2016.07.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/25/2016] [Accepted: 07/10/2016] [Indexed: 01/09/2023]
Abstract
Cognitive impairment is a common adverse effect of electroconvulsive therapy (ECT) during treatment for severe depression. Dexmedetomidine (DEX), a sedative-anesthetic drug, is used to treat post-ECT agitation. However, it is not known if DEX can protect against ECT-induced cognitive impairments. To address this, we used chronic unpredictable mild stress (CUMS) to establish a model of depression for ECT treatment. Our Morris water maze and sucrose preference test results suggest that DEX alleviates ECT-induced learning and memory impairments without altering the antidepressant efficacy of ECT. To further investigate the underlying mechanisms of DEX, hippocampal expression of NR2B, p-ERK/ERK, p-CREB/CREB, and BDNF were quantified by western blotting. These results show that DEX suppresses over-activation of NR2B and enhances phosphorylation of ERK1/2 in the hippocampus of ECT-treated depressed rats. Furthermore, DEX had no significant effect on ECT-induced increases in p-CREB and BDNF. Overall, our findings suggest that DEX ameliorates ECT-induced learning and memory impairments in depressed rats via the NR2B-ERK signaling cascade. Moreover, CREB/BDNF seems not appear to participate in the cognitive protective mechanisms of DEX during ECT treatment.
Collapse
Affiliation(s)
- Xin Gao
- Jiangsu Key Laboratory of Brain Disease Bioinformation, Research Center for Biochemistry and Molecular Biology, Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Fu-Zhi Zhuang
- Jiangsu Key Laboratory of Brain Disease Bioinformation, Research Center for Biochemistry and Molecular Biology, Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Shou-Jun Qin
- Jiangsu Key Laboratory of Brain Disease Bioinformation, Research Center for Biochemistry and Molecular Biology, Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Li Zhou
- Department of Anaesthesiology, The Affiliated Hospital of Xuzhou Medical University, Key Laboratory for Anesthesiology of Jiangsu Province, Xuzhou 221004, Jiangsu, China
| | - Yun Wang
- Jiangsu Key Laboratory of Brain Disease Bioinformation, Research Center for Biochemistry and Molecular Biology, Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Qing-Feng Shen
- Department of Geriatric Psychiatry, The East People's Hospital of Xuzhou, Xuzhou 221004, Jiangsu, China
| | - Mei Li
- Jiangsu Key Laboratory of Brain Disease Bioinformation, Research Center for Biochemistry and Molecular Biology, Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | | | - Lauren Benefield
- Texas A&M University'16, College Station 77841, TX, United States
| | - Shu-Ling Gu
- Jiangsu Key Laboratory of Brain Disease Bioinformation, Research Center for Biochemistry and Molecular Biology, Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Teng-Fei Ma
- Jiangsu Key Laboratory of Brain Disease Bioinformation, Research Center for Biochemistry and Molecular Biology, Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou 221004, Jiangsu, China.
| |
Collapse
|
26
|
Man Y, Guo Z, Cao J, Mi W. Efficacy of perioperative dexmedetomidine in postoperative neurocognitive function: a meta-analysis. Clin Exp Pharmacol Physiol 2015; 42:837-42. [PMID: 26016826 DOI: 10.1111/1440-1681.12432] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/21/2015] [Accepted: 05/19/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Yuanyuan Man
- Anaesthesia and Operation Centre; Chinese PLA General Hospital; Beijing China
| | - Zhenggang Guo
- Department of Anaesthesiology; The First Hospital Affiliated to the Chinese PLA Hospital; Beijing China
| | - Jiangbei Cao
- Anaesthesia and Operation Centre; Chinese PLA General Hospital; Beijing China
| | - Weidong Mi
- Anaesthesia and Operation Centre; Chinese PLA General Hospital; Beijing China
| |
Collapse
|