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Surgical Pharmacy for Optimizing Medication Therapy Management Services within Enhanced Recovery after Surgery (ERAS ®) Programs. J Clin Med 2023; 12:jcm12020631. [PMID: 36675560 PMCID: PMC9861533 DOI: 10.3390/jcm12020631] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/16/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Drug-related problems (DRPs) are common among surgical patients, especially older patients with polypharmacy and underlying diseases. DRPs can potentially lead to morbidity, mortality, and increased treatment costs. The enhanced recovery after surgery (ERAS) system has shown great advantages in managing surgical patients. Medication therapy management for surgical patients (established as "surgical pharmacy" by Guangdong Province Pharmaceutical Association (GDPA)) is an important part of the ERAS system. Improper medication therapy management can lead to serious consequences and even death. In order to reduce DRPs further, and promote the rapid recovery of surgical patients, the need for pharmacists in the ERAS program is even more pressing. However, the medication therapy management services of surgical pharmacy and how surgical pharmacists should participate in ERAS programs are still unclear worldwide. Therefore, this article reviews the main perioperative medical management strategies and precautions from several aspects, including antimicrobial agents, antithrombotic agents, pain medication, nutritional therapy, blood glucose monitoring, blood pressure treatment, fluid management, treatment of nausea and vomiting, and management of postoperative delirium. Additionally, the way surgical pharmacists participate in perioperative medication management, and the relevant medication pathways are explored for optimizing medication therapy management services within the ERAS programs. This study will greatly assist surgical pharmacists' work, contributing to surgeons accepting that pharmacists have an important role in the multidisciplinary team, benefitting medical workers in treating, counseling, and advocating for their patients, and further improving the effectiveness, safety and economy of medication therapy for patients and promoting patient recovery.
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Huang Q, Shi Q, Yi X, Zeng J, Dai X, Lin L, Yang Y, Wu X, Gong G. Effect of Repeated Intranasal Administration of Different Doses of Insulin on Postoperative Delirium, Serum τ and Aβ Protein in Elderly Patients Undergoing Radical Esophageal Cancer Surgery. Neuropsychiatr Dis Treat 2023; 19:1017-1026. [PMID: 37144143 PMCID: PMC10153451 DOI: 10.2147/ndt.s405426] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023] Open
Abstract
Objective Postoperative delirium is common after general anesthesia in older patients. However, there are currently no effective preventive measures. This study investigated the effect of repeated intranasal administration of different insulin doses before surgery on postoperative delirium in older patients with esophageal cancer, and the possible mechanism for its efficacy. Methods In this randomized, placebo-controlled, double-blind, parallel-group study, 90 older patients were randomly assigned to either a Control (normal saline), Insulin 1 (20 U/0.5 mL intranasal insulin), or Insulin 2 (30 U/0.75 mL intranasal insulin) group. Delirium was assessed on postoperative days 1 (T2), 2 (T3), and 3 (T4) using the Confusion Assessment Method for the Intensive Care Unit. Serum τ and Aβ protein levels were measured at T0 (before insulin/saline administration), T1 (end of surgery), T2, T3 and T4. Results The Insulin 2 group had a significantly lower prevalence of delirium compared to the Control and Insulin 1 groups three days after surgery. Compared to baseline, τ and Aβ protein levels increased significantly at T1-T4. Compared to the Control group, the Insulin 1 and 2 groups had significantly lower τ and Aβ protein levels at T1-T4, and the Insulin 2 group had significantly lower levels than the Insulin 1 group at T1-T2. Conclusion The administration of 30 U of intranasal insulin twice daily, from 2 days preoperatively until 10 minutes preanesthesia on the day of surgery, can significantly reduce postoperative delirium in older patients undergoing radical esophagectomy. It can also decrease postoperative τ and Aβ protein expression without causing hypoglycemia. Clinical Trial Registration This study was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn, with the unique identifier: ChiCTR2100054245; December 11, 2021).
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Affiliation(s)
- Qingqing Huang
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, People’s Republic of China
| | - Qin Shi
- Department of Anesthesiology, North Sichuan Medical College, Nanchong, People’s Republic of China
| | - Xiaobo Yi
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, People’s Republic of China
| | - Jingzheng Zeng
- Department of Anesthesiology, North Sichuan Medical College, Nanchong, People’s Republic of China
| | - Xuemei Dai
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, People’s Republic of China
| | - Lu Lin
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, People’s Republic of China
| | - Yanling Yang
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, People’s Republic of China
| | - Xiao Wu
- Department of Anesthesiology, North Sichuan Medical College, Nanchong, People’s Republic of China
| | - Gu Gong
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, People’s Republic of China
- Correspondence: Gu Gong, Department of Anesthesiology, The General Hospital of Western Theater Command, 270 Tianhui Road, Rongdu Avenue, Jinniu District, Chengdu, Sichuan, 610083, People’s Republic of China, Tel +8617360137572, Fax +86 28570423, Email
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Zhao J, Liang G, Hong K, Pan J, Luo M, Liu J, Huang B. Risk factors for postoperative delirium following total hip or knee arthroplasty: A meta-analysis. Front Psychol 2022; 13:993136. [PMID: 36248575 PMCID: PMC9565976 DOI: 10.3389/fpsyg.2022.993136] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThe purpose of this study was to identify risk factors for delirium after total joint arthroplasty (TJA) and provide theoretical guidance for reducing the incidence of delirium after TJA.MethodsThe protocol for this meta-analysis is registered with PROSPERO (CRD42020170031). We searched PubMed, the Cochrane Library and Embase for observational studies on risk factors for delirium after TJA. Review Manager 5.3 was used to calculate the relative risk (RR) or standard mean difference (SMD) of potential risk factors related to TJA. STATA 14.0 was used for quantitative publication bias evaluation.ResultsIn total, 25 studies including 3,767,761 patients from 9 countries were included. Old age has been widely recognized as a risk factor for delirium. Our results showed that the main risk factors for delirium after TJA were patient factors (alcohol abuse: RR = 1.63; length of education: SMD = −0.93; and MMSE score: SMD = −0.39), comorbidities (hypertension: RR = 1.26; diabetes mellitus: RR = 1.67; myocardial infarction: RR = 17.75; congestive heart failure: RR = 2.54; dementia: RR = 17.75; renal disease: RR = 2.98; history of stroke: RR = 4.83; and history of mental illness: RR = 2.36), surgical factors (transfusion: RR = 1.53; general anesthesia: RR = 1.10; pre-operative albumin: SMD = −0.38; pre-operative hemoglobin: SMD = −0.29; post-operative hemoglobin: SMD = −0.24; total blood loss: SMD = 0.15; duration of surgery: SMD = 0.29; and duration of hospitalization: SMD = 2.00) and drug factors (benzodiazepine use: RR = 2.14; ACEI use: RR = 1.52; and beta-blocker use: RR = 1.62).ConclusionsMultiple risk factors were associated with delirium after TJA. These results may help doctors predict the occurrence of delirium after surgery and determine the correct treatment.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42020170031.
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Affiliation(s)
- Jinlong Zhao
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Guihong Liang
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Kunhao Hong
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
| | - Jianke Pan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Minghui Luo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun Liu
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Jun Liu
| | - Bin Huang
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Bin Huang
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Chen M, Zhang L, Shao M, Du J, Xiao Y, Zhang F, Zhang T, Li Y, Zhou Q, Liu K, Wang Z, Wu B. E4BP4 Coordinates Circadian Control of Cognition in Delirium. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2200559. [PMID: 35713240 PMCID: PMC9376827 DOI: 10.1002/advs.202200559] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/24/2022] [Indexed: 05/07/2023]
Abstract
Improved understanding of the etiologies of delirium, a common and severe neuropsychiatric syndrome, would facilitate the disease prevention and treatment. Here, the authors invesitgate the role of circadian rhythms in the pathogenesis of delirium. They observe perturbance of circadian rhythms in mouse models of delirium and disrupted clock gene expression in patients with delirium. In turn, physiological and genetic circadian disruptions sensitize mice to delirium with aggravated cognitive impairment. Likewise, global deletion of E4bp4 (E4 promoter-binding protein), a clock gene markedly altered in delirium conditions, results in exacerbated delirium-associated cognitive decline. Cognitive decline in delirium models is attributed to microglial activation and impaired long-term potentiation in the hippocampus. Single-cell RNA-sequencing reveals microglia as the regulatory target of E4bp4. E4bp4 restrains microglial activation via inhibiting the ERK1/2 signaling pathway. Supporting this, mice lacking in microglial E4bp4 are delirious prone, whereas mice with E4bp4 specifically deleted in hippocampal CA1 neurons have a normal phenotype. Mechanistically, E4bp4 inhibits ERK1/2 signaling by trans-repressing Mapk1/3 (genes encoding ERK1/2) via direct binding to a D-box element in the promoter region. These findings define a causal role of clock dysfunction in delirium development and indicate E4bp4 as a regulator of cognition at the crosstalk between circadian clock and delirium.
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Affiliation(s)
- Min Chen
- Institute of Molecular Rhythm and MetabolismGuangzhou University of Chinese MedicineGuangzhou510006China
- College of PharmacyJinan UniversityGuangzhou510632China
| | - Li Zhang
- College of PharmacyJinan UniversityGuangzhou510632China
| | - Mingting Shao
- Guangdong‐Hongkong‐Macau Institute of CNS RegenerationJinan UniversityGuangzhou510632China
| | - Jianhao Du
- College of PharmacyJinan UniversityGuangzhou510632China
| | - Yifei Xiao
- Institute of Molecular Rhythm and MetabolismGuangzhou University of Chinese MedicineGuangzhou510006China
| | - Fugui Zhang
- Institute of Molecular Rhythm and MetabolismGuangzhou University of Chinese MedicineGuangzhou510006China
| | - Tianpeng Zhang
- Institute of Molecular Rhythm and MetabolismGuangzhou University of Chinese MedicineGuangzhou510006China
| | - Yifang Li
- College of PharmacyJinan UniversityGuangzhou510632China
| | - Qianqian Zhou
- Shenzhen People's Hospital (The Second Clinical Medical CollegeJinan University; The First Affiliated HospitalSouthern University of Science and Technology)Shenzhen518119China
| | - Kaisheng Liu
- Shenzhen People's Hospital (The Second Clinical Medical CollegeJinan University; The First Affiliated HospitalSouthern University of Science and Technology)Shenzhen518119China
| | - Zhigang Wang
- Department of Intensive Care UnitFirst Affiliated Hospital of Jinan UniversityGuangzhou510630China
| | - Baojian Wu
- Institute of Molecular Rhythm and MetabolismGuangzhou University of Chinese MedicineGuangzhou510006China
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Xu X, Hu X, Wu Y, Li Y, Zhang Y, Zhang M, Yang Q. Effects of different BP management strategies on postoperative delirium in elderly patients undergoing hip replacement: A single center randomized controlled trial. J Clin Anesth 2020; 62:109730. [DOI: 10.1016/j.jclinane.2020.109730] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/17/2019] [Accepted: 01/18/2020] [Indexed: 12/19/2022]
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Duque AF, Post ZD, Orozco FR, Lutz RW, Ong AC. A Proactive Approach to High Risk Delirium Patients Undergoing Total Joint Arthroplasty. J Arthroplasty 2018; 33:1171-1176. [PMID: 29174758 DOI: 10.1016/j.arth.2017.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Delirium is a common complication among elderly patients undergoing total joint arthroplasty (TJA). Its incidence has been reported from 4% to 53%. The Centers for Medicare and Medicaid Services consider delirium following TJA a "never-event." The purpose of this study is to evaluate a simple perioperative protocol used to identify delirium risk patients and prevent its incidence following TJA. METHODS Our group developed a protocol to identify and prevent delirium in patients undergoing TJA. All patients were screened and scored in the preoperative assessment, on criteria such as age, history of forgetfulness, history of agitation or visual hallucinations, history of falls, history of postoperative confusion, and inability to perform higher brain functions. Patients were scored on performance in a simple mental examination. The patients were classified as low, medium, or high risk. Patients who were identified as high risk were enrolled in a delirium avoidance protocol that minimized narcotics and emphasized nursing involvement and fluids administration. RESULTS Five of 7659 (0.065%) consecutive TJA patients from 2010 to 2015 developed delirium. A total of 422 patients were identified as high risk. All 5 patients who suffered delirium were within the high risk group. No low or medium risk patients suffered a delirium complication. Three (0.039%) patients suffered drug-induced delirium, 1 (0.013%) had delirium related to alcohol withdrawal, and 1 (0.013%) had delirium after a systemic infection. CONCLUSION This protocol is effective in identifying patients at high delirium risk and diminishing the incidence of this complication by utilizing a simple screening tool and perioperative protocol.
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Affiliation(s)
- Andres F Duque
- The Rothman Institute of Orthopaedics at Thomas Jefferson University, Egg Harbor Township, New Jersey
| | - Zachary D Post
- The Rothman Institute of Orthopaedics at Thomas Jefferson University, Egg Harbor Township, New Jersey
| | - Fabio R Orozco
- The Rothman Institute of Orthopaedics at Thomas Jefferson University, Egg Harbor Township, New Jersey
| | - Rex W Lutz
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Alvin C Ong
- The Rothman Institute of Orthopaedics at Thomas Jefferson University, Egg Harbor Township, New Jersey
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Huang BWY, Kuo BIT, Chen CC, Chang WH, Sun FJ, Yen DHT. Comparative Analysis of Different Methods of Pain Management for Elderly Patients in the Surgical Intensive Care Unit. INT J GERONTOL 2017. [DOI: 10.1016/j.ijge.2017.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Reddy SV, Irkal JN, Srinivasamurthy A. Postoperative delirium in elderly citizens and current practice. J Anaesthesiol Clin Pharmacol 2017; 33:291-299. [PMID: 29109625 PMCID: PMC5672535 DOI: 10.4103/joacp.joacp_180_16] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Postoperative delirium (POD) represents an acute brain dysfunction in the postsurgical period. Perioperative physicians caring for the older adults are familiar with the care of dysfunction of organs such as lungs, heart, liver, or kidney in the perioperative setting, but they are less familiar with management of brain dysfunction. As early detection and prompt treatment of inciting factors are utmost important to prevent or minimize the deleterious outcomes of delirium. The purpose of this review is to prepare perioperative physicians with a set of current clinical practice recommendations to provide optimal perioperative care of older adults, with a special focus on specific perioperative interventions that have been shown to prevent POD. On literature search in EMBASE, CINAHL, and PUBMED between January 2000 and September 2015 using search words delirium, POD, acute postoperative confusion, and brain dysfunction resulted in 9710 articles. Among them, 73 articles were chosen for review, in addition, National Institute for Health and Clinical Excellence guidelines, American Geriatric Society guidelines, hospital elderly life program-confusion assessment method training manual, New York geriatric nursing protocols, World Health Organization's International Classification of Diseases, 10th Revision classification of mental disorders, Food and Drug Administration requests boxed warnings on older class of antipsychotic drugs 2008 and delirium in Miller's text book of anesthesia were reviewed and relevant information presented in this article.
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Affiliation(s)
- Siddareddygari Velayudha Reddy
- Department of Anaesthesiology and Critical Care, Navodaya Medical College and Research Center, Raichur, Karnataka, India
| | - Jawaharlal Narayanasa Irkal
- Department of Anaesthesiology and Critical Care, Navodaya Medical College and Research Center, Raichur, Karnataka, India
| | - Ananthapuram Srinivasamurthy
- Department of Anaesthesiology and Critical Care, Navodaya Medical College and Research Center, Raichur, Karnataka, India
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Inouye SK, Robinson T, Blaum C, Busby-Whitehead J, Boustani M, Chalian A, Deiner S, Fick D, Hutchison L, Johanning J, Katlic M, Kempton J, Kennedy M, Kimchi E, Ko C, Leung J, Mattison M, Mohanty S, Nana A, Needham D, Neufeld K, Richter H. Postoperative Delirium in Older Adults: Best Practice Statement from the American Geriatrics Society. J Am Coll Surg 2015; 220:136-48.e1. [DOI: 10.1016/j.jamcollsurg.2014.10.019] [Citation(s) in RCA: 291] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 10/24/2014] [Indexed: 12/17/2022]
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Maintaining comfort, cognitive function, and mobility in surgical intensive care unit patients. J Trauma Acute Care Surg 2014; 77:364-75. [PMID: 25058266 DOI: 10.1097/ta.0000000000000282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Heo DY, Hwang BM. Intravenous Patient-controlled Analgesia Has a Positive Effect on the Prognosis of Delirium in Patients Undergoing Orthopedic Surgery. Korean J Pain 2014; 27:271-7. [PMID: 25031814 PMCID: PMC4099241 DOI: 10.3344/kjp.2014.27.3.271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/17/2014] [Accepted: 06/10/2014] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Postoperative delirium is relatively common. However, the relationship between intravenous patient-controlled analgesia (IV-PCA) and delirium has not been thoroughly investigated. The aim of this study was to evaluate the effects of IV-PCA on the prognosis of postoperative delirium in patients undergoing orthopedic surgery. METHODS Medical records of 129 patients with postoperative delirium were reviewed. Patients were divided into two groups according to whether they used IV-PCA with fentanyl and ketorolac. The IV-PCA group consisted of 73 patients who were managed with IV-PCA; the NO-PCA group consisted of 56 patients who were managed without PCA. RESULTS Incidences of multiple psychiatric consultations and prolonged delirium were significantly lower in patients using IV-PCA with fentanyl and ketorolac than in those without PCA. CONCLUSIONS We recommend the use of IV-PCA for pain control and management of delirium in patients with postoperative delirium.
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Affiliation(s)
- Dae Young Heo
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Byeong Mun Hwang
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Korea
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Probasco J, Sahin B, Tran T, Chung TH, Rosenthal LS, Mari Z, Levy M. The preoperative neurological evaluation. Neurohospitalist 2014; 3:209-20. [PMID: 24198903 DOI: 10.1177/1941874413476042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Neurological diseases are prevalent in the general population, and the neurohospitalist has an important role to play in the preoperative planning for patients with and at risk for developing neurological disease. The neurohospitalist can provide patients and their families as well as anesthesiologists, surgeons, hospitalists, and other providers guidance in particular to the patient's neurological disease and those he or she is at risk for. Here we present considerations and guidance for the neurohospitalist providing preoperative consultation for the neurological patient with or at risk of disturbances of consciousness, cerebrovascular and carotid disease, epilepsy, neuromuscular disease, and Parkinson disease.
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Affiliation(s)
- John Probasco
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Yavuz S. eComment. Postoperative delirium in elderly cardiac surgery patients. Interact Cardiovasc Thorac Surg 2013; 17:797-8. [PMID: 24150051 DOI: 10.1093/icvts/ivt414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Senol Yavuz
- Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
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Zhang H, Lu Y, Liu M, Zou Z, Wang L, Xu FY, Shi XY. Strategies for prevention of postoperative delirium: a systematic review and meta-analysis of randomized trials. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R47. [PMID: 23506796 PMCID: PMC3672487 DOI: 10.1186/cc12566] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 03/12/2013] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The ideal measures to prevent postoperative delirium remain unestablished. We conducted this systematic review and meta-analysis to clarify the significance of potential interventions. METHODS The PRISMA statement guidelines were followed. Two researchers searched MEDLINE, EMBASE, CINAHL and the Cochrane Library for articles published in English before August 2012. Additional sources included reference lists from reviews and related articles from 'Google Scholar'. Randomized clinical trials (RCTs) on interventions seeking to prevent postoperative delirium in adult patients were included. Data extraction and methodological quality assessment were performed using predefined data fields and scoring system. Meta-analysis was accomplished for studies that used similar strategies. The primary outcome measure was the incidence of postoperative delirium. We further tested whether interventions effective in preventing postoperative delirium shortened the length of hospital stay. RESULTS We identified 38 RCTs with interventions ranging from perioperative managements to pharmacological, psychological or multicomponent interventions. Meta-analysis showed dexmedetomidine sedation was associated with less delirium compared to sedation produced by other drugs (two RCTs with 415 patients, pooled risk ratio (RR)=0.39; 95% confidence interval (CI)=0.16 to 0.95). Both typical (three RCTs with 965 patients, RR=0.71; 95% CI=0.54 to 0.93) and atypical antipsychotics (three RCTs with 627 patients, RR=0.36; 95% CI=0.26 to 0.50) decreased delirium occurrence when compared to placebos. Multicomponent interventions (two RCTs with 325 patients, RR=0.71; 95% CI=0.58 to 0.86) were effective in preventing delirium. No difference in the incidences of delirium was found between: neuraxial and general anesthesia (four RCTs with 511 patients, RR=0.99; 95% CI=0.65 to 1.50); epidural and intravenous analgesia (three RCTs with 167 patients, RR=0.93; 95% CI=0.61 to 1.43) or acetylcholinesterase inhibitors and placebo (four RCTs with 242 patients, RR=0.95; 95% CI=0.63 to 1.44). Effective prevention of postoperative delirium did not shorten the length of hospital stay (10 RCTs with 1,636 patients, pooled SMD (standard mean difference)=-0.06; 95% CI=-0.16 to 0.04). CONCLUSIONS The included studies showed great inconsistencies in definition, incidence, severity and duration of postoperative delirium. Meta-analysis supported dexmedetomidine sedation, multicomponent interventions and antipsychotics were useful in preventing postoperative delirium.
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Gray LD, Morris C. The principles and conduct of anaesthesia for emergency surgery. Anaesthesia 2012; 68 Suppl 1:14-29. [DOI: 10.1111/anae.12057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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