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Almashari Y, Alshaya RA, Alenazi RR, Alanazi AM, Alhanan R, Al-Shammari FA, Muawad R. Incidence and Risk Factors of Developing Post-operative Delirium Among Elderly Patients in a Tertiary Care Hospital: A Retrospective Chart Review. Cureus 2024; 16:e65188. [PMID: 39176316 PMCID: PMC11340268 DOI: 10.7759/cureus.65188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2024] [Indexed: 08/24/2024] Open
Abstract
Introduction Delirium is an acute and fluctuating decline in attention and cognition caused by reversible neural disruption. Post-operative delirium (POD) may happen 10 minutes after anesthesia administration up to discharge. POD has been associated with increased days of mechanical ventilation, increased patients' functional decline, prolonged intensive care unit (ICU) stay, and prolonged hospital length of stay, which can lead to nosocomial complications, further investigations, and increased treatment costs. In this study, we aim to determine the prevalence of POD and identify demographic or surgical variables associated with POD. Materials and methods This retrospective cross-sectional study was conducted at the National Guard Health Affairs Hospital (NGHA), a teaching tertiary care center in Riyadh, Kingdom of Saudi Arabia. The study included all patients older than 65 who developed POD from January 2017 to January 2023 and a control group of the same time window. The data were analyzed using custom Python code. Results The study included 108 patients, 72 of whom were male patients. General anesthesia was most used compared to other anesthesia techniques (79.630%). Patients with hypertension (HTN) and diabetes mellitus (DM) each account for 75 cases. Elective surgeries account for 86.111% of cases. Our analysis showed a significant association between POD and advanced age, male gender, DM, HTN, congestive heart failure (CHF), and chronic kidney disease (CKD). Conclusion With our study, we hope to aid the process of better understanding POD to help healthcare providers identify high-risk patients, implement preventative measures, and enhance patient safety and satisfaction.
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Affiliation(s)
- Yasser Almashari
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Rand A Alshaya
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | | | | | | | - Rayan Muawad
- Pediatric Anesthesia, King Abdulaziz Medical City Riyadh, Riyadh, SAU
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2
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Ma Z, Wang J, He T, Zhu S, Sheng C, Ge Y, Yuan L. Correlation between preoperative frailty and postoperative delirium in elderly patients undergoing hip arthroplasty. Medicine (Baltimore) 2023; 102:e34785. [PMID: 37653780 PMCID: PMC10470691 DOI: 10.1097/md.0000000000034785] [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: 05/26/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) refers to acute brain dysfunction occurring within 7 days after operation or before discharge. Frailty refers to the state that the body's physiological reserve is insufficient, so that the compensative capacity to endogenous and exogenous stress stimuli decreases. The purpose of this study is to explore the association of preoperative frailty (PF) with POD in elderly patients undergoing hip arthroplasty. METHODS Totally 228 elderly patients (age ≥ 65 years) who received elective hip arthroplasty in the Ningbo No. 6 Hospital between December 2021 and June 2022 were enrolled. One day before surgery, the frailty phenotype scale was adopted for evaluation of patients' frailty. On the 1st-3rd day after operation, the confusion assessment method was adopted for evaluation of delirium, and the patients were grouped into a POD group and non-POD group. Logistic regression was conducted to analyze the correlation between PF and POD. RESULTS Among the patients, the incidence of PF was 30.70% (70/228), and the incidence of delirium within 3 days after operation was 25.88% (59/228). According to binary logistic regression analysis, PF, age, hypertension, diabetes mellitus, and preoperative sleep disorder were independent risk factors for POD in elderly patients undergoing hip arthroplasty (all P < .05). CONCLUSION PF is a crucial risk factor for POD in elderly patients undergoing hip arthroplasty.
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Affiliation(s)
- Zihan Ma
- Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Jianlin Wang
- Department of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, Zhejiang, China
| | - Tianyi He
- Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Shaoxiong Zhu
- Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Chaoxu Sheng
- Department of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, Zhejiang, China
| | - Yeying Ge
- Department of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, Zhejiang, China
| | - Liyong Yuan
- Department of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, Zhejiang, China
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3
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Correlation Analysis of Inflammatory Markers CRP and IL-6 and Postoperative Delirium (POD) in Elderly Patients: A Meta-Analysis of Observational Studies. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:1136386. [PMID: 36444287 PMCID: PMC9701131 DOI: 10.1155/2022/1136386] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/23/2022] [Indexed: 11/21/2022]
Abstract
Background Postoperative delirium (POD) is very common in the elderly surgical population, and its occurrence is associated with multiple factors such as preoperative, intraoperative, and postoperative factors, and the increase of serum inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6) is considered to be associated with the occurrence of POD, but the results of multiple studies are inconsistent. In this study, we investigated the correlation between inflammatory markers CRP and IL-6 and POD in elderly patients by literature search and meta-analysis. Methods We searched PubMed, Web of Science, the Cochrane library, Embase, Ovid, and Springer Link for cohort studies or case-control studies that investigated the factors involved in the occurrence of POD, used the Newcastle-Ottawa Scale (NOS) to assess the quality of the selected literature, and combined the differences in serum CRP and IL-6 levels between POD and non-POD patients after surgery to evaluate the predictive value of CRP and IL-6 for the occurrence of POD. Results This research comprised 16 papers for quantitative analysis, with a total of 2967 patients, 758 with POD and 2209 with non-POD. There were 16 cohort studies (100%) and 0 case-control studies (0%) across all the collected literatures; there were 15 prospective cohort studies and 1 retrospective cohort research. A meta-analysis revealed a statistically significant difference in serum IL-6 levels between POD patients after surgery and non-POD patients [MD = 115.68, 95% CI (25.70, 206.66), Z = 2.52, P = 0.012], as well as a statistically significant difference in serum CRP levels [MD = 27.67, 95% CI (12.77, 42.58), Z = 3.64, P = 0.0003]. Discussion. Early after surgery, serum IL-6 and CRP levels were considerably higher in POD patients than in non-POD patients, indicating that early serum inflammatory variables are likely to be predictors of POD. After surgery, the levels of the aforementioned inflammatory factors should be actively monitored to forecast the emergence of delirium, and active treatment should be used to limit the creation and release of the aforementioned inflammatory factors.
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4
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Song J, Cheng C, Sheng K, Jiang LL, Li Y, Xia XQ, Hu XW. Association between the reactivity of local cerebral oxygen saturation after hypo-to-hypercapnic tests and delirium after abdominal surgery in older adults: A prospective study. Front Psychiatry 2022; 13:907870. [PMID: 36405895 PMCID: PMC9672925 DOI: 10.3389/fpsyt.2022.907870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the correlation between changes in regional cerebral oxygen saturation (rSO2) and postoperative delirium in older adults undergoing major abdominal surgery. MATERIALS AND METHODS This prospective study enrolled older adults scheduled for elective major abdominal surgery at the Second Affiliated Hospital of Anhui Medical University from August 2021 to January 2022. The change in rSO2 from baseline was determined using the hypo-to-hypercapnic test. The main study outcome was the occurrence of postoperative delirium. RESULTS A total of 101 participants were included for analysis, of whom 16 (15.8%) developed postoperative delirium. Compared with non-delirium participants, the mean arterial pressure and heart rate were not significantly different in the postoperative delirium group at T0, T1, T2, T3, T4, and T6 (all Pinteraction > 0.05), but the delirium group had lower pH, lower PaO2, and higher lactate levels at T4, T5, and T6 (all Pinteraction < 0.05). rSO2 at T0, T1, T2, T3, T4, and T6 was 69.0 (63.2-75.2), 70.7 ± 7.3, 68.2 ± 7.5, 72.1 ± 8.0, 69.9 ± 7.8, 67.4 ± 7.2, and 71.7 ± 8.1, respectively. The postoperative change in rSO2 during the hypercapnia test (TΔrSO2%) was 6.62 (5.31-9.36). Multivariable analysis showed that the Cumulative Illness Rating Scale (odd ratio, OR = 1.89, 95% confidence interval, CI: 1.10-3.25, P = 0.021), preoperative albumin levels (OR = 0.67, 95% CI: 0.48-0.94, P = 0.022), rSO2 at T4 (OR = 0.61, 95% CI: 0.41-0.89, P = 0.010), and postoperative TΔrSO2% (OR = 0.80, 95% CI: 0.66-0.98, P = 0.028) were independently associated with postoperative delirium in older adults undergoing elective abdominal surgery. CONCLUSION The rSO2 measured at T4 and postoperative TΔrSO2% were independently associated with postoperative delirium in older adults undergoing elective abdominal surgery.
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Affiliation(s)
- Jie Song
- Department of Anaesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chen Cheng
- Department of Anaesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Kui Sheng
- Department of Anaesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ling-Ling Jiang
- Department of Anaesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yun Li
- Department of Anaesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiao-Qiong Xia
- Department of Anaesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.,Department of Anaesthesiology, The Chaohu Affliated Hospital of Anhui Medical University, Hefei, China
| | - Xian-Wen Hu
- Department of Anaesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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5
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Visser L, Prent A, Banning LBD, van Leeuwen BL, Zeebregts CJ, Pol RA. Risk Factors for Delirium after Vascular Surgery: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2021; 76:500-513. [PMID: 33905851 DOI: 10.1016/j.avsg.2021.03.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/05/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Vascular surgery is considered a risk factor for the development of postoperative delirium (POD). In this systematic review we provide a report on the incidence and risk-factors of POD after vascular surgery. METHODS A systematic literature search was conducted using Pubmed with the MeSH terms and key words "delirium" or "confusion", "vascular surgery procedures" and "risk factors or "risk assessment". Studies were selected for review after meeting the following inclusion criteria: vascular surgery, POD diagnosed using validated screening tools, and DSM-derived criteria to assess delirium. A meta-analysis was performed for each endpoint if at least two studies could be combined. RESULTS Sixteen articles met the abovementioned criteria. The incidence of delirium ranged from 5% to 39%. Various preoperative risk factors were identified that is, age (Random MD 3.96, CI 2.57-5.35), hypertension (Fixed OR 1.30, CI 1.05-1.59), diabetes mellitus (Random OR 2.15, CI 1.30-3.56), hearing impairment (Fixed OR 1.89, CI 1.28-2.81), history of cerebrovascular incident or transient ischemic attack (Fixed OR 2.20, CI 1.68-2.88), renal failure (Fixed OR 1.61, CI 1.19-2.17), and pre-operative low haemoglobin level (fixed MD -0.76, CI -1.04 to -0.47). Intra-operative risk factors were duration of surgery (Random MD 15.68; CI 2.79-28.57), open aneurysm repair (Fixed OR 4.99, CI 3.10-8.03), aortic cross clamping time (fixed MD 7.99, CI 2.56-13.42), amputation surgery (random OR 3.77, CI 2.13-6.67), emergency surgery (Fixed OR 4.84, CI 2.81-8.32) and total blood loss (Random MD 496.5, CI 84.51-908.44) and need for blood transfusion (Random OR 3.72, CI 1.57-8.80). Regional anesthesia on the other hand, had a protective effect. Delirium was associated with longer ICU and hospital length of stay, and more frequent discharge to a care facility. CONCLUSIONS POD after vascular surgery is a frequent complication and effect-size pooling supports the concept that delirium is a heterogeneous disorder. The risk factors identified can be used to either design a validated risk factor model or individual preventive strategies for high-risk patients.
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Affiliation(s)
- Linda Visser
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Anna Prent
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Louise B D Banning
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clark J Zeebregts
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert A Pol
- Department of Surgery, Division of Transplantation Surgery, University Medical Center Groningen, Groningen, The Netherlands
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Abstract
Delirium is the most common psychiatric diagnoses encountered in patients with various medical-surgical illnesses, in all the treatment set-ups, with relatively higher incidence and prevalence in the intensive care units. As delirium is encountered in multiple specialties, it is important to understand the research on this diagnosis. This study aims to assess the research output involving patients of delirium from India. A comprehensive search was undertaken using Medline (PubMed) and other databases. Search words included were “delirium,” “delirious,” “delirium tremens” AND “India.” No filters were used. Internet and hand searches yielded 305 articles. Out of these articles, 151 had the terms “delirium,” “delirious,” “delirium tremens” in the title and these were included for the review. Additionally, 14 articles were included for the review, although these did not have these terms in the title, but delirium was one of the major outcome parameters in these studies. Majority of the papers were original articles (
n
= 81), and these were followed by, case reports (
n
= 58), review articles (
n
= 10), letter to the editor (not as case reports but as a communication;
n
= 13), editorials (
n
= 2) and one clinical practice guideline. Most of the original papers have either focused on epidemiology (incidence, prevalence, outcome, etc.), symptom profile, with occasional studies focusing on effectiveness of various pharmacological interventions. There is a dearth of research in the field of delirium from India. There is a lack of studies on biomarkers, evaluation of nonpharmacological interventions, and evaluation of prevention strategies. It is the need of the hour to carry out more studies to further our understanding of delirium in the Indian context.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjana Kathiravan
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Devakshi Dua
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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7
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Joo C, Lee S, Kang JW, Lee JD. Acupuncture for postoperative delirium (POD): A systematic review and meta-analysis protocol. Medicine (Baltimore) 2021; 100:e23822. [PMID: 33545947 PMCID: PMC7837831 DOI: 10.1097/md.0000000000023822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a form of delirium that is newly diagnosed after a surgical procedure. This study aims to examine the effectiveness and safety of acupuncture treatment for POD in patients who underwent surgery. METHODS Randomized controlled trials for patients diagnosed with POD using validated delirium assessment scales will be included in this review. Electronic databases, such as MEDLINE, EMBASE, CENTRAL, CINAHL (English DB), CNKI, Wanfang, VIP (Chinese database), KoreaMed, RISS, KISS, DBpia, OASIS (Korean DB), and J-STAGE (Japanese DB) will be searched without language limitation from their inception to October 2020. The intervention group will include patients who have received any type of acupuncture treatment for POD. The control group will include individuals with no treatment, sham acupuncture treatment, and conventional treatment. The primary outcome is the incidence of POD in each study. Quality assessment will be performed using the Cochrane risk of bias tool. A meta-analysis will be performed to pool the estimated effect. CONCLUSION This study will provide evidence for acupuncture as a potential treatment for POD, in researchers, patients, and policy makers. DISSEMINATION The result of the study will be disseminated through posters, press releases, conference presentations, and peer-reviewed papers. TRIAL REGISTRATION NUMBER OSF 2020: (https://osf.io/usvdg).
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Affiliation(s)
- Chanwoo Joo
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
- Department of Acupuncture & Moxibustion Medicine, Kyung Hee University Korean Medicine Hospital
| | - Seunghoon Lee
- Department of Acupuncture & Moxibustion Medicine, Kyung Hee University Korean Medicine Hospital
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Won Kang
- Department of Acupuncture & Moxibustion Medicine, Kyung Hee University Korean Medicine Hospital
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jae-Dong Lee
- Department of Acupuncture & Moxibustion Medicine, Kyung Hee University Korean Medicine Hospital
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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8
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Velkers C, Berger M, Gill SS, Eckenhoff R, Stuart H, Whitehead M, Austin PC, Rochon PA, Seitz D. Association Between Exposure to General Versus Regional Anesthesia and Risk of Dementia in Older Adults. J Am Geriatr Soc 2020; 69:58-67. [PMID: 33025584 DOI: 10.1111/jgs.16834] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Cognitive changes are commonly observed in older adults following surgical procedures. There are concerns that exposure to general anesthesia (GA) may contribute to an increased risk of Alzheimer's disease. Our study examined the associations between exposure to GA compared with regional anesthesia (RA) administered for elective surgical procedures and the development of dementia. DESIGN Population-based propensity matched retrospective cohort study. SETTING Linked administrative databases were accessed from ICES (formerly called the Institute for Clinical Evaluative Services) in Ontario, Canada. PARTICIPANTS We included all community-dwelling individuals aged 66 and older who underwent one of five elective surgical procedures in Ontario, Canada, between April 1, 2007, and March 31, 2011. Individuals with evidence of dementia preceding cohort entry were excluded. Individuals who received GA were matched within surgical procedures to those who received RA on age, sex, cohort entry year, and a propensity score to control for potential confounders. MEASUREMENTS The baseline characteristics of the study sample were compared before and after matching. Individuals were followed for up to 5 years following cohort entry for the occurrence of dementia using a validated algorithm. Cox proportional hazards analysis was used to determine the hazard ratio (HR) and 95% confidence interval (CI) for the association between anesthetic type and dementia. Subgroup and sensitivity analyses were undertaken. RESULTS A total of 7,499 matched pairs were included in the final analysis. Overall, no difference was observed in the risk of being diagnosed with dementia for individuals who received GA when compared with RA (HR = 1.0; 95% CI = .8-1.2). There was also no association between anesthesia and dementia in most subgroup and sensitivity analyses. CONCLUSION Elective surgery using GA was not associated with an overall elevated risk of dementia when compared with RA. Future studies are required to determine whether surgery is a risk factor for dementia irrespective of anesthetic technique.
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Affiliation(s)
- Clive Velkers
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada.,ICES, Kingston, Ontario, Canada
| | - Miles Berger
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Sudeep S Gill
- ICES, Kingston, Ontario, Canada.,Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Roderic Eckenhoff
- Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather Stuart
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | | | | | - Paula A Rochon
- ICES, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Dallas Seitz
- ICES, Kingston, Ontario, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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9
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Delirium is associated with higher mortality in transcatheter aortic valve replacement: systemic review and meta-analysis. Cardiovasc Interv Ther 2019; 35:168-176. [DOI: 10.1007/s12928-019-00592-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/23/2019] [Indexed: 12/15/2022]
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10
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Singh PM, Borle A, Makkar JK, Trikha A, Fish D, Sinha A. Haloperidol Versus 5-HT 3 Receptor Antagonists for Postoperative Vomiting and QTc Prolongation: A Noninferiority Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials. J Clin Pharmacol 2017; 58:131-143. [PMID: 28914976 DOI: 10.1002/jcph.999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/17/2017] [Indexed: 11/09/2022]
Abstract
Haloperidol is an antipsychotic with well-known antiemetic potential. It is underutilized for postoperative nausea vomiting due to reported corrected QT interval (QTc) prolongation. This meta-analysis evaluates its safety and efficacy as an antiemetic in the perioperative period. Trials comparing haloperidol to 5-HT3 -receptor antagonists (5-HT3 -RA) for 24 postoperative vomiting incidences published up to May 2017 were searched in the medical database. Comparisons were made for antiemetic efficiency variables (vomiting incidence, rescue antiemetic need, and patients with complete response) during early (until 6 hours) and late postoperative phases. Eight randomized controlled double-blinded trials were included in the final analysis. Twenty-four-hour vomiting incidence was similar in groups (fixed effects, P = 0.52, I2 = 0%). Trial-sequential analysis confirmed noninferiority of haloperidol over 5-HT3 -RAs (α = 5%, β = 20%, δ = 10%), with "information size" being 859 (required > 812). Pooled results did not demonstrate superiority/inferiority of 5-HT3 -RAs over haloperidol in all other antiemetic efficacy variables (early and delayed). Negligible heterogeneity was found in all the comparisons made. Pooled Mantel Haenszel odds ratio for QTc prolongation was equivalent in both groups (fixed effects, P = 0.23, I2 = 0%). The mean dose of haloperidol used was 1.34 mg, and no trial reported extrapyramidal side effects. Trial-sequential analysis showed statistical equivalence (α = 5%, β = 20%, δ = 10%), with information size being 745 (required > 591). Publication bias was unlikely (Egger test, X-intercept = 2.07, P = 0.10). We conclude that haloperidol is equivalent to the well-established 5-HT3 -RAs in preventing vomiting during the first day after surgery. The incidence of QTc prolongation with haloperidol is statistically equivalent to 5-HT3 -RAs and thus should not be the factor that discourages its use for treatment/prophylaxis of postoperative nausea vomiting.
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Affiliation(s)
- Preet Mohinder Singh
- Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Anuradha Borle
- Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Jeetinder Kaur Makkar
- Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjan Trikha
- Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - David Fish
- Division Chief for Critical Care, Department of Anesthesiology, Temple University Health System, Philadelphia, PA, USA
| | - Ashish Sinha
- Anesthesiology and Perioperative, Medicine, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, PA, USA
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11
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Kallenbach TF, Amado LA. Assessment of delirium in the intensive care unit. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2017. [DOI: 10.1080/22201181.2017.1332809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- TF Kallenbach
- Department of Anaesthesia, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - LA Amado
- Department of Anaesthesia, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
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12
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Epidemiologic data and trends concerning the use of regional anaesthesia for shoulder arthroscopy in the United States of America. INTERNATIONAL ORTHOPAEDICS 2016; 40:2105-2113. [DOI: 10.1007/s00264-016-3274-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 08/01/2016] [Indexed: 01/02/2023]
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13
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Khan SA, Chua HW, Hirubalan P, Karthekeyan RB, Kothandan H. Association between frailty, cerebral oxygenation and adverse post-operative outcomes in elderly patients undergoing non-cardiac surgery: An observational pilot study. Indian J Anaesth 2016; 60:102-7. [PMID: 27013748 PMCID: PMC4787120 DOI: 10.4103/0019-5049.176278] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and Aims: Although both frailty and low cerebral oxygen saturation increase the risk of post-operative complications, their relationship is yet to be investigated. The purpose of this observational study was to investigate the association between frailty, intraoperative cerebral oxygen saturation and post-operative complications in elderly patients undergoing non-cardiac surgery. Methods: After approval from the Institutional Review Board, 25 elderly patients (>65 years) undergoing non-cardiac major surgery were included in this study. Pre-operatively, all included patients were assessed for frailty and classified into frail and non-frail groups. All patients had routine intraoperative monitors, and a cerebral oximeter applied during anaesthesia. The ‘intraoperative’ anaesthesiologist and the post-operative study investigator were blinded to cerebral oximeter readings throughout the study. The incidence of significant intraoperative cerebral oxygen desaturation, adverse post-operative outcomes and length of hospital stay were compared. Statistical significance was defined as a value of P < 0.05. Results: We found that the frail group had more intraoperative cerebral desaturation (odds ratio [OR] [95% confidence interval [CI]]: 1.75 [1.11–2.75]) and longer median (interquartile range) length of hospital stay compared to the non-frail group (13.5 days [8.75–27.5] and 8 days [6–11], respectively). Furthermore, in patients with a low-baseline cerebral oxygen saturation (<55%), intraoperative cerebral desaturation (OR [95% CI]: 2.10 [1.00–4.42]), adverse post-operative outcomes (OR [95% CI]: 1.80 [1.00–3.23]) and median (interquartile range) length of hospital stay (15 days [9–31.5] vs. 9 days [6.25–13.75], P = 0.04) were significantly higher compared to subjects with higher baseline (≥55%) cerebral oxygen saturation. Conclusions: Frail patients have more intraoperative cerebral desaturation and longer lengths of hospital stay compared to non-frail patients.
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Affiliation(s)
| | | | | | - Ranjith Baskar Karthekeyan
- Department of Anaesthesiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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Bhaskar SB, Bajwa SJS. From pre-operative comorbidities to post-operative cognitive dysfunction: The challenging face of geriatric anaesthesia. Indian J Anaesth 2014; 58:248-50. [PMID: 25024464 PMCID: PMC4090987 DOI: 10.4103/0019-5049.135024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- S Bala Bhaskar
- Department of Anaesthesiology and Critical Care, Vijayanagar Institute of Medical Sciences, Bellary, Karnataka, India. E-mail:
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