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Williams CT, Whyman J, Loewenthal J, Chahal K. Managing Geriatric Patients with Falls and Fractures. Orthop Clin North Am 2023; 54:e1-e12. [PMID: 37349065 DOI: 10.1016/j.ocl.2023.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Orthopedic fractures in adults 65 and older are common and can lead to functional decline and increased morbidity and mortality. Falls are often the precipitating event for fractures in this population, linked to common aging physiology with increasing comorbid conditions and advancing frailty. Managing falls and orthopedic fractures in the geriatric population is complex, requiring a systematic and collaborative approach spearheaded by a multidisciplinary team focused on improving patient outcomes.
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Affiliation(s)
- Carla T Williams
- Division of Gerontology, Harvard Medical School, Beth Israel Deaconess Medical Center, 1 Brookline Place, Suite 230, Boston, MA 02445, USA.
| | - Jeremy Whyman
- Harvard Medical School Multicampus Geriatric Fellowship Program, Division of Gerontology, Section of Palliative Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Julia Loewenthal
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Karen Chahal
- Geriatric Inpatient Fracture Trauma Service (GIFTS), Department of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Wang J, Zhu L, Li Y, Yin C, Hou Z, Wang Q. The Potential Role of Lung-Protective Ventilation in Preventing Postoperative Delirium in Elderly Patients Undergoing Prone Spinal Surgery: A Preliminary Study. Med Sci Monit 2020; 26:e926526. [PMID: 33011734 PMCID: PMC7542993 DOI: 10.12659/msm.926526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Postoperative delirium (POD) is a frequent complication in elderly patients, usually occurring within a few days after surgery. This study investigated the effect of lung-protective ventilation (LPV) on POD in elderly patients undergoing spinal surgery and the mechanism by which LPV suppresses POD. Material/Methods Seventy-one patients aged ≥65 years were randomized to receive LPV or conventional mechanical ventilation (MV), consisting of intermittent positive pressure ventilation following induction of anesthesia. The tidal volume in patients who received MV was 8 ml/kg predicted body weight (PBW), and the ventilation frequency was 12 times/min. The tidal volume in patients who received LPV was 6 ml/kg PBW, the positive end-expiratory pressure was 5 cmH2O, and the ventilation frequency was 15 times/min, with a lung recruitment maneuver performed every 30 min. Blood samples were collected immediately before anesthesia induction (T0), 10 min (T1) and 60 min (T2) after turning over, immediately after the operation (T3), and 15 min after extubation (T4) for blood gas analysis. Simultaneous cerebral oxygen saturation (rSO2) and cerebral desaturation were recorded. Preoperative and postoperative serum concentrations of interleukin (IL)-6, IL-10 and glial fibrillary acidic protein (GFAP) were measured by ELISA. POD was assessed by nursing delirium screening score. Results Compared with the MV group, pH was lower and PaCO2 higher in the LPV group at T2. In addition PaO2, SaO2, and PaO2/FiO2 were higher at T1, and T4, and rSO2 was higher at T3, and T4 in the LPV than in the MV group (P<0.05 each). Postoperative serum GFAP and IL-6 were lower and IL-10 higher in the LPV group. The incidences of cerebral desaturation and POD were significantly lower in the LPV group (P<0.05). Conclusions LPV may reduce POD in elderly patients undergoing spinal surgery by inhibiting inflammation and improving cerebral oxygen metabolism.
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Affiliation(s)
- Jing Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Lian Zhu
- Department of Emergency Center of Trauma, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Yanan Li
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Chunping Yin
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Zhiyong Hou
- Department of Emergency Center of Trauma, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Qiujun Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
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Effects of protocol on prevention of delirium in hospitalized hip fracture patients: A quality improvement project. Int J Orthop Trauma Nurs 2020; 36:100710. [DOI: 10.1016/j.ijotn.2019.100710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 07/25/2019] [Accepted: 07/31/2019] [Indexed: 11/22/2022]
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Pareja Sierra T, Bartolomé Martín I, Rodríguez Solís J, Bárcena Goitiandia L, Torralba González de Suso M, Morales Sanz M, Hornillos Calvo M. Predictive factors of hospital stay, mortality and functional recovery after surgery for hip fracture in elderly patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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5
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Pareja Sierra T, Bartolomé Martín I, Rodríguez Solís J, Bárcena Goitiandia L, Torralba González de Suso M, Morales Sanz MD, Hornillos Calvo M. Predictive factors of hospital stay, mortality and functional recovery after surgery for hip fracture in elderly patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:427-435. [PMID: 28888685 DOI: 10.1016/j.recot.2017.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/09/2017] [Accepted: 06/21/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Due to its high prevalence and serious consequences it is very important to be well aware of factors that might be related to medical complications, mortality, hospital stay and functional recovery in elderly patients with hip fracture. MATERIAL AND METHODS A prospective study of a group of 130 patients aged over 75 years admitted for osteoporotic hip fracture. Their medical records, physical and cognitive status prior to the fall, fracture type and surgical treatment, medical complications and functional and social evolution after hospitalization were evaluated. RESULTS Patients with greater physical disability, more severe cognitive impairment and those who lived in a nursing home before the fracture had worse functional recovery after surgery. Treatment with intravenous iron to reduce transfusions reduced hospital stay and improved walking ability. Infections and heart failure were the most frequent medical complications and were related to a longer hospital stay. The prescription of nutritional supplements for the patients with real indication improved their physical recovery after the hip fracture CONCLUSIONS: Evaluation of physical, cognitive and social status prior to hip fracture should be the basis of an individual treatment plan because of its great prognostic value. Multidisciplinary teams with continuous monitoring of medical problems should prevent and treat complications as soon as possible. Intravenous iron and specific nutritional supplements can improve functional recovery six months after hip fracture.
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Affiliation(s)
- T Pareja Sierra
- Sección de Geriatría, Hospital Universitario de Guadalajara, SESCAM, Guadalajara, España.
| | - I Bartolomé Martín
- Sección de Geriatría, Hospital Universitario de Guadalajara, SESCAM, Guadalajara, España
| | - J Rodríguez Solís
- Sección de Geriatría, Hospital Universitario de Guadalajara, SESCAM, Guadalajara, España
| | - L Bárcena Goitiandia
- Sección de Geriatría, Hospital Universitario de Guadalajara, SESCAM, Guadalajara, España
| | | | - M D Morales Sanz
- Servicio de Hematología, Hospital Universitario de Guadalajara, SESCAM, Guadalajara, España
| | - M Hornillos Calvo
- Sección de Geriatría, Hospital Universitario de Guadalajara, SESCAM, Guadalajara, España
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Cerveira CCT, Pupo CC, Dos Santos SDS, Santos JEM. Delirium in the elderly: A systematic review of pharmacological and non-pharmacological treatments. Dement Neuropsychol 2017; 11:270-275. [PMID: 29213524 PMCID: PMC5674671 DOI: 10.1590/1980-57642016dn11-030009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Delirium is a common disorder associated with poor prognosis, especially in the elderly. The impact of different treatment approaches for delirium on morbimortality and long-term welfare is not completely understood. OBJECTIVE To determine the efficacy of pharmacological and non-pharmacological treatments in elderly patients with delirium. METHODS This systematic review compared pharmacological and non-pharmacological treatments in patients over 60 years old with delirium. Databases used were: MEDLINE (PubMed), EMBASE, Cochrane CENTRAL and LILACS from inception to January 6th, 2016. RESULTS A total of ten articles were selected. The six non-pharmacological intervention studies showed no impact on duration of delirium, mortality or institutionalization, but a decrease in severity of delirium and improvement in medium-term cognitive function were observed. The most commonly used interventions were temporal-spatial orientation, orientation to self and others, early mobilization and sleep hygiene. The four studies with pharmacological interventions found that rivastigmine reduced the duration of delirium, improved cognitive function and reduced caregiver burden; olanzapine and haloperidol decreased the severity of delirium; droperidol reduced length of hospitalization and improved delirium remission rate. CONCLUSION Although the pharmacological approach has been used in the treatment of delirium among elderly, there have been few studies assessing its efficacy, involving a small number of patients. However, the improvements in delirium duration and severity suggest these drugs are effective in treating the condition. Once delirium has developed, non-pharmacological treatment seems less effective in controlling symptoms, and there is a lack of studies describing different non-pharmacological interventions.
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Affiliation(s)
| | - Cláudia Cristina Pupo
- MD, Departamento de Medicina, Centro de Ciências Biológicas e da Saúde, Universidade Federal de São Carlos, SP, Brazil
| | - Sigrid De Sousa Dos Santos
- MD, PhD, Departamento de Medicina, Centro de Ciências Biológicas e da Saúde, Universidade Federal de São Carlos, SP, Brazil
| | - José Eduardo Mourão Santos
- MD, PhD, Departamento de Medicina, Centro de Ciências Biológicas e da Saúde, Universidade Federal de São Carlos, SP, Brazil
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Peng W, Shimin S, Hongli W, Yanli Z, Ying Z. Delirium Risk of Dexmedetomidine and Midazolam in Patients Treated with Postoperative Mechanical Ventilation: a Meta-analysis. Open Med (Wars) 2017; 12:252-256. [PMID: 28828407 PMCID: PMC5553133 DOI: 10.1515/med-2017-0036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 06/13/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate by meta-analysis the effects of dexmedetomidine versus midazolam on postoperative delirium in patients that received postoperative mechanical ventilation. METHODS The electronic databases of PubMed, Web of Science, EMbase, CNKI, CBM, Cochrane library and WanFang were searched by two reviewers. All the clinical studies related to dexmedetomidine versus midazolam on postoperative delirium were screened and collected in this meta-analysis. The combined postoperative delirium risk between dexmedetomidine and midazolam groups was pooled by random effect model. The publication bias was assessed by Begg's funnel plot and Egger's line regression test. RESULTS A total of six studies including 386 subjects (202 in the dexmedetomidine group and 184 in the midazolam group) were finally included in this meta-analysis. All six studies reported adequate sequence generation. Three studies used blindness methods and 2 publications were free of selective reporting. However, only 1 publication reported allocation concealment. Because of significant heterogeneity across the studies (I2=61.7%, p<0.05), the data were pooled by random effect model. Pooled data showed the postoperative delirium risk in the dexmedetomidine group was significantly lower than that of the midazolam group (RR=0.20 (095%CI:0.09~0.47, p<0.05)).The Begg's funnel plot showed obvious asymmetry at the bottom and Egger's line regression test also indicated significant publication bias (t=-6.51, p<0.05). CONCLUSION Compared with midazolam, patients that received dexmedetomidine for postoperative mechanical ventilation sedation had less risk of developing delirium.
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Affiliation(s)
- Wang Peng
- Department of Anesthesiology, 5th Central Hospital of Tianjin, Peking University BinHai Hospital300450TianjinChina
| | - Shan Shimin
- Department of Anesthesiology, 5th Central Hospital of Tianjin, Peking University BinHai Hospital300450TianjinChina
| | - Wang Hongli
- Department of Anesthesiology, 5th Central Hospital of Tianjin, Peking University BinHai Hospital300450TianjinChina
| | - Zhang Yanli
- Department of Anesthesiology, 5th Central Hospital of Tianjin, Peking University BinHai Hospital300450TianjinChina
| | - Zhang Ying
- Department of Anesthesiology, 5th Central Hospital of Tianjin, Peking University BinHai Hospital300450TianjinChina
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Bosmak FDS, Gibim PT, Guimarães S, Ammirati AL. Incidence of delirium in postoperative patients treated with total knee and hip arthroplasty. Rev Assoc Med Bras (1992) 2017; 63:248-251. [DOI: 10.1590/1806-9282.63.03.248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 10/19/2016] [Indexed: 11/22/2022] Open
Abstract
Summary Introduction: Delirium is a common disorder that can potentiate mortality and comorbidity rates of patients hospitalized in intensive care units. Patients undergoing major orthopedic surgeries, such as knee and hip arthroplasty, are particularly vulnerable as they often have multiple risk factors for this disorder. Method: Descriptive study of the incidence of delirium in patients treated with total knee and hip arthroplasty, given the advanced age and comorbidities in this population. We evaluated the medical records of patients who had previously undergone the designated surgeries for identification of postoperative delirium. Results: We observed in this study an incidence of 8.92% of delirium, mostly affecting females with a mean age of 73 years and hypertension. Conclusion: The incidence of delirium in our study is similar to that observed in the general population, according to the literature. We found no correlation with sleep disorders, smoking or diabetes mellitus in this study, even though the importance of these factors for the onset of delirium is well-established in the literature.
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Affiliation(s)
| | | | - Sandra Guimarães
- Universidade Anhembi Morumbi, Brazil; Beneficência Portuguesa de São Paulo, Brazil
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Fukata S, Kawabata Y, Fujishiro K, Kitagawa Y, Kuroiwa K, Akiyama H, Takemura M, Ando M, Hattori H. Haloperidol prophylaxis for preventing aggravation of postoperative delirium in elderly patients: a randomized, open-label prospective trial. Surg Today 2016; 47:815-826. [DOI: 10.1007/s00595-016-1441-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/10/2016] [Indexed: 12/20/2022]
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Qiu Y, Chen D, Huang X, Huang L, Tang L, Jiang J, Chen L, Li S. Neuroprotective effects of HTR1A antagonist WAY-100635 on scopolamine-induced delirium in rats and underlying molecular mechanisms. BMC Neurosci 2016; 17:66. [PMID: 27760517 PMCID: PMC5070354 DOI: 10.1186/s12868-016-0300-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 10/05/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Limited surveys have assessed the performance of 5-hydroxytreptamine receptor 1A and its antagonist WAY-100635 in pharmacological manipulations targeting delirium therapies. The purpose of this paper was to assess the central pharmacological activity of WAY-100635 in a rat model of scopolamine-induced delirium and its underlying mechanism. RESULTS A delirium rat model was established by intraperitoneal injection of scopolamine and behavioral changes evaluated through open field and elevated plus maze experiments. Concentrations of monoamines in the hippocampus and amygdalae were detected by high performance liquid chromatography. The effect of WAY-100635 on the recovery of rats from delirium was assessed by stereotactic injection of WAY-100635 and its mechanism of action determined by measuring mRNA and protein expression via real time PCR and western blotting methods. The total distance and the number of crossing and rearing in the elevated plus maze test and the time spent in the light compartment in the dark/light test of scopolamine-treated rats were significantly increased while the percentage of time spent in the open arms was decreased, showing the validity of the established delirium rat model. The measurement of the concentrations of noradrenaline, 3,4-dihydroxyphenylacetic acid, the homovanillic acid, 5-hydroxy-3-indoleacetic acid and serotonin concentrations in the cerebrospinal fluid (CSF) of scopolamine-induced delirium rats were significantly increased. The intra-hippocampus and intra-BLA injections of WAY-100635 improved the delirium-like behavior of rats by significantly reducing the expression of NLRP3 inflammasome and the release of IL1-β and IL8 into CSF. CONCLUSIONS Taken together, these findings indicate that WAY-100635 may exert a therapeutic effect on post-operative delirium by controlling neurotransmission as well as suppressing neuroinflammation in the central nervous system.
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Affiliation(s)
- Yimin Qiu
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University, 800 Dongchuan Rd., Minhang District, Shanghai, 200080 China
| | - Dongmei Chen
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University, 800 Dongchuan Rd., Minhang District, Shanghai, 200080 China
| | - Xiaojing Huang
- Department of Pain Management, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Lina Huang
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University, 800 Dongchuan Rd., Minhang District, Shanghai, 200080 China
| | - Liang Tang
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University, 800 Dongchuan Rd., Minhang District, Shanghai, 200080 China
| | - Jihong Jiang
- Department of Pain Management, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Lianhua Chen
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University, 800 Dongchuan Rd., Minhang District, Shanghai, 200080 China
| | - Shitong Li
- Department of Anesthesiology and Pain Management, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
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Qiu Y, Huang X, Huang L, Tang L, Jiang J, Chen L, Li S. 5-HT(1A) receptor antagonist improves behavior performance of delirium rats through inhibiting PI3K/Akt/mTOR activation-induced NLRP3 activity. IUBMB Life 2016; 68:311-9. [PMID: 26946964 DOI: 10.1002/iub.1491] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/28/2016] [Indexed: 11/11/2022]
Abstract
Postoperative delirium is a common complication that often results in poor outcomes in surgical and elderly patients. Accumulating evidences suggest that the pathophysiology of delirium results from multiple neurotransmitter system dysfunctions. To further clarify the effects of the selective serotonin (5-HT) (1A) antagonist WAY-100635 on the behaviors in scopolamine induced-delirium rats and to explore the molecular mechanism, in this study, we investigated the change of monoamine levels in the cerebrospinal fluid (CSF) and different brain regions using high-performance liquid chromatography and assessed the behavioral retrieval of delirium rats treated with WAY-100635. It was found that 5-hydroxy-3-indoleacetic acid (5-HIAA), 3,4-dihydroxyphenylacetic acid, and homovanillic acid concentrations in the CSF of scopolamine-induced delirium rats were significantly increased, among which 5-HIAA was also increased in hippocampus and basolateral amygdala (BLA), and 5-HT(1A) receptor was significantly higher in the hippocampuses and BLA than other brain regions. Furthermore, intrahippocampus and intra-BLA stereotactic injection of WAY-100635 improved the delirium-like behavior of rats. Mechanistically, after WAY-100635 treatment, significant reduction of IL-1β release into CSF and NOD-like receptor family, pyrin domain containing 3 (NLRP3) expression, phosphorylated phosphatidylinositol-3-kinase (PI3K), protein kinase B (AKT), and S6K was observed. Altogether, these results suggest that delirium rats induced by scopolamine may be correlated with an increased cerebral concentration of 5-HT and dopamine neurotransmitters system; the selective 5-HT(1A) antagoniszts can reverse the delirium symptoms at some extent through tendering PI3K/Akt/mammalian target of rapamycin complex 1 (mTOR) activation-induced NLRP3 activity and then reducing IL-1β release.
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Affiliation(s)
- Yimin Qiu
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xiaojing Huang
- Department of Pain Management, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Lina Huang
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Liang Tang
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jihong Jiang
- Department of Pain Management, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Lianhua Chen
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Shitong Li
- Department of Anesthesiology and Pain Management, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
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Whalin MK, Kreuzer M, Halenda KM, García PS. Missed Opportunities for Intervention in a Patient With Prolonged Postoperative Delirium. Clin Ther 2015; 37:2706-10. [PMID: 26492795 DOI: 10.1016/j.clinthera.2015.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/25/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Postoperative delirium is a common and costly state of brain dysfunction that complicates postsurgical management in some patients. The purpose of this report was to describe a case of prolonged postoperative delirium and to review the appropriate identification and management of this condition. METHODS A 56-year-old female patient who presented with newly diagnosed diabetes mellitus and dry gangrene underwent a vascular bypass procedure while under general anesthesia. After extubation, the patient became disoriented and agitated. FINDINGS The delirium continued in a hypoactive form for 10 days before it progressed to severe agitation. During the patient's 2-month hospitalization, she underwent 6 additional surgeries. Eventually, the delirium improved with the use of antipsychotic agents, and the patient was discharged to a skilled nursing facility. IMPLICATIONS This patient's history, medications, and anesthetic and surgical exposure placed her at high risk for postoperative delirium. Her exceptionally prolonged course of postoperative delirium was likely perpetuated by a multitude of factors, including the continued use of high-risk medications, the stress of repeated surgeries, urinary issues, and infection. CONCLUSION In this high-risk patient, a proactive approach to the prevention and treatment of delirium may have avoided or mitigated the prolonged delirium and, potentially, long-term cognitive deficits.
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Affiliation(s)
- Matthew K Whalin
- Department of Anesthesiology, Grady Memorial Hospital/Emory University, Atlanta, Georgia; Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Matthias Kreuzer
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Kevin M Halenda
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Paul S García
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; Anesthesiology and Research Service, Atlanta VA Medical Center, Decatur, Georgia.
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Abstract
Delirium is a serious but potentially avoidable complication in critically ill patients. Various pathophysiological processes have been associated with delirium development; however, neuroinflammation hypothesis and pleiotropic effects are the reasons why HMG-CoA reductase inhibitors have been evaluated for delirium prevention. Statin therapy is associated with favorable outcomes in critically ill patients, but significant variability of results exists in patients who received these agents postoperatively. Study design methodological weaknesses, inconsistent delirium assessment, and lack of information on sedation regimens may have confounded these outcomes. Furthermore, no evidence exists on the type of statin, lipophilic or non-lipophilic, that is associated with the most benefit or when therapy with a statin should be initiated. Thus, the efficacy of HMGM-CoA reductase inhibitors on delirium prevention has not been fully established and non-pharmacological methods should remain mainstay of therapy.
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Affiliation(s)
- Margarita Taburyanskaya
- PGY2 Pharmacy Critical Care Residency Program, Medical University of South Carolina, 280 Calhoun St., Charleston, SC, 29412, USA,
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