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Postoperative Delirium in Lung Cancer Anatomical Resection-Analysis of Risk Factors and Prognosis. World J Surg 2022; 46:1196-1206. [PMID: 35028705 DOI: 10.1007/s00268-022-06442-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND The incidence of postoperative delirium after anatomical lung resection ranges from 5 to 16%. This study aimed to analyze the risk factors and prognosis of postoperative delirium in anatomical lung resection for lung cancer. METHODS This study included 1351 patients undergoing anatomical lung resection between April 2010 and October 2020. We analyzed the perioperative risk factors of postoperative delirium. We also compared postoperative complications and survival between the delirium and non-delirium groups. RESULTS Postoperative delirium was identified in 44 (3.3%) of 1351 patients who underwent anatomical lung resection for lung cancer. Age, peripheral vascular disease, depression, and current smoking status were independent risk factors for postoperative delirium in the multivariate analysis. The percentage of postoperative delirium was 0.6% in never smokers and 6.0% in current smokers. The delirium and non-delirium groups showed significant differences in overall survival (p = 0.0144) and non-disease-specific survival (p = 0.0080). After propensity score matching, the two groups did not significantly differ in overall survival (p = 0.9136), non-disease-specific survival (p = 0.8146), or disease-specific survival (p = 0.6804). CONCLUSIONS Age, peripheral vascular disease, depression, and current smoking status were considered independent risk factors for postoperative delirium in anatomical lung resection for lung cancer. Smoking cessation for at least four weeks before surgery is recommended for reducing incidence of post-operative delirium.
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Fatehi Hassanabad A, Bahrami N, Novick RJ, Ali IS. Delirium and depression in cardiac surgery: A comprehensive review of risk factors, pathophysiology, and management. J Card Surg 2021; 36:2876-2889. [PMID: 34120376 DOI: 10.1111/jocs.15610] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Mental health and wellbeing continue to gain more attention as they are inextricably associated with clinical outcomes, particularly quality of life. Many medical ailments and major surgeries affect patients' mental health, including depression and delirium. AIMS The objective of this manuscript was to comprehensively review and critically examine the literature pertaining to cardiac surgery, depression, and delirium. METHODS This is a narrative review article. We performed our search analysis by using the following key words: "Cardiac Surgery", "Depression", "Delirium", "Clinical outcomes", and "Mental Health". Search analysis was done on MedLine PubMed, accessing indexed peer-reviewed publications. RESULTS Cardiac Surgery is a life-altering intervention indicated to improve morbidity and mortality in patients with cardiovascular diseases. Psychiatric conditions before and after cardiac surgery worsen patient prognosis and increase mortality rate. Specifically, preoperative depression increases postoperative depression and is associated with impaired functional status, slow physical recovery, and an increased readmission rate. DISCUSSION Although the exact pathophysiology between depression and cardiovascular disease (CVD) is unknown, several pathways have been implicated. Unmanaged depression can also lead to other psychological conditions such as delirium. Like depression, the exact association between delirium and CVD is not well understood, but believed to be multifactorial. CONCLUSION Herein, we provide a comprehensive review of the links between depression, delirium, and cardiovascular surgery. We critically examine the current data that pertains to the pathophysiology of these debilitating mental health issues in the context of cardiac surgery. Finally, we summarize the various treatment options available for managing depression and delirium in the cardiac surgery patient population.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Nabila Bahrami
- Department of Medicine, Department of Medicine, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Richard J Novick
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Imtiaz S Ali
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, Alberta, Canada
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Abstract
Agitation in the intensive care unit (ICU) patient is a complication of severe medical illness that requires prompt attention and treatment. The first step in managing an agitated ICU patient is a thorough investigation for factors that may cause or predispose to the agitated state. This entails detailed review of the history and available laboratory data as well as examination of the patient's physical and mental status. Important factors that may contribute to the development of agitation include (1) the presence of delirium or psychosis; (2) the type of ICU setting (e.g., coronary, surgical, respiratory, or medical); (3) a history of psychiatric disorder; (4) a history of central nervous system disorder; and (5) patients' personalities, which affect their reactions to illness and its treatment. The treatment of agitation is then based on its identified causes. The principles of treatment include (1) correction of metabolic and systemic abnormalities, (2) elimination of drug toxicity, (3) treatment of drug withdrawal, (4) maximization of the patient's comfort, and (5) use of neuroleptic medication. Medically oriented psychiatric consultants can help to organize the evaluation and management of the agitated patient and can assist staff members in dealing with their emotional reactions to difficult management problems.
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Affiliation(s)
- George E. Tesar
- Psychiatric Consultation Service, Massachusetts General Hospital, and the Harvard Medical School, Boston, MA
| | - Theodore A. Stern
- Psychiatric Consultation Service, Massachusetts General Hospital, and the Harvard Medical School, Boston, MA
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Hollinger A, Siegemund M, Goettel N, Steiner LA. Postoperative Delirium in Cardiac Surgery: An Unavoidable Menace? J Cardiothorac Vasc Anesth 2015; 29:1677-87. [DOI: 10.1053/j.jvca.2014.08.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Indexed: 01/20/2023]
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Basten CJ, McGuire BE. Delirium: The role of the psychologist in assessment and management. AUSTRALIAN PSYCHOLOGIST 2007. [DOI: 10.1080/00050060008257479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kazmierski J, Kowman M, Banach M, Pawelczyk T, Okonski P, Iwaszkiewicz A, Zaslonka J, Sobow T, Kloszewska I. Preoperative predictors of delirium after cardiac surgery: a preliminary study. Gen Hosp Psychiatry 2006; 28:536-8. [PMID: 17088170 DOI: 10.1016/j.genhosppsych.2006.08.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 08/24/2006] [Accepted: 08/24/2006] [Indexed: 02/04/2023]
Abstract
Preoperative risk factors of postoperative delirium were evaluated in 260 patients admitted for open heart surgery. The incidence of delirium was 11.5%. Independent predictors included cognitive impairment, atrial fibrillation, a history of peripheral vascular disease major depression and advanced age. Aforementioned factors might be helpful in predicting delirium following cardiac surgery.
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Affiliation(s)
- Jakub Kazmierski
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, 92-216 Lodz, Poland
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Sockalingam S, Parekh N, Bogoch II, Sun J, Mahtani R, Beach C, Bollegalla N, Turzanski S, Seto E, Kim J, Dulay P, Scarrow S, Bhalerao S. Delirium in the postoperative cardiac patient: a review. J Card Surg 2006; 20:560-7. [PMID: 16309412 DOI: 10.1111/j.1540-8191.2005.00134.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED BACKGROUND AND AIM OF REVIEW: Cardiac surgery is increasingly common and relatively safe, but there are frequent reports of neuropsychiatric sequelae occurring in the postoperative period. One of the most common neuropsychiatric presentations of cardiac surgery is delirium, also called postcardiotomy delirium (PCD). Despite the vast numbers of cardiac surgeries performed today, there is a paucity of data on risk factors and management options of PCD available to the clinician. This review aims to summarize available information, increase clinicians' awareness of PCD and suggest effective management of this illness. METHODS Our literature search was completed using the databases Medline and CINAHL; it was limited to human and English language studies from 1964 to the present. Search terms included "delirium," "agitation," "postoperative," "cardiac," "neuropsychiatric," "neuroleptics," "psychosis," "surgery," "treatment," "postcardiotomy," and "pharmacotherapy." RESULTS Our review of the literature revealed several risk factors for PCD, as well as various options for its pharmacological management. CONCLUSIONS A multifactorial model should be applied when considering risk stratification for and prevention of delirium postoperatively. Pharmacologically, conventional antipsychotic agents, such as haloperidol, have long been used to manage delirium. In light of haloperidol's side effects, particularly those applicable to the cardiac patient, further research is required into the role of second generation antipsychotics. These agents are common in clinical use, and may be the preferred medications.
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Lin SM, Liu CY, Wang CH, Lin HC, Huang CD, Huang PY, Fang YF, Shieh MH, Kuo HP. The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med 2005; 32:2254-9. [PMID: 15640638 DOI: 10.1097/01.ccm.0000145587.16421.bb] [Citation(s) in RCA: 295] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To revalidate a means of assessing delirium in intensive care unit patients and to investigate the independent effect of delirium on the mortality of mechanically ventilated patients. DESIGN A prospective cohort study. SETTING A 37-bed medical intensive care unit of a tertiary care hospital. PATIENTS Subjects were 102 of 131 consecutive mechanically ventilated patients. MEASUREMENTS All the enrolled patients were assessed for delirium using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Mortality rate were compared between patients with or without delirium, and the predictors of death were investigated. RESULTS The two CAM-ICU assessors' sensitivities in diagnosing delirium compared with reference standard were 91% and 95%, whereas their specificities were both 98%. They also demonstrated high interrater reliability with kappa statistics of 0.91. Delirium was present in 22 of 102 (22%) patients in the first 5 days. The delirious patients had higher intensive care unit mortality rate than nondelirious patients (63.6% vs. 32.5%, respectively), with a hazard ratio of 2.57 (95% confidence interval, 1.56-8.15). In multivariate analysis, delirium (odds ratio, 13.0; 95% confidence interval, 2.69-62.91), shock (odds ratio, 12.91; 95% confidence interval, 2.93-56.92), and illness severity (odds ratio, 9.61; 95% confidence interval, 2.24-41.18) were independent predictors of mortality. CONCLUSIONS This study confirms previous work showing that delirium is an independent predictor for increased mortality among mechanically ventilated patients.
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Affiliation(s)
- Shu-Min Lin
- Department of Thoracic Medicine II, Chang Gung Memorial Hospital, Taipei, Taiwan
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Bayndr O, Akpnar B, Can E, Güden M, Sönmez B, Demiroğlu C. The use of the 5-HT3-receptor antagonist ondansetron for the treatment of postcardiotomy delirium. J Cardiothorac Vasc Anesth 2000. [DOI: 10.1053/cr.2000.5851] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Okita Y, Takamoto S, Ando M, Morota T, Matsukawa R, Kawashima Y. Mortality and cerebral outcome in patients who underwent aortic arch operations using deep hypothermic circulatory arrest with retrograde cerebral perfusion: no relation of early death, stroke, and delirium to the duration of circulatory arrest. J Thorac Cardiovasc Surg 1998; 115:129-38. [PMID: 9451056 DOI: 10.1016/s0022-5223(98)70451-9] [Citation(s) in RCA: 150] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Our goal was to investigate factors for mortality and cerebral outcome in patients with aneurysm of the aortic arch. METHODS From 1993 to 1996, 148 patients with aortic arch aneurysm underwent operations involving deep hypothermic circulatory arrest with retrograde cerebral perfusion. Age was 63.9 +/- 11.6 years (mean +/- standard deviation) and 52 patients were older than 70 years. Twenty-eight had acute aortic dissection. Twelve had ruptured aneurysms. Fourteen had redo operations. Seventy had aortic dissection. The aneurysms were caused by atherosclerosis in 123 patients and by other causes in 25. Median sternotomy was used in 92 and left thoracotomy in 56. Twenty-eight patients underwent replacement of the ascending aorta to the proximal arch, 62 had total arch replacement, 38 had distal arch replacement, 12 had simultaneous replacement of the distal arch and the descending aorta or thoracoabdominal aorta, and 8 had patch repair. RESULTS Fifteen (10.1%) early deaths occurred. New stroke occurred in six (4.0%) patients and transient delirium in 37 (25.0%). The duration of deep hypothermic circulatory arrest plus retrograde cerebral perfusion was 49 +/- 17 minutes, and it was more than 60 minutes in 36 patients. Patients awoke 7.5 +/- 8.2 hours after the operation. Logistic regression analysis demonstrated that risk factors for mortality were ruptured aneurysm, chronic obstructive pulmonary disease, arterial cannulation in the ascending aorta, and stroke. Risks for stroke were ruptured aneurysm and replacement of the distal arch. Risks for delirium were age older than 70 years and atherosclerotic aneurysm. Duration of circulatory arrest plus cerebral perfusion did not correlate with length of time before the patient regained consciousness. No difference was found in mortality, stroke, and delirium between patients with and those without more than 60 minutes of circulatory arrest and cerebral perfusion. CONCLUSION Prolonged (> 60 minutes) deep hypothermic circulatory arrest with retrograde cerebral perfusion was not a risk factor for mortality and stroke in patients who underwent surgery for aneurysms of the aortic arch. However, the prevalence of transient delirium necessitates further investigations.
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Affiliation(s)
- Y Okita
- Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
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Menon G, Gillbe C, Pepper JR, Das SK. Case 2--1997. Aorto-iliac occlusion and rhabdomyolysis after coronary artery revascularization. J Cardiothorac Vasc Anesth 1997; 11:242-5. [PMID: 9106000 DOI: 10.1016/s1053-0770(97)90221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- G Menon
- Department of Anesthesia, Royal Brompton National Heart and Lung Hospital, London, UK
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12
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Abstract
The aim in this literature review is to describe the definitions, denominations, clinical signs and symptoms, explanations, causative factors and interrelationships of the intensive care syndrome discussed since 1950. It was found that there is no agreement about which symptoms should be included in the syndrome, when the syndrome may appear and how many patients may be affected. Furthermore, it is unclear what causes the development of the syndrome; most authors conclude that there are many reasons for it. The syndrome has generally been examined by using a medical or psychological approach, but during the last few years it has also been described and analysed from a nursing care perspective. From this nursing perspective the syndrome may be seen as an individual pattern developed by patients during their stay in an intensive care unit (ICU) and sometimes this pattern of clinical signs and symptoms lasts for a shorter or longer period even after discharge from the unit. From a wider viewpoint the development of the syndrome can be seen as an increase by degrees or as a vicious circle. finally, most authors agree that the ICU syndrome consists of, and is caused by, a complex interaction between many factors.
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Wilson LD. SENSORY PERCEPTUAL ALTERATION. Nurs Clin North Am 1993. [DOI: 10.1016/s0029-6465(22)02904-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schindler BA, Shook J, Schwartz GM. Beneficial effects of psychiatric intervention on recovery after coronary artery bypass graft surgery. Gen Hosp Psychiatry 1989; 11:358-64. [PMID: 2792747 DOI: 10.1016/0163-8343(89)90124-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The effects of perioperative psychiatric intervention were studied in 33 patients undergoing coronary artery bypass graft (CABG) surgery. All patients were evaluated preoperatively using the Mini-Mental State Exam and the Psychological Adjustment to Illness Scale-Self-Report. Participants in the study group (N = 16) had a structured psychiatric interview prior to surgery and were followed daily with supportive psychotherapy throughout their hospitalization. The number of medical complications was higher in the control group. No significant differences were found in neurologic or psychologic complications. The study group used significantly more oxycodone-acetaminophen (Percocet), but less morphine-sulfate or benzodiazepine on postoperative days 3, 4, and 6. The mean length of stay was 3 days shorter for patients in the study group. In the current era of escalating health care costs and high technology, clinical protocols and research studies that evaluate the cost effectiveness and efficacy of psychiatric intervention in medically ill patients should be pursued.
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Affiliation(s)
- B A Schindler
- Department of Psychiatry, Medical College of Pennsylvania, Philadelphia 19129
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18
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Sirois F. Delirium: 100 cases. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1988; 33:375-8. [PMID: 3409154 DOI: 10.1177/070674378803300512] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
One hundred consecutive cases of delirium seen in a psychiatric consultation service of a general hospital are discussed. Two thirds of the patients came from pneumology and cardiology since the hospital serves as a regional thoracic center. The frequency of delirium was 12.6% of consultations: three men were seen for every one woman; 80% of cases were over fifty years of age. The clinical aspects of delirium are studied according to DSM-III criteria to evaluate: a) the frequency of the symptoms, b) the temporal course of the disorder, c) any clinical characteristic of delirium linked with potential etiological factors, d) the role of anxiety.
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Affiliation(s)
- F Sirois
- Department of Psychiatry, Laval Hospital, Ste-Foy, P.Q
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19
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Sirois F, Laperrier S, Rousseau L. [Psychiatric consultations in a general hospital]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1986; 31:630-5. [PMID: 3779590 DOI: 10.1177/070674378603100706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A statistical analysis of psychiatric referrals for inpatients in a urban general hospital are presented: Data are compared to reports from the last twenty years. Significant differences for age, sex and diagnosis are noted. These are attributed to the specific vocation of the hospital as a chest and cardio center for eastern Quebec. The discussion deals with various aspects of the clinical material. References from out-patient clinics are not included.
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20
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Mai FM, McKenzie FN, Kostuk WJ. Psychiatric aspects of heart transplantation: preoperative evaluation and postoperative sequelae. BMJ 1986; 292:311-3. [PMID: 3080151 PMCID: PMC1339283 DOI: 10.1136/bmj.292.6516.311] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The contribution of a liaison psychiatrist to a cardiac transplant programme is described. Ninety one patients were referred to the transplant unit for assessment over four years, and of these, 86 were assessed by the psychiatrist. A high prevalence of preoperative anxiety and depression was found. Thirty four transplants were performed on 33 patients during the study and 22 patients survived. Six patients developed transient delirious episodes during the first 10 postoperative days, three showed symptoms of considerable anxiety, and three developed social and behavioural problems during the convalescent period. Subjects with higher scores on the somatic scale of the general health questionnaire showed increased postoperative mortality. In conclusion, the liaison psychiatrist is useful in evaluating and managing heart transplant patients before and after operation.
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Levenson JL, Friedel RO. Major depression in patients with cardiac disease: diagnosis and somatic treatment. PSYCHOSOMATICS 1985; 26:91-102. [PMID: 3975342 DOI: 10.1016/s0033-3182(85)72885-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Perine PL, Totten PA, Knapp JS, Holmes KK, Bentsi C, Klufio CA. Diversity of gonococcal plasmids, auxotypes, and serogroups in Ghana. Lancet 1983; 1:1051-2. [PMID: 6133094 DOI: 10.1016/s0140-6736(83)92681-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Davey P. New cephalosporins: a warning. Lancet 1983; 1:1052. [PMID: 6133095 DOI: 10.1016/s0140-6736(83)92682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Naber D, Schmidt-Habelmann P, Bullinger M, Neff A, Büchler A, Dietzfelbinger A. Serum cortisol correlates with depression score after open-heart surgery. Lancet 1983; 1:1052-3. [PMID: 6133096 DOI: 10.1016/s0140-6736(83)92683-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Meyendorf R. Psychopatho-ophthalmology, gnostic disorders, and psychosis in cardiac surgery. Visual disturbances after open heart surgery. ARCHIV FUR PSYCHIATRIE UND NERVENKRANKHEITEN 1982; 232:119-35. [PMID: 6984325 DOI: 10.1007/bf00343694] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The visual disturbances of 45 patients following open heart surgery could be divided into disturbances of (1) visual acuity, (2) visual accuracy, and (3) visual reality testing. The non-hallucinatory phenomena consisted mainly of loss of colour vision, metamorphopsias, visual gnostic disorders and cortical blindness. The hallucinatory phenomena could be divided into the delirium type of hallucinations with clouding of consciousness and the spectator type of hallucinations with a clear sensorium. The causes of the visual symptomatology and cardiac psychoses are seen in microembolization and/or ischemic hypoxia. The basal ganglia and the occipital lobe are areas of predilection for embolic and hypoxic changes. Identical psychoses also occur in cerebral malaria and polycythemia vera which show the same embolic and anoxic neuropathological changes of vascular occlusion as do many patients who die following open heart surgery with extracorporal circulation.
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Marana E, Cavaliere F, Beccia F, Sollazzi L, Schiavello R. Cerebral protection during extracorporeal circulation. Resuscitation 1982; 10:89-100. [PMID: 6294772 DOI: 10.1016/0300-9572(82)90016-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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30
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Morin P, Coupal P. [Delirium following heart surgery with extracorporeal circulation: clinical aspects and observations in a specialized center]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1982; 27:31-9. [PMID: 7066834 DOI: 10.1177/070674378202700107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Delirium following heart surgery with extra-corporeal circulation recently has been the subject of several studies that show a syndrome with variable diagnostic criteria and incidence which tend to confuse the entity. The diagnostic criteria proposed by the recent DSM-III of the American Psychiatric Association allow a better circumscription of the syndrome but exclude a group of patients manifesting visual hallucinations, sometimes paranoid features and cognitive functions that are less disturbed. Heller's and Kornfeld's less rigid criteria, on the other hand, have the disadvantage of including functional psychotic states that can arise after surgery without a true delirium with organic brain syndrome. We suggest the use of standard criteria that could include only delirium following cardiac surgery with E.C.C. and subdivision of the patients following the kind of surgery. In a retrospective study of the last four years at the Montreal Heart Institute, our clinical observations show an incidence of delirium after heart surgery with E.C.C. of 3%. a finding much lower than that reported in other centres which show an incidence between 13 and 67%. The more important factors found, were the kind of surgery (valve replacement more than coronary bypass), the age of the patients, and the degree of sickness after surgery during the stay in the intensive care unit. Those risk factors were also found in other recent studies. We describe the clinical syndrome and discuss its etiology in reviewing the more common risk factors before, during and after surgery. We underline the importance of the quality of the relationship with the patient before and after surgery in discussing prevention and treatment.
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31
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Tune LE, Damlouji NF, Holland A, Gardner TJ, Folstein MF, Coyle JT. Association of postoperative delirium with raised serum levels of anticholinergic drugs. Lancet 1981; 2:651-3. [PMID: 6116042 DOI: 10.1016/s0140-6736(81)90994-6] [Citation(s) in RCA: 151] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Drugs with anticholinegic effects are often used in surgical procedures and may impair higher cognitive functions and produce delirious states. This prospective study examined the relation between serum levels of anticholinergic drugs, measured by a radioreceptor assay, and the development of delirium in patients undergoing cardiac surgery. Most patients who had postoperative delirium had high serum levels of anticholinergic drugs, whereas those who remained cognitively intact had low levels; and impairment in cortical function correlated with serum levels of anticholinergic drugs (p less than 0.001). Raised serum levels of drugs with anticholinergic effects may contribute to the development of delirium, and to the increase in risk of morbidity following cardiac surgery.
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Coupal P, Morin P, Paiement B. [Delirium after surgery with extra-corporeal circulation]. CANADIAN ANAESTHETISTS' SOCIETY JOURNAL 1981; 28:350-5. [PMID: 7260713 DOI: 10.1007/bf03007802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The recent literature still reports a high incidence of delirium in patients operated with extracorporeal circulation. This syndrome is found more often in patients over 50 years and in patients with a previous history of delirium, alcoholism, drug addiction or cerebral damage and is more frequent after valvular than after coronary surgery. It is also often observed in patients who present major post-operative complications. Attention and concentration capacity are characteristically modified (diminished most of the time) with or without faulty perception (hallucinations), sleep alterations, incoherent language, apathy or agitation. Disorientation and memory troubles are common. Delirium appears within a few hours or a few days of the surgery, its evolution is fluctuant and generally benign. A retrospective study at the Montreal Heart Institute showed an incidence of 2.98 per cent (84 cases/2811 open heart surgery cases) over the last four years. The mean age of these patients was 57.5 years (versus 50.4 for patients without delirium). Major post-operative complications were found in 37 (44 per cent) of these 84 patients. The incidence was lower (1.45 per cent) in coronary than in valvular (4.6 per cent) surgery cases. Several explanations are presented to explain this low incidence.
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Maghen K, Naylor DA, Zalut WJ. Psychophysiologic Changes After Cardiac Surgery. Psychiatr Ann 1981. [DOI: 10.3928/0048-5713-19810701-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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