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Han S, Cai Z, Cao L, Li J, Huang L. Effects of Chinese traditional five-element music intervention on postoperative delirium and sleep quality in elderly patients after non-cardiac surgery: a randomized controlled trial. Perioper Med (Lond) 2024; 13:47. [PMID: 38807220 PMCID: PMC11134639 DOI: 10.1186/s13741-024-00408-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/23/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a common neurologic disorder among elderly patients after non-cardiac surgery, which leads to various negative outcomes. Sleep disorder is considered an important cause of POD. The objective of this study was to investigate whether the Chinese traditional five-element music intervention could reduce POD by improving sleep quality in elderly patients undergoing non-cardiac surgery. METHODS A total of 132 patients aged 65 to 90 years who underwent non-cardiac surgery were randomized to two groups: the intervention (n = 60) and the control group (n = 63). Patients in the intervention group were subjected to the Chinese traditional five-element music intervention during the perioperative, while patients in the control group had no music intervention. POD was evaluated using the Confusion Assessment Method (CAM) in the first 5 days after surgery. The Richards‒Campbell Sleep Questionnaire (RCSQ) was used to assess subjective sleep quality. The levels of nocturnal melatonin and cortisol in saliva were measured on the preoperative and the first 2 postoperative days. RESULTS The incidence of POD within 5 days was 27.0% in the control group and 11.7% in the intervention group. Preoperative PSQI and MMSE scores were associated with POD. The RCSQ scores on the first postoperative day were significantly decreased in the two groups compared to the preoperative day. Compared to the control group, the RCSQ scores showed a significant improvement in the intervention group on the first postoperative day. Compared to the control group, the level of saliva melatonin in the intervention group showed a significant increase on the first postoperative day. However, there was no statistical difference in cortisol levels between the two groups. CONCLUSIONS Chinese traditional five-element music intervention decreased the incidence of POD in elderly patients who underwent noncardiac surgery via improving sleep quality, which may be associated with increased levels of melatonin.
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Affiliation(s)
- Shuang Han
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050061, Hebei, China
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, Hebei, China
| | - Zenghua Cai
- Department of Anesthesiology, Bethune International Peace Hospital, Shijiazhuang, 050082, Hebei, China
| | - Longlu Cao
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, Hebei, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, Hebei, China.
| | - Lining Huang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050061, Hebei, China.
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Zhao L, Guo Y, Zhou X, Mao W, Zhu H, Chen L, Liu X, Zhang L, Xie Y, Li L. The research progress of perioperative non-pharmacological interventions on postoperative cognitive dysfunction: a narrative review. Front Neurol 2024; 15:1369821. [PMID: 38751891 PMCID: PMC11094646 DOI: 10.3389/fneur.2024.1369821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Postoperative cognitive dysfunction (POCD) is a common neurological complication in elderly patients after surgery and general anesthesia. The occurrence of POCD seriously affects the postoperative recovery of patients, and leads to prolonged hospital stay, reduced quality of life, increased medical costs, and even higher mortality. There is no definite and effective drug treatment for POCD. More evidence shows that perioperative non-pharmacological intervention can improve postoperative cognitive function and reduce the incidence of POCD. Therefore, our studies summarize the current non-pharmacological interventions of POCD from the aspects of cognitive training, physical activity, transcutaneous electrical acupoint stimulation, noninvasive brain stimulation, non-pharmacological sleep improvement, music therapy, environment, and multimodal combination Interventions, to provide more data for clinical application and research.
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Affiliation(s)
- Li Zhao
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Yiping Guo
- School of Humanities and Management, Key Laboratory for Quality of Life and Psychological Assessment and Intervention, Guangdong Medical University, Dongguan, China
- Nanchong Center for Disease Control and Prevention, Nanchong, China
| | - Xuelei Zhou
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Wei Mao
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Hongyu Zhu
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Linlin Chen
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Xianchun Liu
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Longyi Zhang
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Ying Xie
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Linji Li
- Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
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Cao X, Wang B, Liu M, Li J. Effect of recorded mother's voice on emergence delirium in pediatric patients: a systematic review with meta-analysis. J Pediatr (Rio J) 2024; 100:231-241. [PMID: 37844877 PMCID: PMC11065670 DOI: 10.1016/j.jped.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE Emergence delirium is a common complication in children. Recorded mother's voice, as a non-pharmacological measure, is increasingly used to prevent the emergence of delirium in pediatric patients, but sufficient evidence is still needed to prove its efficacy. METHODS Embase, PubMed, Cochrane Library, Web of Science, CINAHL, and Sinomed databases were searched for randomized controlled trials exploring the efficacy of recorded mother's voice in preventing the emergence of delirium in pediatric patients undergoing general anesthesia. The original data were pooled for the meta-analysis with Review Manager 5.4.1. This study was conducted based on the Cochrane Review Methods. RESULTS Eight studies with 724 children were included in the analysis. Recorded mother's voice reduced the incidence of emergence delirium when compared with either no voice (RR: 0.45; [95 % CI, 0.34 - 0.61]; p < 0.01; I2 = 7 %) or stranger's voice (RR: 0.51; [95 % CI, 0.28 - 0.91]; p = 0.02; I2 = 38 %) without increasing other untoward reactions. In addition, it shortened the post-anesthesia care unit stay time when compared with no voice (MD = -5.64; [95 % CI, -8.43 to -2.58]; p < 0.01, I2 = 0 %), but not stranger's voice (MD = -1.23; [95 % CI, -3.08 to 0.63]; p = 0.19, I2 = 0 %). It also shortened the extubation time and reduced the incidence of postoperative rescue analgesia. CONCLUSION The current analysis indicated that recorded mother's voices could reduce the incidence of emergency delirium, shorten post-anesthesia care unit stay time and extubation time, and decrease the incidence of postoperative rescue analgesia in children.
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Affiliation(s)
- Xinyu Cao
- Hebei General Hospital, Department of Anesthesiology, Shijiazhuang, Hebei Province, China; Graduate School of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Bei Wang
- Hebei General Hospital, Department of Gynecology, Shijiazhuang, Hebei Province, China
| | - Meinv Liu
- Hebei General Hospital, Department of Anesthesiology, Shijiazhuang, Hebei Province, China
| | - Jianli Li
- Hebei General Hospital, Department of Anesthesiology, Shijiazhuang, Hebei Province, China.
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Siemer CP, Siemer LC, Schlesinger JJ. Music in Medicine: Novel Use of an Ancient Medium. Anesth Analg 2023; 137:708-713. [PMID: 37590803 DOI: 10.1213/ane.0000000000006359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Affiliation(s)
- Christopher P Siemer
- From the Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lauren C Siemer
- Department of Anesthesiology, Division of Multispecialty Adult Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph J Schlesinger
- From the Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Kappen PR, Mos MI, Jeekel J, Dirven CMF, Kushner SA, Osse RJ, Coesmans M, Poley MJ, van Schie MS, van der Holt B, Klimek M, Vincent AJPE. Music to prevent deliriUm during neuroSurgerY (MUSYC): a single-centre, prospective randomised controlled trial. BMJ Open 2023; 13:e069957. [PMID: 37369412 PMCID: PMC10410844 DOI: 10.1136/bmjopen-2022-069957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/11/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES Delirium is a serious complication following neurosurgical procedures. We hypothesise that the beneficial effect of music on a combination of delirium-eliciting factors might reduce delirium incidence following neurosurgery and subsequently improve clinical outcomes. DESIGN Prospective randomised controlled trial. SETTING Single centre, conducted at the neurosurgical department of the Erasmus Medical Center, Rotterdam, the Netherlands. PARTICIPANTS Adult patients undergoing craniotomy were eligible. INTERVENTIONS Patients in the intervention group received preferred recorded music before, during and after the operation until day 3 after surgery. Patients in the control group were treated according to standard of clinical care. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was presence or absence of postoperative delirium within the first 5 postoperative days measured with the Delirium Observation Screening Scale (DOSS) and, in case of a daily mean score of 3 or higher, a psychiatric evaluation with the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Secondary outcomes included anxiety, heart rate variability (HRV), depth of anaesthesia, delirium severity and duration, postoperative complications, length of stay and location of discharge. RESULTS We enrolled 189 patients (music=95, control=94) from July 2020 through September 2021. Delirium, as assessed by the DOSS, was less common in the music (n=11, 11.6%) than in the control group (n=21, 22.3%, OR:0.49, p=0.048). However, after DSM-5 confirmation, differences in delirium were not significant (4.2% vs 7.4%, OR:0.47, p=0.342). Moreover, music increased the HRV (root mean square of successive differences between normal heartbeats, p=0.012). All other secondary outcomes were not different between groups. CONCLUSION Our results support the efficacy of music in reducing the incidence of delirium after craniotomy, as found with DOSS but not after DSM-5 confirmation, substantiated by the effect of music on preoperative autonomic tone. Delirium screening tools should be validated and the long-term implications should be evaluated after craniotomy. TRIAL REGISTRATION NUMBER Trialregister.nl: NL8503 and ClinicalTrials.gov: NCT04649450.
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Affiliation(s)
- Pablo R Kappen
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M I Mos
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Johannes Jeekel
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Steven A Kushner
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert-Jan Osse
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Michiel Coesmans
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marten J Poley
- Institute for Medical Technology Assessment (iMTA), Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Paediatric Surgery and Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bronno van der Holt
- Department of Haematology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Klimek
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Zhou C, Ma H, Qi X, Xu C, Liang Z. The effect of music therapy on delirium in patients receiving mechanical ventilatory support in the Intensive Care Unit: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33956. [PMID: 37327279 PMCID: PMC10270468 DOI: 10.1097/md.0000000000033956] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Delirium is a very common sick syndrome in patients receiving mechanical ventilatory support in the Intensive Care Unit (ICU). Music therapy is a promising non-pharmacological intervention. However, its effect on the duration, incidence and severity of delirium is unknown. So we will perform a systematic review and meta-analysis to evaluate the effect of music therapy on delirium in patients receiving mechanical ventilatory support in the ICU. METHODS This systematic review was registered in the PROSPERO. We will follow the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocol to accomplish the systematic review protocol. Searches of PubMed, EMbase, the Cochrane library, CBM, CNKI and Wanfang databases will be conducted through computer to collect randomized controlled trials (RCTs) on the effects of music therapy on delirium in patients receiving mechanical ventilatory support in the ICU. The search time will be all from database establishment to April 2023. Two evaluators will independently screen the literature, extract information and evaluate the risk of bias of included studies, then data analysis will be performed using Stata 14.0 software. RESULTS The results of this systematic review and meta-analysis will be publicly available and published in a peer-reviewed journal. CONCLUSION This study will provide evidence-based medical evidence for music therapy to control delirium in patients receiving mechanical ventilatory support in the ICU.
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Affiliation(s)
- Changyan Zhou
- Department of Critical Care Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hong Ma
- Department of Critical Care Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoxue Qi
- Child Intensive Care Unit, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chunru Xu
- Child Intensive Care Unit, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zina Liang
- Child Intensive Care Unit, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Williams EC, Estime S, Kuza CM. Delirium in trauma ICUs: a review of incidence, risk factors, outcomes, and management. Curr Opin Anaesthesiol 2023; 36:137-146. [PMID: 36607823 DOI: 10.1097/aco.0000000000001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW This article reviews the impact and importance of delirium on patients admitted to the ICU after trauma, including the latest work on prevention and treatment of this condition. As the population ages, the incidence of geriatric trauma will continue to increase with a concomitant rise in the patient and healthcare costs of delirium in this population. RECENT FINDINGS Recent studies have further defined the risk factors for delirium in the trauma ICU patient population, as well as better demonstrated the poor outcomes associated with the diagnosis of delirium in these patients. Recent trials and meta-analysis offer some new evidence for the use of dexmedetomidine and quetiapine as preferred agents for prevention and treatment of delirium and add music interventions as a promising part of nonpharmacologic bundles. SUMMARY Trauma patients requiring admission to the ICU are at significant risk of developing delirium, an acute neuropsychiatric disorder associated with increased healthcare costs and worse outcomes including increased mortality. Ideal methods for prevention and treatment of delirium are not well established, especially in this population, but recent research helps to clarify optimal prevention and treatment strategies.
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Affiliation(s)
- Elliot C Williams
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Stephen Estime
- Department of Anesthesiology and Critical Care, University of Chicago Medicine, Chicago, Illinois
| | - Catherine M Kuza
- Department of Anesthesiology and Critical Care, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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