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Elhadjene N, Grand N, Azarnoush K, Petrosyan A, Raissouni K, Campisi S, Sandri F, Palao JC, Awad S, Magand C, Molliex S, Ollier E, Morel J, Lanoiselee J. Regional anaesthesia via parasternal catheters inserted preoperatively and postoperative delirium after cardiac surgery: A prospective unrandomised clinical trial. Eur J Anaesthesiol 2024; 41:447-450. [PMID: 38357808 DOI: 10.1097/eja.0000000000001973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
VISUAL ABSTRACT http://links.lww.com/EJA/A927.
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Affiliation(s)
- Nory Elhadjene
- From the Département d'Anesthésie-Réanimation et Médecine Périopératoire (NE, NG, FS, JCP, SA, CM, SM, JM, JL), Département de Chirurgie Cardio-Vasculaire, Centre Hospitalier Universitaire de Saint-Etienne (KA, AP, KR, SC), Laboratoire de Pharmacologie Toxicologie, CHU Saint-Etienne (EO), Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité (NE, JM), INSERM, U1059, Dysfonction Vasculaire et Hémostase, Saint-Etienne, France (SM, EO, JL)
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Sun Z. Postoperative delirium in geriatric patients with thoracic and orthopedic surgery. J Clin Anesth 2024; 94:111399. [PMID: 38246067 DOI: 10.1016/j.jclinane.2024.111399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/17/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Zhongpeng Sun
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 33 Badachu Rd, Shijingshan District, Beijing, China.
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Rohmah I, Chen YC, Lin CJ, Tsao NH, Chiu HY. Diagnostic accuracy of the pediatric CAM-ICU, pre-school CAM-ICU, Pediatric Anesthesia Emergence Delirium and Cornell Assessment of Pediatric Delirium for detecting delirium in the pediatric intensive care unit: A systematic review and meta-analysis. Intensive Crit Care Nurs 2024; 82:103606. [PMID: 38158251 DOI: 10.1016/j.iccn.2023.103606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Delirium is a frequent complication of critical illness, affecting 34% of children admitted to pediatric intensive care units. The commonly used tools for detecting delirium in the pediatric intensive care unit include the Pediatric Confusion Assessment Method for the intensive care unit (ICU, pCAM-ICU), Preschool Confusion Assessment Method for the ICU (psCAM-ICU), Pediatric Anesthesia Emergence Delirium and the Cornell Assessment of Pediatric Delirium. DATA SOURCES We searched four electronic databases for relevant articles from inception to March 1, 2023. STUDY SELECTION All full-text observational studies examining the sensitivity and specificity of the four tools for screening delirium in the pediatric intensive care units were included. DATA EXTRACTION Two researchers independently identified articles, extracted data, and retrieved the diagnostic accuracy parameters of the pediatric CAM-ICU, pre-school CAM-ICU, Pediatric Anesthesia Emergence Delirium, and Cornell Assessment of Pediatric Delirium relative to standard references. A bivariate diagnostic statistical analysis with a random-effects model was performed. DATA SYNTHESIS Four, five, three and seven studies on the pediatric CAM-ICU, pre-school CAM-ICU, Pediatric Anesthesia Emergence Delirium, and Cornell Assessment of Pediatric Delirium, respectively, were identified. Due to the limited number of Pediatric Anesthesia Emergence Delirium articles included, no pooled diagnostic accuracy was produced. The pooled sensitivity was 0.73, 0.84, and 0.95 for the pediatric CAM-ICU, pre-school CAM-ICU, and Cornell Assessment of Pediatric Delirium, respectively, whereas the pooled specificity was 0.98, 0.90, and 0.81, respectively. The Cornell Assessment of Pediatric Delirium had greater sensitivity compared to both the pediatric CAM-ICU and pre-school CAM-ICU (both p = 0.04) and lower specificity than the pediatric CAM-ICU did (p < 0.001). Age, sample size, and mechanical ventilation use were significant moderators of the specificity of the pediatric CAM-ICU (p < 0.001, <0.001, and = 0.001, respectively). CONCLUSIONS Our data indicate that the Cornell Assessment of Pediatric Delirium is a more dependable instrument than the pediatric CAM-ICU and pre-school CAM-ICU for detecting pediatric intensive care delirium occurrence. More studies on the Pediatric Anesthesia Emergence Delirium are warranted. IMPLICATIONS FOR CLINICAL PRACTICE Healthcare providers are suggested adopting the Cornell Assessment of Pediatric Delirium into daily routine for the early detection of delirium in pediatric intensive care units.
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Affiliation(s)
| | - Yi-Chen Chen
- School of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chia-Jou Lin
- School of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Nan-Hsuan Tsao
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan; Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Hight D, Ehrhardt A, Lersch F, Luedi MM, Stüber F, Kaiser HA. Lower alpha frequency of intraoperative frontal EEG is associated with postoperative delirium: A secondary propensity-matched analysis. J Clin Anesth 2024; 93:111343. [PMID: 37995609 DOI: 10.1016/j.jclinane.2023.111343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/23/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Postoperative delirium (POD) is a serious complication of surgery, especially in the elderly patient population. It has been proposed that decreasing the amount of anesthetics by titrating to an EEG index will lower POD rate, but clear evidence is missing. A strong age-dependent negative correlation has been reported between the peak oscillatory frequency of alpha waves and end-tidal anesthetic concentration, with older patients generating slower alpha frequencies. We hypothesized, that slower alpha oscillations are associated with a higher rate of POD. METHOD Retrospective analysis of patients` data from a prospective observational study in cardiac surgical patients approved by the Bernese Ethics committee. Frontal EEG was recorded during Isoflurane effect-site concentrations of 0.7 to 0.8 and peak alpha frequency was measured at highest power between 6 and 17 Hz. Delirium was assessed by chart review. Demographic and clinical characteristics were compared between POD and non-POD groups. Selection bias was addressed using nearest neighbor propensity score matching (PSM) for best balance. This incorporated 18 variables, whereas patients with missing variable information or without an alpha oscillation were excluded. RESULT Of the 1072 patients in the original study, 828 were included, 73 with POD, 755 without. PSM allowed 328 patients into the final analysis, 67 with, 261 without POD. Before PSM, 8 variables were significantly different between POD and non-POD groups, none thereafter. Mean peak alpha frequency was significantly lower in the POD in contrast to non-POD group before and after matching (7.9 vs 8.9 Hz, 7.9 vs 8.8 Hz respectively, SD 1.3, p < 0.001). CONCLUSION Intraoperative slower frontal peak alpha frequency is independently associated with POD after cardiac surgery and may be a simple intraoperative neurophysiological marker of a vulnerable brain for POD. Further studies are needed to investigate if there is a causal link between alpha frequency and POD.
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Affiliation(s)
- Darren Hight
- Inselspital, Bern University Hospital, University of Bern, Department of Anaesthesiology & Pain Medicine, Bern, Switzerland
| | - Alexander Ehrhardt
- Inselspital, Bern University Hospital, University of Bern, Department of Anaesthesiology & Pain Medicine, Bern, Switzerland; Hirslanden Clinic Aarau, Center for Anaesthesiology and Intensive Care Medicine, Aarau, Switzerland
| | - Friedrich Lersch
- Inselspital, Bern University Hospital, University of Bern, Department of Anaesthesiology & Pain Medicine, Bern, Switzerland
| | - Markus M Luedi
- Inselspital, Bern University Hospital, University of Bern, Department of Anaesthesiology & Pain Medicine, Bern, Switzerland; Department for Anesthesiology, Intensive, Rescue and Pain medicine, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Frank Stüber
- Inselspital, Bern University Hospital, University of Bern, Department of Anaesthesiology & Pain Medicine, Bern, Switzerland
| | - Heiko A Kaiser
- Inselspital, Bern University Hospital, University of Bern, Department of Anaesthesiology & Pain Medicine, Bern, Switzerland; Hirslanden Clinic Aarau, Center for Anaesthesiology and Intensive Care Medicine, Aarau, Switzerland.
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Shang Z, Jiang Y, Fang P, Zhu W, Guo J, Li L, Liang Y, Zhang S, Ma S, Mei B, Fan Y, Xie Z, Shen Q, Liu X. The Association of Preoperative Diabetes With Postoperative Delirium in Older Patients Undergoing Major Orthopedic Surgery: A Prospective Matched Cohort Study. Anesth Analg 2024; 138:1031-1042. [PMID: 38335150 DOI: 10.1213/ane.0000000000006893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
BACKGROUND Postoperative delirium (POD) is a common form of postoperative brain dysfunction, especially in the elderly. However, its risk factors remain largely to be determined. This study aimed to investigate whether (1) preoperative diabetes is associated with POD after elective orthopedic surgery and (2) intraoperative frontal alpha power is a mediator of the association between preoperative diabetes and POD. METHODS This was a prospective matched cohort study of patients aged 60 years or more, with a preoperative diabetes who underwent elective orthopedic surgery. Nondiabetic patients were matched 1:1 to diabetic patients in terms of age, sex, and type of surgery. Primary outcome was occurrence of POD, assessed using the 3-minute Diagnostic Confusion Assessment Method (3D-CAM) once daily from 6 pm to 8 pm during the postoperative days 1-7 or until discharge. Secondary outcome was the severity of POD which was assessed for all participants using the short form of the CAM-Severity. Frontal electroencephalogram (EEG) was recorded starting before induction of anesthesia and lasting until discharge from the operating room. Intraoperative alpha power was calculated using multitaper spectral analyses. Mediation analysis was used to estimate the proportion of the association between preoperative diabetes and POD that could be explained by intraoperative alpha power. RESULTS A total of 138 pairs of eligible patients successfully matched 1:1. After enrollment, 6 patients in the diabetes group and 4 patients in the nondiabetes group were excluded due to unavailability of raw EEG data. The final analysis included 132 participants with preoperative diabetes and 134 participants without preoperative diabetes, with a median age of 68 years and 72.6% of patients were female. The incidence of POD was 16.7% (22/132) in patients with preoperative diabetes vs 6.0% (8/134) in patients without preoperative diabetes. Preoperative diabetes was associated with increased odds of POD after adjustment of age, sex, body mass index, education level, hypertension, arrhythmia, coronary heart disease, and history of stroke (odds ratio, 3.2; 95% confidence interval [CI], 1.4-8.0; P = .009). The intraoperative alpha power accounted for an estimated 20% (95% CI, 2.6-60%; P = .021) of the association between diabetes and POD. CONCLUSIONS This study suggests that preoperative diabetes is associated with an increased risk of POD in older patients undergoing major orthopedic surgery, and that low intraoperative alpha power partially mediates such association.
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Affiliation(s)
- Zixiang Shang
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yu Jiang
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Panpan Fang
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Wenjie Zhu
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Jiaxin Guo
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Lili Li
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yongjie Liang
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Sichen Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, P.R. China
| | - Shenglan Ma
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, P.R. China
| | - Bin Mei
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yinguang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, P.R. China
| | - Zhongcong Xie
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts
| | - Qiying Shen
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Xuesheng Liu
- From the Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
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Sari D, Widyastuti Y, Hendy HH, Dharma IA, Pancarani A, Krislee A. Scoring systems, expert assessment, and identification of risk factors for the emergence of delirium in paediatric patients: Prospective cohort study. Med J Malaysia 2024; 79:151-156. [PMID: 38553919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Emergence delirium (ED) is a transient irritative and dissociative state that arises after the cessation of anaesthesia in patients who do not respond to calming measures. There are many risk factors for ED, but the exact cause and underlying mechanism have not been determined because the definition of ED is still unclear in consensus. This study aims to determine ED incidence, identify ED risk factors and external validation of Watcha, Cravero and expert assessment to Pediatric Anesthesia Emergence Delirium (PAED) scoring system in ED prediction. MATERIALS AND METHODS This study is a prospective cohort study on 79 paediatrics who underwent elective surgery with general anaesthesia. Parameter measures include the incidence of ED, ED risk factors, and the relationship between PAED, Watcha, Cravero score and expert assessment. The ED risk factor was analysed using univariate and multivariate analysis. The relationship between PAED, Watcha, Cravero score, and expert assessment was determined using Receiver Operating Characteristic (ROC) curve analysis. RESULTS The incidence of ED was 22.8%. All parameters examined in this study showed p < 0.05. Watcha's scoring correlates with the PAED scoring and shows the highest discrimination ability with AUC 0.741 and p < 0.05. CONCLUSION The incidence of ED in paediatrics is relatively high. Compared to others, Watcha score are more reliable for ED prediction. However, some demographic and perioperative factors are not the risk factor of ED.
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Affiliation(s)
- D Sari
- Gadjah Mada University/Dr. Sardjito General Hospital, Faculty of Medicine, Public Health, and Nursing, Anesthesiology and Intensive Therapy Department, Yogyakarta, Indonesia.
| | - Y Widyastuti
- Gadjah Mada University/Dr. Sardjito General Hospital, Faculty of Medicine, Public Health, and Nursing, Anesthesiology and Intensive Therapy Department, Yogyakarta, Indonesia
| | - H H Hendy
- Gadjah Mada University/Dr. Sardjito General Hospital, Faculty of Medicine, Public Health, and Nursing, Yogyakarta, Indonesia
| | - I A Dharma
- Gadjah Mada University/Dr. Sardjito General Hospital, Faculty of Medicine, Public Health, and Nursing, Yogyakarta, Indonesia
| | - A Pancarani
- Gadjah Mada University/Dr. Sardjito General Hospital, Faculty of Medicine, Public Health, and Nursing, Yogyakarta, Indonesia
| | - A Krislee
- Gadjah Mada University/Dr. Sardjito General Hospital, Faculty of Medicine, Public Health, and Nursing, Yogyakarta, Indonesia
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Ou-yang CL, Ma LB, Wu XD, Ma YL, Liu YH, Tong L, Li H, Lou JS, Cao JB, Mi WD. Association of sleep quality on the night of operative day with postoperative delirium in elderly patients: A prospective cohort study. Eur J Anaesthesiol 2024; 41:226-233. [PMID: 38230449 PMCID: PMC10842671 DOI: 10.1097/eja.0000000000001952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Sleep disturbances in the peri-operative period have been associated with adverse outcomes, including postoperative delirium (POD). However, research on sleep quality during the immediate postoperative period is limited. OBJECTIVES This study aimed to investigate the association between sleep quality on the night of the operative day assessed using the Sleep Quality Numeric Rating Scale (SQ-NRS), and the incidence of POD in a large cohort of surgical patients. DESIGN A prospective cohort study. SETTING A tertiary hospital in China. PATIENTS This study enrolled patients aged 65 years or older undergoing elective surgery under general anaesthesia. The participants were categorised into the sleep disturbance and no sleep disturbance groups according to their operative night SQ-NRS. MAIN OUTCOME MEASURES The primary outcome was delirium incidence, whereas the secondary outcomes included acute kidney injury, stroke, pulmonary infection, cardiovascular complications and all-cause mortality within 1 year postoperatively. RESULTS In total, 3072 patients were included in the analysis of this study. Among them, 791 (25.72%) experienced sleep disturbances on the night of operative day. Patients in the sleep disturbance group had a significantly higher risk of developing POD (adjusted OR 1.43, 95% CI 1.11 to 1.82, P = 0.005). Subgroup analysis revealed that age 65-75 years; male sex; ASA III and IV; haemoglobin more than 12 g l -1 ; intra-operative hypotension; surgical duration more than 120 min; and education 9 years or less were significantly associated with POD. No interaction was observed between the subgroups. No significant differences were observed in the secondary outcomes, such as acute kidney injury, stroke, pulmonary infection, cardiovascular complications and all-cause mortality within 1 year postoperatively. CONCLUSIONS The poor subjective sleep quality on the night of operative day was independently associated with increased POD risk, especially in certain subpopulations. Optimising peri-operative sleep may reduce POD. Further research should investigate potential mechanisms and causal relationships. TRIAL REGISTRY chictr.org.cn: ChiCTR1900028545.
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Aldecoa C, Bettelli G, Bilotta F, Sanders RD, Aceto P, Audisio R, Cherubini A, Cunningham C, Dabrowski W, Forookhi A, Gitti N, Immonen K, Kehlet H, Koch S, Kotfis K, Latronico N, MacLullich AMJ, Mevorach L, Mueller A, Neuner B, Piva S, Radtke F, Blaser AR, Renzi S, Romagnoli S, Schubert M, Slooter AJC, Tommasino C, Vasiljewa L, Weiss B, Yuerek F, Spies CD. Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients. Eur J Anaesthesiol 2024; 41:81-108. [PMID: 37599617 PMCID: PMC10763721 DOI: 10.1097/eja.0000000000001876] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Postoperative delirium (POD) remains a common, dangerous and resource-consuming adverse event but is often preventable. The whole peri-operative team can play a key role in its management. This update to the 2017 ESAIC Guideline on the prevention of POD is evidence-based and consensus-based and considers the literature between 01 April 2015, and 28 February 2022. The search terms of the broad literature search were identical to those used in the first version of the guideline published in 2017. POD was defined in accordance with the DSM-5 criteria. POD had to be measured with a validated POD screening tool, at least once per day for at least 3 days starting in the recovery room or postanaesthesia care unit on the day of surgery or, at latest, on postoperative day 1. Recent literature confirmed the pathogenic role of surgery-induced inflammation, and this concept reinforces the positive role of multicomponent strategies aimed to reduce the surgical stress response. Although some putative precipitating risk factors are not modifiable (length of surgery, surgical site), others (such as depth of anaesthesia, appropriate analgesia and haemodynamic stability) are under the control of the anaesthesiologists. Multicomponent preoperative, intra-operative and postoperative preventive measures showed potential to reduce the incidence and duration of POD, confirming the pivotal role of a comprehensive and team-based approach to improve patients' clinical and functional status.
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Affiliation(s)
- César Aldecoa
- From the Department of Anaesthesia and Postoperative Critical Care, Hospital Universitario Rio Hortega, Valladolid, Spain (CA), Department of Biomedical Studies, University of the Republic of San Marino, San Marino (GB), Department of Anesthesiology, Critical Care and Pain Medicine, 'Sapienza' University of Rome, Rome, Italy (FB, AF, LM), Specialty of Anaesthetics & NHMRC Clinical Trials Centre, University of Sydney & Department of Anaesthetics and Institute of Academic Surgery, Royal Prince Alfred Hospital (RDS), Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt Universität zu Berlin, Campus Charité Mitte, and Campus Virchow Klinikum (CDS, SK, AM, BN, LV, BW, FY), Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (PA), Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy (PA), Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden (RA), Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy (AC), School of Biochemistry and Immunology and Trinity College Institute of Neuroscience, Trinity College, Dublin, Ireland (CC), First Department of Anaesthesiology and Intensive Care Medical University of Lublin, Poland (WD), Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland (KI), Section of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (HK), Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland (KK), Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia (NG, NL, SP, SR), Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy (NL, SP), Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom (AMJM), Department of Anaesthesia and Intensive Care, Nykoebing Hospital; University of Southern Denmark, SDU (SK, FR), Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia (ARB), Center for Intensive Care Medicine, Luzerner Kantonsspital, Lucerne, Switzerland (ARB), Department of Health Science, Section of Anesthesiology, University of Florence (SR), Department of Anaesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy (SR), School of Health Sciences, Institute of Nursing, ZHAW Zurich University of Applied Science, Winterthur, Switzerland (MS), Departments of Psychiatry and Intensive Care Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (AJCS), Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium (AJCS) and Dental Anesthesia and Intensive Care Unit, Polo Universitario Ospedale San Paolo, Department of Biomedical, Surgical and Odontoiatric Sciences, University of Milano, Milan, Italy (CT)
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Bruder N, Chew M. Guidelines on postoperative delirium: Where do we go from here? Eur J Anaesthesiol 2024; 41:79-80. [PMID: 38164095 DOI: 10.1097/eja.0000000000001935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Nicolas Bruder
- From the Department of Anaesthesiology and Intensive care, Hôpital de la Conception, Aix-Marseille University, Marseille, France (NB), the Department of Intensive care and Acute Medicine, Linköping University Hospital, Linköping, Sweden (MC)
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Acker L, Wong MK, Wright MC, Reese M, Giattino CM, Roberts KC, Au S, Colon-Emeric C, Lipsitz LA, Devinney MJ, Browndyke J, Eleswarpu S, Moretti E, Whitson HE, Berger M, Woldorff MG. Preoperative electroencephalographic alpha-power changes with eyes opening are associated with postoperative attention impairment and inattention-related delirium severity. Br J Anaesth 2024; 132:154-163. [PMID: 38087743 PMCID: PMC10797508 DOI: 10.1016/j.bja.2023.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In the eyes-closed, awake condition, EEG oscillatory power in the alpha band (7-13 Hz) dominates human spectral activity. With eyes open, however, EEG alpha power substantially decreases. Less alpha attenuation with eyes opening has been associated with inattention; thus, we analysed whether reduced preoperative alpha attenuation with eyes opening is associated with postoperative inattention, a delirium-defining feature. METHODS Preoperative awake 32-channel EEG was recorded with eyes open and eyes closed in 71 non-neurological, noncardiac surgery patients aged ≥ 60 years. Inattention and other delirium features were assessed before surgery and twice daily after surgery until discharge. Eyes-opening EEG alpha-attenuation magnitude was analysed for associations with postoperative inattention, primarily, and with delirium severity, secondarily, using multivariate age- and Mini-Mental Status Examination (MMSE)-adjusted logistic and proportional-odds regression analyses. RESULTS Preoperative alpha attenuation with eyes opening was inversely associated with postoperative inattention (odds ratio [OR] 0.73, 95% confidence interval [CI]: 0.57, 0.94; P=0.038). Sensitivity analyses showed an inverse relationship between alpha-attenuation magnitude and inattention chronicity, defined as 'never', 'newly', or 'chronically' inattentive (OR 0.76, 95% CI: 0.62, 0.93; P=0.019). In addition, preoperative alpha-attenuation magnitude was inversely associated with postoperative delirium severity (OR 0.79, 95% CI: 0.65, 0.95; P=0.040), predominantly as a result of the inattention feature. CONCLUSIONS Preoperative awake, resting, EEG alpha attenuation with eyes opening might represent a neural biomarker for risk of postoperative attentional impairment. Further, eyes-opening alpha attenuation could provide insight into the neural mechanisms underlying postoperative inattention risk.
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Affiliation(s)
- Leah Acker
- Department of Anaesthesiology, Duke University School of Medicine, Durham, NC, USA; Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA; Center for Cognitive Neuroscience, Duke University, Durham, NC, USA; Duke-UNC Alzheimer's Disease Research Center, Durham, NC, USA.
| | - Megan K Wong
- Department of Anaesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Mary C Wright
- Department of Anaesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Melody Reese
- Department of Anaesthesiology, Duke University School of Medicine, Durham, NC, USA; Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Sandra Au
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
| | - Cathleen Colon-Emeric
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA; Duke-UNC Alzheimer's Disease Research Center, Durham, NC, USA; Division of Geriatric Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael J Devinney
- Department of Anaesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Jeffrey Browndyke
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA; Center for Cognitive Neuroscience, Duke University, Durham, NC, USA; Geriatrics Research Education and Clinical Center, Durham VA Medical Center, Durham, NC, USA
| | - Sarada Eleswarpu
- Department of Anaesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Eugene Moretti
- Department of Anaesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Heather E Whitson
- Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA; Duke-UNC Alzheimer's Disease Research Center, Durham, NC, USA; Division of Geriatric Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Geriatrics Research Education and Clinical Center, Durham VA Medical Center, Durham, NC, USA
| | - Miles Berger
- Department of Anaesthesiology, Duke University School of Medicine, Durham, NC, USA; Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA; Center for Cognitive Neuroscience, Duke University, Durham, NC, USA; Duke-UNC Alzheimer's Disease Research Center, Durham, NC, USA
| | - Marty G Woldorff
- Center for Cognitive Neuroscience, Duke University, Durham, NC, USA; Division of Behavioural Medicine & Neurosciences, Department of Psychiatry & Behavioural Sciences, Duke University Medical Center, Durham, NC, USA; Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
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Urbánek L, Urbánková P, Satinský I, Trávníček T, Penka I, Hruda J. Postoperative delirium. Rozhl Chir 2024; 102:381-386. [PMID: 38302424 DOI: 10.33699/pis.2023.102.10.381-386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Postoperative delirium is a serious complication occurring mainly in patients over 65 years. This complication is common in the above mentioned age group and has been described in up to 50% of patients. Postoperative delirium has a significant impact both on postoperative morbidity and mortality. Systematic and early detection of at-risk patients is essential to reduce the risk of postoperative delirium. Targeted efforts are then developed in thus identified patients to reduce the risk factors for developing delirium. An individualized approach to anesthesia is adopted during the surgery. Procedures that contribute to reducing the risk of developing delirium are preferred in the postoperative period. If this complication does occur, it is primarily preferred to manage any potential cause of the condition using non-pharmacological procedures. Pharmacological interven- tion should be reserved only for patients with a hyperactive form of delirium. The aim of the article was to shed more light on measures that help to prevent the delirium and on the therapeutic procedures used.
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Wang Y, Jiang Y, Fu H, Zhao Y, Xu Z. The clinical value of the Duke Anesthesia Resistance Scale in predicting postoperative delirium after hip fracture surgery: a retrospective study. PeerJ 2023; 11:e16535. [PMID: 38077438 PMCID: PMC10704981 DOI: 10.7717/peerj.16535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Aim This study aims to investigate the clinical value of the Duke Anesthesia Resistance Scale (DARS) in predicting postoperative delirium (POD) after hip fracture surgery. Methods A retrospective study was conducted. Clinical data were collected from the patients who had hip fracture and underwent elective total hip arthroplasty in Shaanxi Provincial People's Hospital, Third Affiliated Hospital of Xi'an Jiaotong University between January 2022 and June 2023. The Consciousness Fuzzy Assessment Scale was used to evaluate the occurrence of POD on postoperative day 3 (POD 3). The enrolled patients were divided into the POD group (n = 26) and the non-POD group (n = 125). Baseline characteristics, surgical data, postoperative information, and laboratory test results were collected. DARS scores were calculated using the minimum alveolar concentration, end-tidal concentration average (ETAC), and bispectral index (BIS). Multivariate logistic regression analysis was conducted to recognize the independent risk factors for POD after hip fracture surgery. Receiver operating characteristic (ROC) curve was plotted to evaluate the value of DARS in POD prediction. Results The average age of POD group was significantly higher, comparing to non-POD group (P < 0.05). DARS scores were statistically lower in the POD group compared to non-POD group (P < 0.05). Multivariate logistic regression analysis found that age and DARS scores were factors impacting post-operative delirium occurrence after hip fracture surgery (P < 0.05). ROC showed that the area under the curve for DARS in predicting POD after hip fracture surgery was 0.929 (95% CI [0.861-0.997]). The optimal cutoff value was 30. The sensitivity was 95.45%, while the specificity was 84.09%. Conclusion DARS score demonstrates good predictive value in hip fracture patients and is feasible in clinical practice, making it suitable for clinical application and promotion.
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Affiliation(s)
- Yaya Wang
- Department of Anesthesiology, Shaanxi Provincial People’s Hospital, Third Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yan’an Jiang
- Department of Anesthesiology, Shaanxi Provincial People’s Hospital, Third Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Huajun Fu
- Department of Anesthesiology, Shaanxi Provincial People’s Hospital, Third Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yikang Zhao
- Department of Anesthesiology, Shaanxi Provincial People’s Hospital, Third Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Zhao Xu
- Department of Anesthesiology, Shaanxi Provincial People’s Hospital, Third Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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Olotu C, Lebherz L, Ascone L, Scherwath A, Kühn S, Härter M, Kiefmann R. Cognitive Deficits in Executive and Language Functions Predict Postoperative Delirium. J Cardiothorac Vasc Anesth 2023; 37:2552-2560. [PMID: 37778949 DOI: 10.1053/j.jvca.2023.08.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES Postoperative delirium (POD) remains the most common complication in older adults, with cognitive impairment being the main risk factor. Patients with mild cognitive impairment, in particular, have much to lose from delirium; despite this, their cognitive impairment might be clinically overlooked. Understanding which cognitive domains are particularly predictive in this regard may improve the sensitivity of preoperative testing and allow for a more targeted application of resource-intensive measures to prevent delirium in the perioperative period. The authors conducted this study with the aim of identifying the most indicative cognitive domains. DESIGN A secondary analysis of a randomized controlled trial. SETTING At a single center, the University Medical Centre Hamburg in Hamburg, Germany. PARTICIPANTS Patients ≥60 years without major neurocognitive disorders (dementia, Mini-Mental State Examination score ≤23) scheduled for cardiovascular surgery. MEASUREMENTS AND MAIN RESULTS Preoperative neuropsychologic testing and delirium screening were performed twice daily until postoperative day 5. A multiple logistic regression model was applied to determine the predictive ability of test performances for the development of delirium. RESULTS A total of 541 patients were included in the analysis; the delirium rate was 15.6%. After controlling for confounders, only low performance within the Trail Making Test B/A (odds ratio [OR] = 1.32; 95% CI: 1.05-1.66) and letter fluency (OR = 0.66; 95% CI: 0.45-0.96) predicted a particularly high risk for delirium development. The discriminative ability of the final multiple logistic regression model to predict POD had an area under the curve of 0.786. CONCLUSIONS Impairment in the cognitive domains of executive function and language skills associated with memory, inhibition, and access speed seem to be particularly associated with the development of delirium after surgery in adults ≥65 years of age without apparent preoperative neurocognitive impairment.
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Affiliation(s)
- Cynthia Olotu
- Department of Anaesthesiology, University Medical Center Hamburg, Hamburg, Germany.
| | - Lisa Lebherz
- Institute of Medical Psychology, University Medical Center Hamburg, Hamburg, Germany
| | - Leonie Ascone
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany
| | - Angela Scherwath
- Institute of Medical Psychology, University Medical Center Hamburg, Hamburg, Germany; Department of Stem Cell Transplantation, University Medical Center Hamburg, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany
| | - Martin Härter
- Institute of Medical Psychology, University Medical Center Hamburg, Hamburg, Germany
| | - Rainer Kiefmann
- Department of Anaesthesiology, University Medical Center Hamburg, Hamburg, Germany; Anesthesia Department, Rotkreuzklinikum Munich, Munich, Germany
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Kinoshita H, Saito J, Kushikata T, Oyama T, Takekawa D, Hashiba E, Sawa T, Hirota K. The Perioperative Frontal Relative Ratio of the Alpha Power of Electroencephalography for Predicting Postoperative Delirium After Highly Invasive Surgery: A Prospective Observational Study. Anesth Analg 2023; 137:1279-1288. [PMID: 36917508 DOI: 10.1213/ane.0000000000006424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
BACKGROUND We investigated the associations between postoperative delirium (POD) and both the relative ratio of the alpha (α)-power of electroencephalography (EEG) and inflammatory markers in a prospective, single-center observational study. METHODS We enrolled 84 patients who underwent radical cancer surgeries with reconstruction for esophageal cancer, oral floor cancer, or pharyngeal cancer under total intravenous anesthesia. We collected the perioperative EEG data and the perioperative data of the inflammatory markers, including neutrophil gelatinase-associated lipocalin, presepsin, procalcitonin, C-reactive protein, and the neutrophil-lymphocyte ratio (NLR). The existence of POD was evaluated based on the Intensive Care Delirium Screening Checklist. We compared the time-dependent changes in the relative ratio of the EEG α-power and inflammatory markers between the patients with and without POD. RESULTS Four of the 84 patients were excluded from the analysis. Of the remaining 80 patients, 25 developed POD and the other 55 did not. The relative ratio of the α-power at baseline was significantly lower in the POD group than the non-POD group (0.18 ± 0.08 vs 0.28 ± 0.11, P < .001). A time-dependent decline in the relative ratio of α-power in the EEG during surgery was observed in both groups. There were significant differences between the POD and non-POD groups in the baseline, 3-h, 6-h, and 9-h values of the relative ratio of α-power. The preoperative NLR of the POD group was significantly higher than that of the non-POD group (2.88 ± 1.04 vs 2.22 ± 1.00, P < .001), but other intraoperative inflammatory markers were comparable between the groups. Two multivariable logistic regression models demonstrated that the relative ratio of the α-power at baseline was significantly associated with POD. CONCLUSIONS Intraoperative frontal relative ratios of the α-power of EEG were associated with POD in patients who underwent radical cancer surgery. Intraoperative EEG monitoring could be a simple and more useful tool for predicting the development of postoperative delirium than measuring perioperative acute inflammatory markers. A lower relative ratio of α-power might be an effective marker for vulnerability of brain and ultimately for the development of POD.
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Affiliation(s)
- Hirotaka Kinoshita
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Junichi Saito
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tetsuya Kushikata
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tasuku Oyama
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daiki Takekawa
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Hashiba
- Division of Intensive Care, Hirosaki University Medical Hospital, Hirosaki, Japan
| | - Teiji Sawa
- Department of Anesthesiology, School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuyoshi Hirota
- From the Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Suzuki Y, Miyasaka KW, Hayashi K, Takahashi O, Nagasaka Y. Protocol for a randomized controlled trial to reduce pediatric anesthesia emergence delirium by titration of sevoflurane anesthesia using brain function monitoring. Trials 2023; 24:734. [PMID: 37974297 PMCID: PMC10655373 DOI: 10.1186/s13063-023-07785-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Emergence agitation or emergence delirium is a common complication of unknown etiology in pediatric anesthesia. Pediatric anesthesia emergence delirium (PAED) has been reported most commonly in younger children and may occur in about 30% of children up to 5-6 years old. Exposure to anesthetic agents may contribute to PAED, and we hypothesized that a management strategy to minimize exposure to volatile anesthetics may reduce PAED. Electroencephalography (EEG) signatures captured and displayed by brain function monitors during anesthesia change with concentration of sevoflurane and level of unconsciousness, and these EEG signatures may be used to inform titration of anesthetics. METHODS A single-center, parallel-group, two-arm, superiority trial with a 1:1 allocation ratio will be performed to compare the incidence of PAED following standard sevoflurane anesthesia (maintained at 1.0MAC) and EEG-guided anesthesia (minimum concentration to sustain surgical anesthesia as determined by monitoring of EEG signatures). Participants between 1 and 6 years of age undergoing surgical procedures involving minimal postoperative pain will be randomly assigned to receive standard (n = 90) or EEG-guided (n = 90) anesthesia. PAED score will be assessed by a blinded observer in the PACU on arrival and after 5, 10, 15, and 30 min. DISCUSSION Anesthesia management with proactive use of brain function monitoring is expected to reduce exposure to sevoflurane without compromising surgical anesthesia. We expect this reduced exposure should help prevent PAED. Routinely administering what may be considered standard levels of anesthetic such as 1.0 MAC sevoflurane may be excessive and potentially associated with unfavorable sequelae such as PAED. TRIAL REGISTRATION Japan Registry of Clinical Trials (jRCT) jRCTs032210248. Prospectively registered on 17 August 2021.
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Affiliation(s)
- Yasuyuki Suzuki
- National Center for Child Health and Development, Tokyo, Japan
- Tokyo Women's Medical University, Tokyo, Japan
| | - Kiyoyuki W Miyasaka
- National Center for Child Health and Development, Tokyo, Japan.
- Tokyo Women's Medical University, Tokyo, Japan.
- St. Luke's International University, Tokyo, Japan.
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Hao D, Fritz BA, Saddawi-Konefka D, Palanca BJA. Pro-Con Debate: Electroencephalography-Guided Anesthesia for Reducing Postoperative Delirium. Anesth Analg 2023; 137:976-982. [PMID: 37862399 DOI: 10.1213/ane.0000000000006399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Postoperative delirium (POD) has significant implications on morbidity, mortality, and health care expenditures. Monitoring electroencephalography (EEG) to adjust anesthetic management has gained interest as a strategy to mitigate POD. In this Pro-Con commentary article, the pro side supports the use of EEG to reduce POD, citing an empiric reduction in POD with processed EEG (pEEG)-guided general anesthesia found in several studies and recent meta-analysis. The Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) trial is the exception to this, and issues with methods and achieved depths are discussed. Meanwhile, the Con side advocates that the use of EEG to reduce POD is not yet certain, citing that there is a lack of evidence that associations between anesthetic depth and POD represent causal relationships. The Con side also contends that the ideal EEG signatures to guide anesthetic titration are currently unknown, and the potential benefits of reduced anesthesia levels may be outweighed by the risks of potentially insufficient anesthetic administration. As the public health burden of POD increases, anesthesia clinicians will be tasked to consider interventions to mitigate risk such as EEG. This Pro-Con debate will provide 2 perspectives on the evidence and rationales for using EEG to mitigate POD.
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Affiliation(s)
- David Hao
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bradley A Fritz
- Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri
| | - Daniel Saddawi-Konefka
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ben Julian A Palanca
- Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri
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17
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Gaskell A, Sleigh JW. The Aporia of Postoperative Delirium. Anesth Analg 2023; 137:973-975. [PMID: 37862398 DOI: 10.1213/ane.0000000000006488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Affiliation(s)
- Amy Gaskell
- From the Department of Anaesthesia, University of Auckland, Hamilton, New Zealand
| | - Jamie W Sleigh
- Department of Anaesthesia and Pain Medicine, Waikato Hospital, Hamilton, New Zealand
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Melguizo Herrera E, Manrique Anaya Y, Torres Contreras C, Rivera Carvajal R, Hueso Montoro C. Validation of Nursing Outcome Indicators in Patients with Postsurgical Delirium. Invest Educ Enferm 2023; 41. [PMID: 38589311 DOI: 10.17533/udea.iee.v41n3e11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Objective To validate the content of the indicators proposed from the Nursing Outcome Classification in a care plan for delirium management in older adults. Methods Content validity study, conducted under the expert judgment technique. The procedure was developed in five moments: organization of indicators that respond to the nursing outcome classification for delirium management, support with literature of the indicators that responds to the result, selection of experts, establishment of agreements, and discussion. Quality criteria evaluated: pertinence and relevance, the Content Validity Coefficient and average scores assigned by the experts were calculated. Results The study had the participation of 14 experts. The indicators, according to criteria of pertinence and relevance evaluated by experts showed a global average content index value of 0.93; 97.05% (66) of the indicators had Content Validity Coefficient > 0.75. Conclusion The quantitative findings of the indicator validation process showed high relevance and pertinence index, which favors their being applied to measure care changes in patients with delirium.
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Affiliation(s)
| | | | - Claudia Torres Contreras
- Nurse, PhD. Professor. Faculty of Medical and Health Sciences, Universidad de Santander. Bucaramanga, Colombia.
| | - Raquel Rivera Carvajal
- Nurse, Masters. Professor. Faculty of Medical and Health Sciences, Universidad de Santander. Bucaramanga, Colombia.
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Chen YC, Hung IY, Hung KC, Chang YJ, Chu CC, Chen JY, Ho CH, Yu CH. Incidence change of postoperative delirium after implementation of processed electroencephalography monitoring during surgery: a retrospective evaluation study. BMC Anesthesiol 2023; 23:330. [PMID: 37794315 PMCID: PMC10548752 DOI: 10.1186/s12871-023-02293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a common complication in the elderly, which is associated with poor outcomes after surgery. Recognized as predisposing factors for POD, anesthetic exposure and burst suppression during general anesthesia can be minimized with intraoperative processed electroencephalography (pEEG) monitoring. In this study, we aimed to evaluate whether implementation of intraoperative pEEG-guided anesthesia is associated with incidence change of POD. METHODS In this retrospective evaluation study, we analyzed intravenous patient-controlled analgesia (IVPCA) dataset from 2013 to 2017. There were 7425 patients using IVPCA after a noncardiac procedure under general anesthesia. Patients incapable of operating the device independently, such as cognitive dysfunction or prolonged sedation, were declined and not involved in the dataset. After excluding patients who opted out within three days (N = 110) and those with missing data (N = 24), 7318 eligible participants were enrolled. Intraoperative pEEG has been implemented since July 2015. Participants having surgery after this time point had intraoperative pEEG applied before induction until full recovery. All related staff had been trained in the application of pEEG-guided anesthesia and the assessment of POD. Patients were screened twice daily for POD within 3 days after surgery by staff in the pain management team. In the first part of this study, we compared the incidence of POD and its trend from 2013 January-2015 July with 2015 July-2017 December. In the second part, we estimated odds ratios of risk factors for POD using multivariable logistic regression in case-control setting. RESULTS The incidence of POD decreased from 1.18 to 0.41% after the administration of intraoperative pEEG. For the age group ≧ 75 years, POD incidence decreased from 5.1 to 1.56%. Further analysis showed that patients with pEEG-guided anesthesia were associated with a lower odd of POD (aOR 0.33; 95% CI 0.18-0.60) than those without after adjusting for other covariates. CONCLUSIONS Implementation of intraoperative pEEG was associated with a lower incidence of POD within 3 days after surgery, particularly in the elderly. Intraoperative pEEG might be reasonably considered as part of the strategy to prevent POD in the elder population. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, Taiwan
| | - I-Yin Hung
- Department of Anesthesiology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, Taiwan
- Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, 60 Erren Road, Rende District, Tainan, Taiwan
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, Taiwan
- Department of Recreation and Health Care Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, 60 Erren Road, Rende District, Tainan, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, 1 Nantai St, Yongkang District, Tainan, Taiwan
| | - Chia-Hung Yu
- Department of Anesthesiology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, Taiwan.
- Department of Computer Science and Information Engineering, Southern Taiwan University of Science and Technology, 1 Nantai St, Yongkang District, Tainan, Taiwan.
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Dexmedetomidine for prevention of postoperative delirium in older adults undergoing oesophagectomy with total intravenous anaesthesia. A double-blind, randomised clinical trial: Erratum. Eur J Anaesthesiol 2023; 40:799. [PMID: 37678205 DOI: 10.1097/EJA.0000000000001899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
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Khalifa C, Lenoir C, Robert A, Watremez C, Kahn D, Mastrobuoni S, Aphram G, Ivanoiu A, Bonhomme V, Mouraux A, Momeni M. Intra-operative electroencephalogram frontal alpha-band spectral analysis and postoperative delirium in cardiac surgery: A prospective cohort study. Eur J Anaesthesiol 2023; 40:777-787. [PMID: 37551153 DOI: 10.1097/eja.0000000000001895] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND Postoperative delirium (POD) remains a frequent complication after cardiac surgery, with pre-operative cognitive status being one of the main predisposing factors. However, performing complete pre-operative neuropsychological testing is challenging. The magnitude of frontal electroencephalographic (EEG) α oscillations during general anaesthesia has been related to pre-operative cognition and could constitute a functional marker for brain vulnerability. OBJECTIVE We hypothesised that features of intra-operative α-band activity could predict the occurrence of POD. DESIGN Single-centre prospective observational study. SETTING University hospital, from 15 May 2019 to 15 December 2021. PATIENTS Adult patients undergoing elective cardiac surgery. MAIN OUTCOME MEASURES Pre-operative cognitive status was assessed by neuropsychological tests and scored as a global z score. A 5-min EEG recording was obtained 30 min after induction of anaesthesia. Anaesthesia was maintained with sevoflurane. Power and peak frequency in the α-band were extracted from the frequency spectra. POD was assessed using the Confusion Assessment Method for Intensive Care Unit, the Confusion Assessment Method and a chart review. RESULTS Sixty-five (29.5%) of 220 patients developed POD. Delirious patients were significantly older with median [IQR] ages of 74 [64 to 79] years vs. 67 [59 to 74] years; P < 0.001) and had lower pre-operative cognitive z scores (-0.52 ± 1.14 vs. 0.21 ± 0.84; P < 0.001). Mean α power (-14.03 ± 4.61 dB vs. -11.59 ± 3.37 dB; P < 0.001) and maximum α power (-11.36 ± 5.28 dB vs. -8.85 ± 3.90 dB; P < 0.001) were significantly lower in delirious patients. Intra-operative mean α power was significantly associated with the probability of developing POD (adjusted odds ratio, 0.88; 95% confidence interval (CI), 0.81 to 0.96; P = 0.007), independently of age and only whenever cognitive status was not considered. CONCLUSION A lower intra-operative frontal α-band power is associated with a higher incidence of POD after cardiac surgery. Intra-operative measures of α power could constitute a means of identifying patients at risk of this complication. TRIAL REGISTRATION NCT03706989.
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Affiliation(s)
- Céline Khalifa
- From the Department of Anaesthesiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain) (CK, CW, DK, MM), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain (UCLouvain) (CK, AR, CW, DK, SM, GA, MM), Institute of Neuroscience (IoNS), Université catholique de Louvain (UCLouvain) (CK, CL, CW, AI, AM, MM), Department of Epidemiology and Biostatistics, Université catholique de Louvain (UCLouvain) (AR), Department of Cardiothoracic and Vascular Surgery, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain) (SM, GA), Department of Neurology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels (AI), Department of Anaesthesia and Intensive Care Medicine, Liège University Hospital (VB) and Anaesthesia and Peri-operative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liege University, Liege, Belgium (VB)
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Affiliation(s)
- Zhongpeng Sun
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China,
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Weidner E, Hancke L, Nydahl P, Spies C, Lütz A. [Non-pharmacological Management of Postoperative Delirium]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:494-512. [PMID: 37725991 DOI: 10.1055/a-2065-3764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Postoperative delirium is common especially in the elderly and is associated with high rates of morbidity and mortality. Non-pharmacological multicomponent interventions are effective in reducing the incidence and to a degree the duration of postoperative delirium and are recommended in international guidelines on postoperative delirium as first line intervention for management of delirium. Non-pharmacological management of postoperative delirium consists of strategies for risk stratification, risk reduction by non-pharmacological bundle interventions, early recognition of delirium by screening protocols and immediate therapy of underlying causes of delirium and continuation of non-pharmacological bundles. Non-pharmacological bundle interventions address common perioperative risk factors. Bundles comprise strategies for oxygenation, mobilization, hydration and nutrition, sensory and cognitive stimulation, reorientation, modifications of environmental factors such as design aspects and noise reduction, adequate analgesia, management of agitation and anxiety, protecting circadian rhythms for example by adequate light exposure during daytime, family involvement and timely reduction of unnecessary catheters and anticholinergic drugs. The article aims at providing an overview of non-pharmacological management of postoperative delirium in the hospital.
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Abstract
Postoperative delirium (POD) is a complex disorder with significant implications for health and well-being. Over the last few years, there has been a significant increase in awareness of the pathophysiological processes, the different clinical forms and the prevention of POD. It is known that POD develops when anaesthetic- and surgery-related precipitating factors coincide with the patient's predisposing vulnerability. Consequently, assessing the preoperative physical, cognitive, psychological, social and resilience capabilities of patients scheduled for surgery is critical to assessing overall risk and determining optimal preoperative, intraoperative and postoperative management, particularly as pharmacological treatment options remain limited. For treatment, non-pharmacological measures remain in the foreground, pharmacological therapy is only used for severe symptoms, and should be symptom-oriented and low-dosed. There is no drug that is suitable for delirium treatment alone.
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Yürek F, Lachmann C. [Postoperative Delirium]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:480-481. [PMID: 37725989 DOI: 10.1055/a-2127-8081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
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Wiredu K, O’Connor S, Naseem H, Brauer BL, Kettenbach AN, Frost HR, Shaefi S, Gerber SA. Intraoperative plasma proteomic changes in cardiac surgery: In search of biomarkers of post-operative delirium. Proteomics Clin Appl 2023; 17:e2200066. [PMID: 36567636 PMCID: PMC10290728 DOI: 10.1002/prca.202200066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 12/02/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Delirium presents a significant healthcare burden. It complicates post-operative care in up to 50% of cardiac surgical patients with worse outcomes, longer hospital stays and higher cost of care. Moreover, the nature of delirium following cardiac surgery with cardiopulmonary bypass (CPB) remains unclear, the underlying pathobiology is poorly understood, status quo diagnostic methods are subjective, and diagnostic biomarkers are currently lacking. OBJECTIVE To identify diagnostic biomarkers of delirium and for insights into possible neuronal pathomechanisms. EXPERIMENTAL DESIGN Comparative proteomic analyses were performed on plasma samples from a nested matched cohort of patients who underwent cardiac surgery. Validation by targeted proteomics was performed in an independent set of samples. Biomarkers were assessed for biological functions and diagnostic accuracy. RESULTS Forty-seven percent of subjects demonstrated delirium. Of 3803 proteins identified from patient samples by multiplexed quantitative proteomics, 16 were identified as signatures of exposure to CPB, and 11 biomarkers distinguished delirium cases from non-cases (AuROC = 93%). Notable among these biomarkers are C-reactive protein, serum amyloid A-1 and cathepsin-B. CONCLUSIONS AND CLINICAL RELEVANCE The interplay of systemic and central inflammatory markers sheds new light on delirium pathogenesis. This work suggests that accurate identification of cases may be achievable using panels of biomarkers.
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Affiliation(s)
- Kwame Wiredu
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Lebanon, NH
- Department of Anesthesia, Critical Care and Pain Medicine, Mass General Hospital, Boston MA
- Department of Anaesthesia, Harvard Medical School, Boston MA
| | - Sean O’Connor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston MA
| | - Heba Naseem
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston MA
| | - Brooke L. Brauer
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Arminja N. Kettenbach
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Lebanon, NH
- Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Hildreth R. Frost
- Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Shahzad Shaefi
- Department of Anaesthesia, Harvard Medical School, Boston MA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston MA
| | - Scott A. Gerber
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Lebanon, NH
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Lebanon, NH
- Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
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Niu JY, Yang N, Tao QY, He Y, Hou YB, Ning RD, Yu JM. Effect of Different Administration Routes of Dexmedetomidine on Postoperative Delirium in Elderly Patients Undergoing Elective Spinal Surgery: A Prospective Randomized Double-Blinded Controlled Trial. Anesth Analg 2023; 136:1075-1083. [PMID: 37058430 DOI: 10.1213/ane.0000000000006464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND Intravenous dexmedetomidine has been reported to decrease the occurrence of postoperative delirium (POD) in elderly patients. Nevertheless, some previous studies have indicated that intratracheal dexmedetomidine and intranasal dexmedetomidine are also effective and convenient. The current study aimed to compare the effect of different administration routes of dexmedetomidine on POD in elderly patients. METHODS We randomly allocated 150 patients (aged 60 years or more) scheduled for spinal surgery to receive intravenous dexmedetomidine (0.6 μg/kg), intranasal dexmedetomidine (1 μg/kg) before anesthesia induction, or intratracheal dexmedetomidine (0.6 µg/kg) after anesthesia induction. The primary outcome was the frequency of delirium during the first 3 postoperative days. The secondary outcomes were the incidence of postoperative sore throat (POST) and sleep quality. Adverse events were recorded, and routine treatment was performed. RESULTS Compared with the intranasal group, the intravenous group had a significantly lower occurrence of POD within 3 days (3 of 49 [6.1%] vs 14 of 50 [28.0%]; odds ratio [OR], 0.17; 95% confidence intervals [CIs], 0.05-0.63; P < .017). Meanwhile, patients in the intratracheal group had a lower incidence of POD than those in the intranasal group (5 of 49 [10.2%] vs 14 of 50 [28.0%]; OR, 0.29; 95% CI, 0.10-0.89; P < .017). Whereas, there was no difference between the intratracheal and intravenous groups (5 of 49 [10.2%] vs 3 of 49 [6.1%]; OR, 1.74; 95% CI, 0.40-7.73; P > .017). The rate of POST was lower in the intratracheal group than that in the other 2 groups at 2 hours after surgery (7 of 49 [14.3%] vs 12 of 49 [24.5%] vs 18 of 50 [36.0%], P < .017, respectively). Intravenous dexmedetomidine had the lowest Pittsburgh Sleep Quality Index score on the second morning after surgery (median [interquartile range {IQR}]: 4 [3-5] vs 6 [4-7] vs 6 [4-7], P < .017, respectively). Compared with the intranasal group, the intravenous group had a higher rate of bradycardia and a lower incidence of postoperative nausea and vomiting ( P < .017). The intranasal group was associated with the highest incidence of hypertension ( P < .017). CONCLUSIONS For patients aged ≥60 years undergoing spinal surgery, compared with the intranasal route of dexmedetomidine, intravenous and intratracheal dexmedetomidine reduced the incidence of early POD. Meanwhile, intravenous dexmedetomidine was associated with better sleep quality after surgery, and intratracheal dexmedetomidine resulted in a lower incidence of POST. Adverse events were mild in all 3 administration routes of dexmedetomidine.
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Affiliation(s)
- Jing-Yi Niu
- From the Department of Anesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Hefei, Anhui, China
| | - Na Yang
- From the Department of Anesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Hefei, Anhui, China
| | - Qing-Yu Tao
- From the Department of Anesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Hefei, Anhui, China
| | - Yan He
- Department of Anesthesiology, Wannan Medical College, Wuhu, Anhui, China
| | - Yong-Bo Hou
- Department of Anesthesiology, Wannan Medical College, Wuhu, Anhui, China
| | - Ren-De Ning
- Department of Orthopedics, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Hefei, Anhui, China
| | - Jun-Ma Yu
- From the Department of Anesthesiology, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Hefei, Anhui, China
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Köditz H, Drouche A, Dennhardt N, Schmidt M, Schultz M, Schultz B. Depth of anesthesia, temperature, and postoperative delirium in children and adolescents undergoing cardiac surgery. BMC Anesthesiol 2023; 23:148. [PMID: 37131120 PMCID: PMC10152600 DOI: 10.1186/s12871-023-02102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 04/20/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND After pediatric cardiosurgical interventions, postoperative delirium can occur, which can be associated with undesirable consequences during and after the hospital stay. It is therefore important to avoid any factors causing delirium as far as possible. Electroencephalogram (EEG) monitoring can be used during anesthesia to individually adjust dosages of hypnotically acting drugs. It is necessary to gain knowledge about the relationship between intraoperative EEG and postoperative delirium in children. METHODS In a dataset comprising 89 children (53 male, 36 female; median age: 0.99 (interquartile range: 0.51, 4.89) years) undergoing cardiac surgery involving use of a heart-lung machine, relationships between depth of anesthesia as measured by EEG (EEG index: Narcotrend Index (NI)), sevoflurane dosage, and body temperature were analyzed. A Cornell Assessment of Pediatric Delirium (CAP-D) score ≥ 9 indicated delirium. RESULTS The EEG could be used in patients of all age groups for patient monitoring during anesthesia. In the context of induced hypothermia, EEG monitoring supported individually adjusted sevoflurane dosing. The NI was significantly correlated with the body temperature; decreasing temperature was accompanied by a decreasing NI. A CAP-D score ≥ 9 was documented in 61 patients (68.5%); 28 patients (31.5%) had a CAP-D < 9. Delirious patients with an intubation time ≤ 24 h showed a moderate negative correlation between minimum NI (NImin) and CAP-D (rho = -0.41, 95% CI: -0.70 - -0.01, p = 0.046), i.e., CAP-D decreased with increasing NImin. In the analysis of all patients' data, NImin and CAP-D showed a weak negative correlation (rho = -0.21, 95% CI: -0.40 - 0.01, p = 0.064). On average, the youngest patients had the highest CAP-D scores (p = 0.002). Patients with burst suppression / suppression EEG had a longer median intubation time in the intensive care unit than patients without such EEG (p = 0.023). There was no relationship between minimum temperature and CAP-D score. CONCLUSIONS The EEG can be used to individually adjust sevoflurane dosing during hypothermia. Of the patients extubated within 24 h and classified as delirious, patients with deeper levels of anesthesia had more severe delirium symptoms than patients with lighter levels of anesthesia.
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Affiliation(s)
- H Köditz
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - A Drouche
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - N Dennhardt
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - M Schmidt
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - M Schultz
- Medical University of Vienna, Vienna, Austria
| | - Barbara Schultz
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
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Payne T, Taylor J, Casey C, Kunkel D, Parker M, Blennow K, Zetterberg H, Pearce RA, Lennertz RC, Sanders RD. Prospective analysis of plasma amyloid beta and postoperative delirium in the Interventions for Postoperative Delirium: Biomarker-3 study. Br J Anaesth 2023; 130:546-556. [PMID: 36842841 PMCID: PMC10273086 DOI: 10.1016/j.bja.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/03/2023] [Accepted: 01/15/2023] [Indexed: 02/28/2023] Open
Abstract
BACKGROUND The effect of postoperative delirium on the amyloid cascade of Alzheimer's dementia is poorly understood. Using early postoperative plasma biomarkers, we explored whether surgery and delirium are associated with changes in amyloid pathways. METHODS We analysed data from 100 participants in the Interventions for Postoperative Delirium: Biomarker-3 (IPOD-B3) cohort study in the USA (NCT03124303 and NCT01980511), which recruited participants aged >65 yr undergoing non-intracranial surgery. We assessed the relationship between the change in plasma amyloid beta ratio (AβR; Aβ42:Aβ40) and delirium incidence (defined by the 3-Minute Diagnostic Confusion Assessment Method) and severity (quantified by the Delirium Rating Scale-Revised-98, the study's primary outcome). We also tested the relationship between plasma amyloid beta and intraoperative variables. RESULTS Across all participants, the plasma AβR increased from the preoperative period to postoperative Day 1 (Wilcoxon P<0.001). However, this increase was not associated with delirium incidence (Wilcoxon P=0.22) or peak severity after adjusting for confounders (log[incidence rate ratio]=0.43; P=0.14). Postoperative Day 1 change in plasma AβR was not associated with postoperative Day 1 change in plasma tau, neurofilament light, or inflammatory markers (interleukin [IL]-1β, IL-1Ra, IL-2, IL-4, IL-6, IL-8, IL-10, and IL-12), or with operative time or low intraoperative arterial pressure. CONCLUSIONS Perioperative changes in plasma amyloid do not appear to be associated with postoperative delirium. Our findings do not support associations of dynamic changes in amyloid with postoperative delirium. CLINICAL TRIAL REGISTRATION .NCT03124303 and NCT01980511.
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Affiliation(s)
- Thomas Payne
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Jennifer Taylor
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Cameron Casey
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - David Kunkel
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Maggie Parker
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK; UK Dementia Research Institute at UCL, London, UK; Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
| | - Robert A Pearce
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Richard C Lennertz
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert D Sanders
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
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Jelly CA, Clifton JC, Billings FT, Hernandez A, Schaffer AJ, Shotwell ME, Freundlich RE. The Association Between Enhanced Recovery After Cardiac Surgery-Guided Analgesics and Postoperative Delirium. J Cardiothorac Vasc Anesth 2023; 37:707-714. [PMID: 36792460 PMCID: PMC10065906 DOI: 10.1053/j.jvca.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/02/2022] [Accepted: 12/23/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Delirium is a common postoperative complication associated with death and long-term cognitive impairment. The authors studied the association between opioid-sparing anesthetics, incorporating Enhanced Recovery After Cardiac Surgery (ERACS)-guided analgesics and postoperative delirium. DESIGN The authors performed a retrospective review of nonemergent coronary, valve, or ascending aorta surgery patients. SETTING A tertiary academic medical institution. PARTICIPANTS The study authors analyzed a dataset of elective adult cardiac surgical patients. All patients ≥18 years undergoing elective cardiac surgery from November 2, 2017 until February 2, 2021 were eligible for inclusion. INTERVENTIONS The ERACS-guided multimodal pain regimen included preoperative oral acetaminophen and gabapentin, and intraoperative intravenous lidocaine, ketamine, and dexmedetomidine. MEASUREMENTS AND MAIN RESULTS Delirium was measured by bedside nurses using the Confusion Assessment Method for the intensive care unit (ICU). Delirium occurred in 220 of the 1,675 patients (13.7%). The use of any component of the multimodal pain regimen was not associated with delirium (odds ratio [OR]: 0.85 [95% CI: 0.63-1.16]). Individually, acetaminophen was associated with reduced odds of delirium (OR: 0.60 [95% CI: 0.37-0.95]). Gabapentin (OR: 1.36 [95% CI: 0.97-2.21]), lidocaine (OR: 0.86 [95% CI: 0.53-1.37]), ketamine (OR: 1.15 [95% CI: 0.72-1.83]), and dexmedetomidine (OR: 0.79 [95% CI: 0.46-1.31]) were not individually associated with postoperative delirium. Individual ERACS elements were associated with secondary outcomes of hospital length of stay, ICU duration, postoperative opioid administration, and postoperative intubation duration. CONCLUSIONS The use of an opioid-sparing perioperative ERACS pain regimen was not associated with reduced postoperative delirium, opioid consumption, or additional poor outcomes. Individually, acetaminophen was associated with reduced delirium.
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Affiliation(s)
- Christina Anne Jelly
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Jacob C Clifton
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
| | - Frederic T Billings
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Antonio Hernandez
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Matthew E Shotwell
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Robert E Freundlich
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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Mevorach L, Forookhi A, Farcomeni A, Romagnoli S, Bilotta F. Perioperative risk factors associated with increased incidence of postoperative delirium: systematic review, meta-analysis, and Grading of Recommendations Assessment, Development, and Evaluation system report of clinical literature. Br J Anaesth 2023; 130:e254-e262. [PMID: 35810005 DOI: 10.1016/j.bja.2022.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Systematic reviews to date have neglected to exclusively include studies using a validated diagnostic scale for postoperative delirium and monitoring patients for more than 24 h. Evidence on current risk factors is evolving with significantly heterogeneous study designs, inconsistent reporting of results, and a lack of adjustment for bias. METHODS This systematic review and meta-analysis aimed to identify risk factors for postoperative delirium in an adult patient population. Study designs suitable for this review included full-text articles, RCTs, observational studies, cohort studies, and case-control studies. Extracted variables from the 169 (7.4%) selected studies were included in qualitative synthesis, quantitative synthesis, and a postoperative delirium checklist. The 16 variables included in the checklist were selected based on consistency, direction of effect, number of studies, and clinical utility as a reference for future studies. RESULTS A total of 576 variables were extracted, but only six were eligible for meta-analysis. Age (mean difference [MD]=4.94; 95% confidence interval [CI], 2.93-6.94; P<0.001), American Society of Anesthesiologists physical status >2 (odds ratio [OR]=2.27; 95% CI, 1.47-3.52; P<0.001), Charlson Comorbidity Index ≥2 (OR=1.9; 95% CI, 1.11-3.25; P=0.0202), and Mini-Mental State Examination (MD=-1.94; 95% CI, -3.6 to -0.27; P=0.0224) were statistically significant. CONCLUSIONS Risk factors can assist in clinical decision-making and identification of high-risk patients. Literature analysis identified inconsistent methodology, leading to challenges in interpretation. A standardised format and evidence-based approach should guide future studies.
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Affiliation(s)
- Lior Mevorach
- Department of Anaesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I Teaching Hospital, Sapienza University of Rome, Rome, Italy.
| | - Ali Forookhi
- Department of Anaesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Alessio Farcomeni
- Department of Economics and Finance, Tor Vergata, University of Rome, Rome, Italy
| | - Stefano Romagnoli
- Department of Anaesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Federico Bilotta
- Department of Anaesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I Teaching Hospital, Sapienza University of Rome, Rome, Italy
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Jangra S, Ashok V, Sethi S, Ram J. Atomised intranasal dexmedetomidine versus oral melatonin in prevention of emergence delirium in children undergoing ophthalmic surgery with sevoflurane: A randomised double-blind study. Eur J Anaesthesiol 2022; 39:868-874. [PMID: 35875916 DOI: 10.1097/eja.0000000000001727] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Melatonin and dexmedetomidine have both been used as a premedication to decrease emergence delirium in children. The effectiveness of oral melatonin, compared with atomised intranasal dexmedetomidine, in this role is not well studied. OBJECTIVE To study the efficacy of pre-operative atomised intranasal dexmedetomidine versus oral melatonin in children scheduled for ophthalmic surgery under sevoflurane. DESIGN A prospective, randomised, double-blind trial. SETTING Ophthalmic surgery in a university teaching hospital, April 2021 to October 2021. PATIENTS A total of 120 children undergoing ophthalmic surgery with sevoflurane anaesthesia. INTERVENTION Children were randomised to receive pre-operative intranasal dexmedetomidine 2 μg/kg via an atomiser device (dexmedetomidine group) or oral melatonin 0.5 mg kg -1 (melatonin group), 45 min before surgery. OUTCOMES MEASURED The primary outcome was the incidence of emergence delirium assessed by the Paediatric Anaesthesia Emergence Delirium scale. Secondary outcomes included pre-operative sedation, quality of inhalational induction, postoperative sedation and pain. RESULTS The incidence of emergence delirium was lower in the dexmedetomidine group than in the melatonin group (17 versus 37%, relative risk 0.45, 95% CI: 0.24 to 0.88; P = 0.01). Children in the dexmedetomidine group were more sedated following premedication and in the postanaesthesia care unit ( P < 0.05). Postoperative pain scores were lower in the dexmedetomidine group than in the melatonin group: 0 [0 to 3] versus 2.5 [0-4], ( P = 0.01). The requirement for and dose of rescue fentanyl analgesia postoperatively was comparable between the two groups. CONCLUSION Atomised intranasal dexmedetomidine significantly reduced emergence delirium in paediatric opthalmic procedures under sevoflurane anaesthesia compared to oral melatonin. TRIAL REGISTRATION Clinical Trials Registry of India CTRI/2021/03/032388 ( www.ctri.nic.in ).
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Affiliation(s)
- Savita Jangra
- From the Department of Anaesthesia and Intensive Care (SJ, VA, SS), and Department of Ophthalmology (JR), Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
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Lei DX, Wu CJ, Wu ZY, Wang LY, Zhao Q, She YJ. Efficacy of different doses of intranasal dexmedetomidine in preventing emergence agitation in children with inhalational anaesthesia: A prospective randomised trial. Eur J Anaesthesiol 2022; 39:858-867. [PMID: 36106493 DOI: 10.1097/eja.0000000000001743] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Emergence agitation is a common paediatric complication after inhalational anaesthesia. Intranasal dexmedetomidine can prevent emergence agitation effectively, but the optimal dose is uncertain. OBJECTIVE The aim of our study was to investigate the 95% effective dose (ED 95 ) of intranasal dexmedetomidine for the prevention of emergence agitation after inhalational anaesthesia for paediatric ambulatory surgery. DESIGN A prospective, randomised, placebo-controlled, double-blind, clinical trial. SETTING The study was conducted in Guangzhou Women and Children's Medical Center in China from August 2017 to December 2018. PATIENTS Three hundred and eighteen children scheduled for ambulatory surgery were enrolled into two age groups of less than 3 years and at least 3 years. INTERVENTIONS The children in each age group were randomised into five equal subgroups to receive either intranasal dexmedetomidine 0.5, 1.0, 1.5 or 2.0 μg kg -1 (Groups D 0.5 , D 1.0 , D 1.5 and D 2.0 ), or intranasal isotonic saline (group C) after induction. MAIN OUTCOME MEASURES The primary outcome was the ED 95 dose of intranasal dexmedetomidine for preventing emergence agitation after inhalational anaesthesia for paediatric ambulatory surgery. RESULTS The incidences of emergence agitation for Groups C, D 0.5 , D 1.0 , D 1.5 and D 2.0 were 63, 40, 23, 13 and 3% in children less than 3 years, and 43, 27, 17, 7 and 3% in children at least 3 years. The ED 95 of intranasal dexmedetomidine for preventing emergence agitation was 1.99 μg kg -1 [95% confidence interval (CI), 1.83 to 3.80 μg kg -1 ] in children less than 3 years, and 1.78 μg kg -1 (95% CI, 0.93 to 4.29 μg kg -1 ) in children at least 3 years. LMA removal time for groups D 1.5 and D 2.0 was 9.6 ± 2.2 and 9.7 ± 2.5 min, respectively, for children less than 3 years, and 9.4 ± 2.0 and 9.9 ± 2.7 min in children at least 3 years, respectively. Length of stay in the postanaesthesia care unit for Groups D 1.5 and D 2.0 was 34.3 ± 9.6 and 37.1 ± 11.2 min, respectively, in children less than 3 years, and 34.7 ± 10.2 and 37.3 ± 8.3 min in children at least 3 years, respectively. These times were longer in the D 1.5 and D 2.0 subgroups than in the control subgroup in the two age groups of less than 3 years and at least 3 years, respectively: 7.2 ± 1.9 min in children less than 3 years and 7.3 ± 2.5 min in children at least 3 years for LMA removal time, 22.2 ± 7.9 min in children less than 3 years and 22.0 ± 7.7 min in children at least 3 years for PACU stay time in control subgroup, respectively ( P < 0.05). CONCLUSION Intranasal dexmedetomidine prevented emergence agitation after paediatric surgery in a dose-dependent manner. The optimal dose of intranasal dexmedetomidine for preventing emergence agitation was higher in younger children. TRIAL REGISTRY chictr.org.cn: ChiCTR-IOR-17012415.
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Affiliation(s)
- Dong-Xu Lei
- From the Department of Anesthesiology and Perioperative Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou (L DX, W CJ, W LY, Z Q, S YJ) and Department of Anesthesiology, Huizhou first people's Hospital, Huizhou, China (W ZY)
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Pedemonte JC, Sun H, Franco-Garcia E, Zhou C, Heng M, Quraishi SA, Westover B, Akeju O. Postoperative delirium mediates 180-day mortality in orthopaedic trauma patients. Br J Anaesth 2021; 127:102-109. [PMID: 34074525 PMCID: PMC8258970 DOI: 10.1016/j.bja.2021.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 03/06/2021] [Accepted: 03/18/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Frailty has been associated with increased incidence of postoperative delirium and mortality. We hypothesised that postoperative delirium mediates a clinically significant (≥1%) percentage of the effect of frailty on mortality in older orthopaedic trauma patients. METHODS This was a single-centre, retrospective observational study including 558 adults 65 yr and older, who presented with an extremity fracture requiring hospitalisation without initial ICU admission. We used causal statistical inference methods to estimate the relationships between frailty, postoperative delirium, and mortality. RESULTS In the cohort, 180-day mortality rate was 6.5% (36/558). Frail and prefrail patients comprised 23% and 39%, respectively, of the study cohort. Frailty was associated with increased 180 day mortality from 1.4% to 12.2% (11% difference; 95% confidence interval [CI], 8.4-13.6), which translated statistically into an 88.7% (79.9-94.3%) direct effect and an 11.3% (5.7-20.1%) postoperative delirium mediated effect. Prefrailty was also associated with increased 180 day mortality from 1.4% to 4.4% (2.9% difference; 2.4-3.4), which was translated into a 92.5% (83.8-99.9%) direct effect and a 7.5% (0.1-16.2%) postoperative delirium mediated effect. CONCLUSIONS Frailty is associated with increased postoperative mortality, and delirium might mediate a clinically significant, but small percentage of this effect. Studies should assess whether, in patients with frailty, attempts to mitigate delirium might decrease postoperative mortality.
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Affiliation(s)
- Juan C Pedemonte
- Department of Anesthesia, Critical Care and Pain Medicine, Boston, MA, USA; División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Haoqi Sun
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Carmen Zhou
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Marilyn Heng
- Department of Orthopaedic Surgery, Boston, MA, USA
| | - Sadeq A Quraishi
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA
| | - Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Henry and Allison McCance Center for Brain Health, Boston, MA, USA; Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, USA
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Boston, MA, USA; Henry and Allison McCance Center for Brain Health, Boston, MA, USA
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Abstract
OBJECTIVES Emergence delirium (ED) occurs in approximately 25% of paediatric general anaesthetics and has significant adverse effects. The goal of the current systematic review was to identify the existing literature investigating performance of predictive models for the development of paediatric ED following general anaesthesia and to determine their usability. DESIGN Systematic review using the Prediction model study Risk Of Bias Assessment Tool (PROBAST) framework. DATA SOURCES Medline (Ovid), PubMed, Embase (Ovid), Cochrane Database of Systematic Reviews (Ovid), Cochrane CENTRAL (Ovid), PsycINFO (Ovid), Scopus (Elsevier) and Web of Science (Clarivate Analytics), ClinicalTrials.gov, International Clinical Trials Registry Platform and ProQuest Digital Dissertations and Theses International through 17 November 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES All randomised controlled trials and cohort studies investigating predictive models for the development of ED in children undergoing general anaesthesia. DATA EXTRACTION AND SYNTHESIS Following title, abstract and full-text screening by two reviewers, data were extracted from all eligible studies, including demographic parameters, details of anaesthetics and performance characteristics of the predictive scores for ED. Evidence quality and predictive score usability were assessed according to the PROBAST framework. RESULTS The current systematic review yielded 9242 abstracts, of which only one study detailing the development and validation of the Emergence Agitation Risk Scale (EARS) met the inclusion criteria. EARS had good discrimination with c-index of 0.81 (95% CI 0.72 to 0.89). Calibration showed a non-significant Homer-Lemeshow goodness-of-fit test (p=0.97). Although the EARS demonstrated low concern of applicability, the high risk of bias compromised the overall usability of this model. CONCLUSIONS The current systematic review concluded that EARS has good discrimination performance but low usability to predict ED in a paediatric population. Further research is warranted to develop novel models for the prediction of ED in paediatric anaesthesia. PROSPERO REGISTRATION NUMBER CRD42019141950.
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Affiliation(s)
- Maria-Alexandra Petre
- Department of Pediatric Anesthesia, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Bibek Saha
- John A Burns School of Medicine at University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Shugo Kasuya
- Department of Anesthesia and Critical Care Medicine, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Nan Gai
- Department of Anesthesia and Pain Medicine, Hospital of Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Arie Peliowski
- Department of Anesthesia and Pain Medicine, Hospital of Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kazuyoshi Aoyama
- Department of Anesthesia and Pain Medicine, Hospital of Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
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Shao YR, Kahali P, Houle TT, Deng H, Colvin C, Dickerson BC, Brown EN, Purdon PL. Low Frontal Alpha Power Is Associated With the Propensity for Burst Suppression: An Electroencephalogram Phenotype for a "Vulnerable Brain". Anesth Analg 2020; 131:1529-1539. [PMID: 33079876 PMCID: PMC7553194 DOI: 10.1213/ane.0000000000004781] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND A number of recent studies have reported an association between intraoperative burst suppression and postoperative delirium. These studies suggest that anesthesia-induced burst suppression may be an indicator of underlying brain vulnerability. A prominent feature of electroencephalogram (EEG) under propofol and sevoflurane anesthesia is the frontal alpha oscillation. This frontal alpha oscillation is known to decline significantly during aging and is generated by prefrontal brain regions that are particularly prone to age-related neurodegeneration. Given that burst suppression and frontal alpha oscillations are both associated with brain vulnerability, we hypothesized that anesthesia-induced frontal alpha power could also be associated with burst suppression. METHODS We analyzed EEG data from a previously reported cohort in which 155 patients received propofol (n = 60) or sevoflurane (n = 95) as the primary anesthetic. We computed the EEG spectrum during stable anesthetic maintenance and identified whether or not burst suppression occurred during the anesthetic. We characterized the relationship between burst suppression and alpha power using logistic regression. We proposed 5 different models consisting of different combinations of potential contributing factors associated with burst suppression: (1) a Base Model consisting of alpha power; (2) an Extended Mechanistic Model consisting of alpha power, age, and drug dosing information; (3) a Clinical Confounding Factors Model consisting of alpha power, hypotension, and other confounds; (4) a Simplified Model consisting only of alpha power and propofol bolus administration; and (5) a Full Model consisting of all of these variables to control for as much confounding as possible. RESULTS All models show a consistent significant association between alpha power and burst suppression while adjusting for different sets of covariates, all with consistent effect size estimates. Using the Simplified Model, we found that for each decibel decrease in alpha power, the odds of experiencing burst suppression increased by 1.33-fold. CONCLUSIONS In this study, we show how a decrease in anesthesia-induced frontal alpha power is associated with an increased propensity for burst suppression, in a manner that captures individualized information above and beyond a patient's chronological age. Lower frontal alpha band power is strongly associated with higher propensity for burst suppression and, therefore, potentially higher risk of postoperative neurocognitive disorders. We hypothesize that low frontal alpha power and increased propensity for burst suppression together characterize a "vulnerable brain" phenotype under anesthesia that could be mechanistically linked to brain metabolism, cognition, and brain aging.
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Affiliation(s)
- Yu Raymond Shao
- From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Pegah Kahali
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Timothy T. Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hao Deng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher Colvin
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bradford C. Dickerson
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emery N. Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Institute for Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Patrick L. Purdon
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Urits I, Peck J, Giacomazzi S, Patel R, Wolf J, Mathew D, Schwartz R, Kassem H, Urman RD, Kaye AD, Viswanath O. Emergence Delirium in Perioperative Pediatric Care: A Review of Current Evidence and New Directions. Adv Ther 2020; 37:1897-1909. [PMID: 32274749 DOI: 10.1007/s12325-020-01317-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Indexed: 12/18/2022]
Abstract
Emergence delirium (ED) is defined as psychomotor agitation and delirium that typically occurs within 45 min from emergence of anesthesia. Preoperative patient conditions such as anxiety and confusion are risk factors for the development of postoperative ED. Common signs of ED are general non-purposeful resistive movements such as kicking, pulling, flailing as well as lack of eye contact and general lack of awareness of surroundings. The use of volatile anesthetics (VA) is contributory, while the use of total intravenous anesthetic techniques (TIVA) may help to reduce the incidence of emergence delirium. Furthermore, various pharmacologic strategies and alternatively non-pharmacologic strategies have been demonstrated to further diminish its occurrence. The objective of this manuscript is to provide a comprehensive review of anesthetic considerations for pediatric ED and to provide an update on techniques that have been found to be effective in reducing the overall risk of developing postoperative ED in pediatric patients.
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Affiliation(s)
- Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Jacquelin Peck
- Department of Anesthesiology, Mount Sinai Medical Center, Miami, FL, USA
| | - Stephen Giacomazzi
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Riki Patel
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - John Wolf
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Denzil Mathew
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Ruben Schwartz
- Department of Anesthesiology, Mount Sinai Medical Center, Miami, FL, USA
| | - Hisham Kassem
- Department of Anesthesiology, Mount Sinai Medical Center, Miami, FL, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
- Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, USA
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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Affiliation(s)
- T Saller
- Edinburgh Royal Infirmary, Edinburgh, UK
- German Center for Neurodegenerative Diseases, Munich, Germany
| | - A M J MacLullich
- Edinburgh Royal Infirmary, Edinburgh, UK
- German Center for Neurodegenerative Diseases, Munich, Germany
| | - R Perneczky
- Edinburgh Royal Infirmary, Edinburgh, UK
- German Center for Neurodegenerative Diseases, Munich, Germany
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Xing H, Zhou W, Fan Y, Wen T, Wang X, Chang G. Development and validation of a postoperative delirium prediction model for patients admitted to an intensive care unit in China: a prospective study. BMJ Open 2019; 9:e030733. [PMID: 31722939 PMCID: PMC6858207 DOI: 10.1136/bmjopen-2019-030733] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES We aimed to develop and validate a postoperative delirium (POD) prediction model for patients admitted to the intensive care unit (ICU). DESIGN A prospective study was conducted. SETTING The study was conducted in the surgical, cardiovascular surgical and trauma surgical ICUs of an affiliated hospital of a medical university in Heilongjiang Province, China. PARTICIPANTS This study included 400 patients (≥18 years old) admitted to the ICU after surgery. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was POD assessment during ICU stay. RESULTS The model was developed using 300 consecutive ICU patients and was validated using 100 patients from the same ICUs. The model was based on five risk factors: Physiological and Operative Severity Score for the enumeration of Mortality and morbidity; acid-base disturbance and history of coma, diabetes or hypertension. The model had an area under the receiver operating characteristics curve of 0.852 (95% CI 0.802 to 0.902), Youden index of 0.5789, sensitivity of 70.73% and specificity of 87.16%. The Hosmer-Lemeshow goodness of fit was 5.203 (p=0.736). At a cutoff value of 24.5%, the sensitivity and specificity were 71% and 69%, respectively. CONCLUSIONS The model, which used readily available data, exhibited high predictive value regarding risk of ICU-POD at admission. Use of this model may facilitate better implementation of preventive treatments and nursing measures.
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Affiliation(s)
- Huanmin Xing
- Nursing Department, Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Nursing Department, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Nursing Department, People's Hospital of Henan University, Zhengzhou, Henan, China
| | - Wendie Zhou
- Nursing School, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yuying Fan
- Nursing School, Harbin Medical University, Harbin, Heilongjiang, China
| | - Taoxue Wen
- Department of Quality Control, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiaohui Wang
- Department of Intensive Care Unit, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Guangming Chang
- The Party Committee, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Chen Y, Lu S, Wu Y, Shen Y, Zhao H, Ding S, Feng X, Sun L, Tao X, Li J, Ma R, Liu W, Wu F, Feng Y. Change in Serum Level of Interleukin 6 and Delirium After Coronary Artery Bypass Graft. Am J Crit Care 2019; 28:462-470. [PMID: 31676521 DOI: 10.4037/ajcc2019976] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Serum level of interleukin 6 (IL-6) is known to be associated with postoperative delirium. However, no consensus has emerged on the postoperative time point at which IL-6 level may predict postoperative delirium after coronary artery bypass graft surgery. OBJECTIVES To compare trends in IL-6 levels in patients with and without postoperative delirium and to examine the relationship between IL-6 levels at different times and postoperative delirium after coronary artery bypass graft. METHODS A prospective cohort study of patients who underwent their first elective isolated coronary artery bypass graft between November 2013 and August 2015 at a cardiac intensive care unit in Beijing, China. Concentrations of IL-6 were measured before the operation and at the 6th, 12th, and 18th postoperative hours. Participants were assessed for postoperative delirium twice daily for 5 days. Univariate and multivariate logistic regression analyses were done to determine associations between IL-6 levels at different time points, postoperative changes in IL-6 levels, and the occurrence of postoperative delirium. RESULTS Postoperative delirium was diagnosed in 85 of 266 patients (32%). Levels of IL-6 were significantly higher in patients with postoperative delirium than in patients without it at the 6th, 12th, and 18th postoperative hours (P = .03, .004, and .001, respectively). Change in IL-6 level (odds ratio, 2.97; 95% CI, 1.20-7.31; P = .02) and IL-6 level of 583 pg/mL or higher at the 18th postoperative hour (odds ratio, 5.20; 95% CI, 1.84-14.70; P = .002) were associated with higher incidence of postoperative delirium. CONCLUSION Interleukin 6 level (≥ 583 pg/mL) at the 18th postoperative hour may serve as a potent predictor of postoperative delirium in coronary artery bypass graft patients.
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Affiliation(s)
- Yuling Chen
- Yuling Chen and Fangqin Wu are doctoral candidates, Ying Wu is dean and professor, Shu Ding is a postgraduate student, Xinwei Feng is a teacher, Li Sun, Xiangjun Tao, and Jinglian Li are postgraduate students, Ruiying Ma and Weiwei Liu are teachers, and Yadi Feng is a postgraduate student, School of Nursing, Capital Medical University, Beijing, China. Sai Lu is a senior lecturer and research fellow, College of Health and Biomedicine, Institute for Health and Sport, Victoria University, Mel-bourne, Australia. Yuzhi Shen and Haibo Zhao are charge nurses, Heart Center, Beijing Chao-Yang Hospital, Beijing, China
| | - Sai Lu
- Yuling Chen and Fangqin Wu are doctoral candidates, Ying Wu is dean and professor, Shu Ding is a postgraduate student, Xinwei Feng is a teacher, Li Sun, Xiangjun Tao, and Jinglian Li are postgraduate students, Ruiying Ma and Weiwei Liu are teachers, and Yadi Feng is a postgraduate student, School of Nursing, Capital Medical University, Beijing, China. Sai Lu is a senior lecturer and research fellow, College of Health and Biomedicine, Institute for Health and Sport, Victoria University, Mel-bourne, Australia. Yuzhi Shen and Haibo Zhao are charge nurses, Heart Center, Beijing Chao-Yang Hospital, Beijing, China
| | - Ying Wu
- Yuling Chen and Fangqin Wu are doctoral candidates, Ying Wu is dean and professor, Shu Ding is a postgraduate student, Xinwei Feng is a teacher, Li Sun, Xiangjun Tao, and Jinglian Li are postgraduate students, Ruiying Ma and Weiwei Liu are teachers, and Yadi Feng is a postgraduate student, School of Nursing, Capital Medical University, Beijing, China. Sai Lu is a senior lecturer and research fellow, College of Health and Biomedicine, Institute for Health and Sport, Victoria University, Mel-bourne, Australia. Yuzhi Shen and Haibo Zhao are charge nurses, Heart Center, Beijing Chao-Yang Hospital, Beijing, China.
| | - Yuzhi Shen
- Yuling Chen and Fangqin Wu are doctoral candidates, Ying Wu is dean and professor, Shu Ding is a postgraduate student, Xinwei Feng is a teacher, Li Sun, Xiangjun Tao, and Jinglian Li are postgraduate students, Ruiying Ma and Weiwei Liu are teachers, and Yadi Feng is a postgraduate student, School of Nursing, Capital Medical University, Beijing, China. Sai Lu is a senior lecturer and research fellow, College of Health and Biomedicine, Institute for Health and Sport, Victoria University, Mel-bourne, Australia. Yuzhi Shen and Haibo Zhao are charge nurses, Heart Center, Beijing Chao-Yang Hospital, Beijing, China
| | - Haibo Zhao
- Yuling Chen and Fangqin Wu are doctoral candidates, Ying Wu is dean and professor, Shu Ding is a postgraduate student, Xinwei Feng is a teacher, Li Sun, Xiangjun Tao, and Jinglian Li are postgraduate students, Ruiying Ma and Weiwei Liu are teachers, and Yadi Feng is a postgraduate student, School of Nursing, Capital Medical University, Beijing, China. Sai Lu is a senior lecturer and research fellow, College of Health and Biomedicine, Institute for Health and Sport, Victoria University, Mel-bourne, Australia. Yuzhi Shen and Haibo Zhao are charge nurses, Heart Center, Beijing Chao-Yang Hospital, Beijing, China
| | - Shu Ding
- Yuling Chen and Fangqin Wu are doctoral candidates, Ying Wu is dean and professor, Shu Ding is a postgraduate student, Xinwei Feng is a teacher, Li Sun, Xiangjun Tao, and Jinglian Li are postgraduate students, Ruiying Ma and Weiwei Liu are teachers, and Yadi Feng is a postgraduate student, School of Nursing, Capital Medical University, Beijing, China. Sai Lu is a senior lecturer and research fellow, College of Health and Biomedicine, Institute for Health and Sport, Victoria University, Mel-bourne, Australia. Yuzhi Shen and Haibo Zhao are charge nurses, Heart Center, Beijing Chao-Yang Hospital, Beijing, China
| | - Xinwei Feng
- Yuling Chen and Fangqin Wu are doctoral candidates, Ying Wu is dean and professor, Shu Ding is a postgraduate student, Xinwei Feng is a teacher, Li Sun, Xiangjun Tao, and Jinglian Li are postgraduate students, Ruiying Ma and Weiwei Liu are teachers, and Yadi Feng is a postgraduate student, School of Nursing, Capital Medical University, Beijing, China. Sai Lu is a senior lecturer and research fellow, College of Health and Biomedicine, Institute for Health and Sport, Victoria University, Mel-bourne, Australia. Yuzhi Shen and Haibo Zhao are charge nurses, Heart Center, Beijing Chao-Yang Hospital, Beijing, China
| | - Li Sun
- Yuling Chen and Fangqin Wu are doctoral candidates, Ying Wu is dean and professor, Shu Ding is a postgraduate student, Xinwei Feng is a teacher, Li Sun, Xiangjun Tao, and Jinglian Li are postgraduate students, Ruiying Ma and Weiwei Liu are teachers, and Yadi Feng is a postgraduate student, School of Nursing, Capital Medical University, Beijing, China. Sai Lu is a senior lecturer and research fellow, College of Health and Biomedicine, Institute for Health and Sport, Victoria University, Mel-bourne, Australia. Yuzhi Shen and Haibo Zhao are charge nurses, Heart Center, Beijing Chao-Yang Hospital, Beijing, China
| | - Xiangjun Tao
- Yuling Chen and Fangqin Wu are doctoral candidates, Ying Wu is dean and professor, Shu Ding is a postgraduate student, Xinwei Feng is a teacher, Li Sun, Xiangjun Tao, and Jinglian Li are postgraduate students, Ruiying Ma and Weiwei Liu are teachers, and Yadi Feng is a postgraduate student, School of Nursing, Capital Medical University, Beijing, China. Sai Lu is a senior lecturer and research fellow, College of Health and Biomedicine, Institute for Health and Sport, Victoria University, Mel-bourne, Australia. Yuzhi Shen and Haibo Zhao are charge nurses, Heart Center, Beijing Chao-Yang Hospital, Beijing, China
| | - Jinglian Li
- Yuling Chen and Fangqin Wu are doctoral candidates, Ying Wu is dean and professor, Shu Ding is a postgraduate student, Xinwei Feng is a teacher, Li Sun, Xiangjun Tao, and Jinglian Li are postgraduate students, Ruiying Ma and Weiwei Liu are teachers, and Yadi Feng is a postgraduate student, School of Nursing, Capital Medical University, Beijing, China. Sai Lu is a senior lecturer and research fellow, College of Health and Biomedicine, Institute for Health and Sport, Victoria University, Mel-bourne, Australia. Yuzhi Shen and Haibo Zhao are charge nurses, Heart Center, Beijing Chao-Yang Hospital, Beijing, China
| | - Ruiying Ma
- Yuling Chen and Fangqin Wu are doctoral candidates, Ying Wu is dean and professor, Shu Ding is a postgraduate student, Xinwei Feng is a teacher, Li Sun, Xiangjun Tao, and Jinglian Li are postgraduate students, Ruiying Ma and Weiwei Liu are teachers, and Yadi Feng is a postgraduate student, School of Nursing, Capital Medical University, Beijing, China. Sai Lu is a senior lecturer and research fellow, College of Health and Biomedicine, Institute for Health and Sport, Victoria University, Mel-bourne, Australia. Yuzhi Shen and Haibo Zhao are charge nurses, Heart Center, Beijing Chao-Yang Hospital, Beijing, China
| | - Weiwei Liu
- Yuling Chen and Fangqin Wu are doctoral candidates, Ying Wu is dean and professor, Shu Ding is a postgraduate student, Xinwei Feng is a teacher, Li Sun, Xiangjun Tao, and Jinglian Li are postgraduate students, Ruiying Ma and Weiwei Liu are teachers, and Yadi Feng is a postgraduate student, School of Nursing, Capital Medical University, Beijing, China. Sai Lu is a senior lecturer and research fellow, College of Health and Biomedicine, Institute for Health and Sport, Victoria University, Mel-bourne, Australia. Yuzhi Shen and Haibo Zhao are charge nurses, Heart Center, Beijing Chao-Yang Hospital, Beijing, China
| | - Fangqin Wu
- Yuling Chen and Fangqin Wu are doctoral candidates, Ying Wu is dean and professor, Shu Ding is a postgraduate student, Xinwei Feng is a teacher, Li Sun, Xiangjun Tao, and Jinglian Li are postgraduate students, Ruiying Ma and Weiwei Liu are teachers, and Yadi Feng is a postgraduate student, School of Nursing, Capital Medical University, Beijing, China. Sai Lu is a senior lecturer and research fellow, College of Health and Biomedicine, Institute for Health and Sport, Victoria University, Mel-bourne, Australia. Yuzhi Shen and Haibo Zhao are charge nurses, Heart Center, Beijing Chao-Yang Hospital, Beijing, China
| | - Yadi Feng
- Yuling Chen and Fangqin Wu are doctoral candidates, Ying Wu is dean and professor, Shu Ding is a postgraduate student, Xinwei Feng is a teacher, Li Sun, Xiangjun Tao, and Jinglian Li are postgraduate students, Ruiying Ma and Weiwei Liu are teachers, and Yadi Feng is a postgraduate student, School of Nursing, Capital Medical University, Beijing, China. Sai Lu is a senior lecturer and research fellow, College of Health and Biomedicine, Institute for Health and Sport, Victoria University, Mel-bourne, Australia. Yuzhi Shen and Haibo Zhao are charge nurses, Heart Center, Beijing Chao-Yang Hospital, Beijing, China
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Abstract
There remain unanswered questions and implications related to emergence delirium in children. Although we know that there are some predisposing factors to emergence delirium, we still are unable to predict accurately those who are at greatest risk. Emergence delirium should be considered as a ‘vital sign’, which should be followed and documented in every child in the postanaesthesia recovery period. Standardized screening tools should be adopted for paediatric emergence delirium.
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Brown CH, Probert J, Healy R, Parish M, Nomura Y, Yamaguchi A, Tian J, Zehr K, Mandal K, Kamath V, Neufeld K, Hogue C. Cognitive Decline after Delirium in Patients Undergoing Cardiac Surgery. Anesthesiology 2018; 129:406-416. [PMID: 29771710 PMCID: PMC6513020 DOI: 10.1097/aln.0000000000002253] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC Cardiac surgery is associated with cognitive decline and postoperative delirium. The relationship between postoperative delirium and cognitive decline after cardiac surgery is unclear WHAT THIS ARTICLE TELLS US THAT IS NEW The development of postoperative delirium is associated with a greater degree of cognitive decline 1 month after cardiac surgery. The development of postoperative delirium is not a predictor of cognitive decline 1 yr after cardiac surgery. BACKGROUND Delirium is common after cardiac surgery and has been associated with morbidity, mortality, and cognitive decline. However, there are conflicting reports on the magnitude, trajectory, and domains of cognitive change that might be affected. The authors hypothesized that patients with delirium would experience greater cognitive decline at 1 month and 1 yr after cardiac surgery compared to those without delirium. METHODS Patients who underwent coronary artery bypass and/or valve surgery with cardiopulmonary bypass were eligible for this cohort study. Delirium was assessed with the Confusion Assessment Method. A neuropsychologic battery was administered before surgery, at 1 month, and at 1 yr later. Linear regression was used to examine the association between delirium and change in composite cognitive Z score from baseline to 1 month (primary outcome). Secondary outcomes were domain-specific changes at 1 month and composite and domain-specific changes at 1 yr. RESULTS The incidence of delirium in 142 patients was 53.5%. Patients with delirium had greater decline in composite cognitive Z score at 1 month (greater decline by -0.29; 95% CI, -0.54 to -0.05; P = 0.020) and in the domains of visuoconstruction and processing speed. From baseline to 1 yr, there was no difference between delirious and nondelirious patients with respect to change in composite cognitive Z score, although greater decline in processing speed persisted among the delirious patients. CONCLUSIONS Patients who developed delirium had greater decline in a composite measure of cognition and in visuoconstruction and processing speed domains at 1 month. The differences in cognitive change by delirium were not significant at 1 yr, with the exception of processing speed.
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Affiliation(s)
- Charles H. Brown
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore MD
| | | | - Ryan Healy
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore MD
| | - Michelle Parish
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore MD
| | - Yohei Nomura
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore MD
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Jing Tian
- Biostatistics Consulting Center, Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore MD
| | - Kenton Zehr
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore MD
| | - Kaushik Mandal
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore MD
| | - Vidyulata Kamath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore MD
| | - Karin Neufeld
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore MD
| | - Charles Hogue
- Department of Anesthesiology & Critical Care Medicine, Northwestern Feinberg School of Medicine, Chicago IL
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Politov ME, Ovechkin AM. DELIRIUM IN ORTHOPEDIC SURGERY: RISK FACTORS, PROPHYLAXIS AND INTENSIVE CARE. Anesteziol Reanimatol 2016; 61:469-473. [PMID: 29894619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Postoperative delirium is common in elderly patients. It increases mortality, duration of hospital stay, promotes disability, reduces the quality of life and independence. In this review, we summarize the scientific literature on epidemiology, assessment, pathogenesis, prophylaxis and treatment of deliriumfollowed after orthopedic surgery.
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