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Hindman BJ, Olinger CR, Woodroffe RW, Zanaty M, Deifelt Streese C, Zacharias ZR, Houtman JC, Wendt LH, Ten Eyck PP, O'Connell-Moore DJ, Ray EJ, Lee SJ, Waldschmidt DF, Havertape LG, Nguyen LB, Chen PF, Banks MI, Sanders RD, Howard MA. Exploratory randomised trial of tranexamic acid to decrease postoperative delirium in adults undergoing lumbar fusion-a trial stopped early. BJA OPEN 2025; 14:100403. [PMID: 40276619 PMCID: PMC12019205 DOI: 10.1016/j.bjao.2025.100403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 03/17/2025] [Indexed: 04/26/2025]
Abstract
Background Postoperative delirium may be mediated by systemic inflammation and neuroinflammation. By inhibiting the proinflammatory actions of plasmin, tranexamic acid (TXA) may decrease postoperative delirium. To explore this hypothesis, we modified an ongoing randomised trial of TXA on blood loss, adding measures of delirium, cognition, systemic inflammation, and astrocyte activation. Methods Adults undergoing elective posterior lumbar fusion randomly received intraoperative i.v. TXA (n=43: 10 mg kg-1 loading dose, 2 mg kg-1 h-1 infusion) or placebo (n=40). Blood was collected before surgery and 24 h after surgery (n=32) for biomarkers (cytokines and S100B). Participants had twice daily delirium assessments (n=65). Participants underwent four measures of cognitive function before surgery and during post-discharge follow-up. Results Postoperative blood loss was ∼38% less in the TXA group compared with the placebo group with medians of 128 and 207 ml level-1, respectively, P=0.013. Total blood loss in the TXA and placebo groups did not differ with medians of 305 and 333 ml level-1, respectively, P=0.472. Delirium incidence in the TXA group (7/32=22%) was not significantly less than in the placebo group (11/33=33%); P=0.408, effect size =-0.258 (95% confidence interval -0.744 to 0.229). Conclusions A potential 33% relative decrease in postoperative delirium incidence justifies an adequately powered clinical trial to determine if intraoperative TXA decreases delirium in adults undergoing lumbar fusion. Clinical trial registration NCT04272606.
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Affiliation(s)
- Bradley J. Hindman
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Catherine R. Olinger
- Department of Orthopedics and Rehabilitation, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Royce W. Woodroffe
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Mario Zanaty
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | | | - Zeb R. Zacharias
- Human Immunology Core Laboratory, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Jon C.D. Houtman
- Human Immunology Core Laboratory, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Microbiology and Immunology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Linder H. Wendt
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Patrick P. Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | | | - Emanuel J. Ray
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Sarah J. Lee
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Daniel F. Waldschmidt
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Lauren G. Havertape
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Lanchi B. Nguyen
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Pei-fu Chen
- Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan
| | - Matthew I. Banks
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robert D. Sanders
- Central Clinical School and National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Department of Anaesthetics and Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Matthew A. Howard
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Cui X, Cao N, Tian S, Liu Y, Xiang J. A Prospective Nested Case-Control Study of Risk Factors for Postoperative Delirium in Elderly Patients with Colorectal Cancer. Clin Interv Aging 2025; 20:639-648. [PMID: 40417053 PMCID: PMC12103907 DOI: 10.2147/cia.s507668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 05/15/2025] [Indexed: 05/27/2025] Open
Abstract
Purpose The objective of this study is to investigate the risk factors associated with postoperative delirium (POD) in elderly patients diagnosed with colorectal cancer (CRC). Patients and Methods This prospective nested case-control study included elderly patients who underwent CRC surgery at Shanxi Provincial Cancer Hospital between May 2022 and September 2023. A propensity score matching (PSM) method was employed to match patients by age and sex. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for POD among elderly patients with CRC. Results A total of 443 patients were enrolled, among them, 70 (15.8% of all patients, age: 69.5[64, 73], 55 [78.6%] males) developed POD and 373 did not develop POD (84.2% of all patients, age: 67[62, 71], 234 [62.7%] males). Following PSM at a 1:3 ratio, 70 POD patients and 210 age- and sex-matched non-POD patients were selected for further analysis. The POD group exhibited a significantly higher sleep quality score (9 [6, 15] vs 7.5 [3, 12], P = 0.004), greater intraoperative infusion volume (2041.43±724.37 vs 1814.05±653.83, P = 0.015), and elevated peak pain levels post-surgery (1 [0, 2] vs 1 [0, 1], P = 0.001). Univariate and multivariate logistic regression analyses identified higher education level (OR: 0.503 [0.259-0.977]) as an independent factor associated with lower POD risk, whereas higher sleep quality scores (OR: 1.103 [1.040-1.171]) and increased peak pain levels post-surgery (OR: 1.727 [1.295-2.304]) were identified as independent risk factors. Conclusion Elevated peak postoperative pain levels, lower education levels, and sleep dysfunction or disturbance are independent risk factors for developing POD.
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Affiliation(s)
- Xinlong Cui
- Department of Anaesthesiology, Shanxi Province Cancer Hospital (Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University), Taiyuan, Shanxi, 030013, People’s Republic of China
| | - Naihan Cao
- College of Anesthesia, Shanxi Medical Universiy, Taiyuan, 030001, People’s Republic of China
| | - Shouyuan Tian
- Department of Anaesthesiology, Shanxi Province Cancer Hospital (Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University), Taiyuan, Shanxi, 030013, People’s Republic of China
| | - Yi Liu
- Department of Anaesthesiology, Shanxi Province Cancer Hospital (Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University), Taiyuan, Shanxi, 030013, People’s Republic of China
| | - Jie Xiang
- College of Computer Science and Technology (College of Big Data), Taiyuan University of Technology, Taiyuan, 030002, People’s Republic of China
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Fu Q, Sandeep B, Li H, Wang BS, Huang X. Impact of perioperative dexmedetomidine on postoperative delirium in adult undergoing cardiac surgery: A comprehensive bibliometrix and meta-analysis. Asian J Psychiatr 2025; 108:104522. [PMID: 40339195 DOI: 10.1016/j.ajp.2025.104522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2025] [Revised: 04/27/2025] [Accepted: 04/28/2025] [Indexed: 05/10/2025]
Abstract
This bibliometrix and meta-analysis aimed to evaluate the efficacy of perioperative dexmedetomidine (DEX) on postoperative delirium (POD) in adult patients undergoing cardiac surgery. A comprehensive search of electronic databases identified 21 randomized controlled trials involving 5210 patients. The primary outcome was the incidence of POD from the first day to seven days post-surgery. The meta-analysis revealed that DEX significantly reduced POD incidence compared to various controls (RR 0.70; 95 % CI 0.54-0.89; P = 0.004). Subgroup analyses showed that DEX was particularly effective when compared to propofol (RR 0.48; 95 % CI 0.30-0.78; P = 0.003). However, no significant differences were observed in the duration of anesthesia, surgery, or ICU/hospital stay. Notably, DEX was associated with a higher incidence of hypotension (RR 1.90; 95 % CI 1.16-3.10; P = 0.01). The study highlights the potential neuroprotective benefits of DEX but underscores the need for careful monitoring of hemodynamic stability. Future research should focus on optimizing DEX dosing protocols and exploring its broader impact on postoperative recovery and patient outcomes.
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Affiliation(s)
- Qiang Fu
- Department of Anesthesiology, The Third People's Hospital of Chengdu, Sichuan Province 610074, China
| | - Bhushan Sandeep
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan Province, China
| | - Hong Li
- Department of Anesthesiology, No. 363 Hospital, Chengdu, Sichuan province 610074, China.
| | - Bao San Wang
- Department of Anesthesiology, No. 363 Hospital, Chengdu, Sichuan province 610074, China.
| | - Xin Huang
- Department of Anesthesiology, The Third People's Hospital of Chengdu, Sichuan Province 610074, China.
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Fang S, Wang X, Chen C, Sun W, Ji Y, Shao D, Sun C. Effect of buccal acupuncture therapy on the incidence of postoperative delirium in older adults undergoing orthopedic lower limb surgery: A randomized controlled trial. J Psychosom Res 2025; 192:112129. [PMID: 40228372 DOI: 10.1016/j.jpsychores.2025.112129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 04/04/2025] [Accepted: 04/05/2025] [Indexed: 04/16/2025]
Abstract
OBJECTIVE This study evaluated the effect of perioperative buccal acupuncture therapy on the incidence of postoperative delirium in elderly patients who underwent orthopedic lower limb surgery. METHODS This was a single-center, prospective, randomized controlled trial. A total of 120 elderly patients (aged ≥65 years) scheduled for elective orthopedic lower limb surgery were randomly assigned to the intervention group (n = 60, buccal acupuncture 30 min before anesthesia induction until the end of surgery and for 30 min each day for the first 2 postoperative days) or the control group (n = 60, no buccal acupuncture). The primary outcome was delirium during the first 7 postoperative days. The secondary outcomes included delirium severity, duration, and subtype; intraoperative total consumption rate of sufentanil and remifentanil; interleukin-6, interleukin-8, and norepinephrine in venous blood; the total number of electronic analgesia pump compressions; nausea and vomiting in 48 h; postoperative pain score; postoperative hospital stay, and postoperative adverse event rates. RESULTS The data of 120 patients were collected. The incidence of delirium during the first 7 postoperative days was significantly lower in the intervention group than in the control group (27 % [16/60] vs. 12 % [7/60]; relative risk, 0.44; 95 % confidence interval, 0.19-0.99; P = 0.037). Intraoperative total consumption rate of sufentanil and remifentanil, postoperative pain scores, and the incidence of postoperative nausea and vomiting were significantly lower in the intervention group. CONCLUSION Buccal acupuncture can reduce the incidence of postoperative delirium in elderly patients who undergo orthopedic lower limb surgery.
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Affiliation(s)
- Shilei Fang
- School of Medicine, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Xiang Wang
- School of Medicine, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Chen Chen
- School of Medicine, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Wenjin Sun
- Department of Anesthesiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yanyan Ji
- School of Medicine, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Donghua Shao
- Department of Anesthesiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
| | - Caixia Sun
- Department of Anesthesiology, Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
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Hikita K, Honda M, Shimizu N, Kanzawa K, Osaki H, Koyama Y, Yamamoto A, Yamane H, Shimizu R, Nishikawa R, Omatsu R, Kimura Y, Yamaguchi N, Morizane S, Takenaka A. Comparison of retroperitoneal laparoscopic radical nephroureterectomy outcomes in elderly patients based on the Geriatric 8 (G8) screening tool. Geriatr Gerontol Int 2025; 25:694-700. [PMID: 40165432 DOI: 10.1111/ggi.70036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 01/04/2025] [Accepted: 03/17/2025] [Indexed: 04/02/2025]
Abstract
AIM The Geriatric 8 (G8) screening tool consists of eight questions and is widely used to assess geriatric frailty. This study aimed to compare laparoscopic radical nephroureterectomy outcomes in patients aged >70 years with high and low G8 scores. MATERIALS AND METHODS Patients who underwent laparoscopic radical nephroureterectomy at a single center between 2017 and 2022 were included in this study. Patient background and perioperative outcomes were evaluated in two groups: low G8 (<14) and high G8 (≥14). The effects of age and body mass index (BMI) were assessed using logistic regression models adjusted for inverse-probability treatment weighting in the low G8 and high G8, respectively. RESULTS In total, 37 cases were categorized as low G8 and 30 cases as high G8. Significant differences in patient background were found in terms of age, BMI, American Society of Anesthesiologists physical status, presence of dementia, and estimated glomerular filtration rate (eGFR). Significant differences in perioperative outcomes were observed in the operative time and number of lymph node dissections. Postoperative delirium and eGFR were significantly higher in the low G8 group. The high G8 group showed significantly higher recurrence-free survival and overall survival rates than the low G8 group. After adjustment using the inverse-probability treatment weighting method, postoperative delirium and eGFR were significantly higher in the low G8 group but there were no significant differences in recurrence-free survival rates, cancer-specific survival, or overall survival. CONCLUSION After adjusting for age and BMI, preoperative G8 had a different frequency of postoperative delirium but had no effect on prognosis. Geriatr Gerontol Int 2025; 25: 694-700.
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Affiliation(s)
- Katsuya Hikita
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Naru Shimizu
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Kazuyoshi Kanzawa
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Hiroki Osaki
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Yuri Koyama
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Atsushi Yamamoto
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Hiroshi Yamane
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Ryutaro Shimizu
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Ryoma Nishikawa
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Rumiko Omatsu
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Yusuke Kimura
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Noriya Yamaguchi
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
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Wang C, Song X, Cao L, Guo F, Gao J. Preoperative quantitative quadriceps muscle ultrasound to predict POD for gastrointestinal surgery in older patients. BMC Gastroenterol 2025; 25:198. [PMID: 40128647 PMCID: PMC11934802 DOI: 10.1186/s12876-025-03782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Accepted: 03/12/2025] [Indexed: 03/26/2025] Open
Abstract
OBJECTIVE Postoperative delirium (POD) is generally associated with increased postoperative adverse events. We aimed to investigate whether preoperative quantitative quadriceps muscle ultrasound could predict POD in older patients after gastrointestinal surgery in order to provide more targeted prevention and treatment measures. METHODS We prospectively collected data from elderly patients who underwent elective gastrointestinal surgery from August to December 2023 at a tertiary hospital in China. Intergroup difference analysis and univariate and multivariate logistic regression analyses were used to explore independent risk factors. We calculated and assessed the parameters via sensitivity, specificity, the Youden index, and the area under the receiver operating characteristic curve (AUC), calibration curves and the Hosmer-Lemeshow test. The nomogram was validated internally through bootstrap resampling. The decision curve analysis (DCA) was used to evaluate its clinical validity. RESULTS A total of 695 patients who underwent gastrointestinal surgery were analyzed in this investigation, among which 137 patients experienced POD with an incidence rate of 19.7%. After conducting multivariate logistic regression analyses using R software, six independent risk factors associated with POD were identified, including age, quadriceps muscle thickness (Q-MT), quadriceps echo intensity (Q-EI), Charlson Comorbidity Index (CCI), preoperative frailty and preoperative Minimum Mental State Examination (MMSE) scores. The AUC value of the model was 0.966 (95% CI: 0.950-0.982; p < 0.05). The calibration curve revealed that the predicted probability of the nomogram was consistent with the actual probability, and the Hosmer-Lemeshow goodness-of-fit test value was 0.811. DCA revealed that the nomogram has a net benefit for POD. CONCLUSION Quantitative quadriceps ultrasound parameters, including the Q-MT and Q-EI, could predict POD after gastrointestinal surgery in older patients. We have developed a new nomogram for predicting POD in older patients who undergo gastrointestinal surgery. STUDY REGISTRATION The trial was registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ) on August 3, 2023, with the registration number of ChiCTR2300074304.
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Affiliation(s)
- Cunjin Wang
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
- Department of Anesthesiology, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
- The Yangzhou Clinical Medical College of Xuzhou Medical University, Yangzhou, 225001, China
| | - Xiaowei Song
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
- Department of Anesthesiology, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Lan Cao
- Department of Anesthesiology, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
- The Yangzhou Clinical Medical College of Xuzhou Medical University, Yangzhou, 225001, China
| | - Fang Guo
- Department of Anesthesiology, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Ju Gao
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China.
- Department of Anesthesiology, Northern Jiangsu People's Hospital, Yangzhou, 225001, China.
- The Yangzhou Clinical Medical College of Xuzhou Medical University, Yangzhou, 225001, China.
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Hung KC, Kao CL, Ho CN, Wu JY, Chang YJ, Lin CM, Chen IW. Efficacy and safety of esketamine in preventing perioperative neurocognitive disorders: a meta-analysis of randomized controlled studies. Syst Rev 2025; 14:68. [PMID: 40121475 PMCID: PMC11929294 DOI: 10.1186/s13643-025-02807-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2024] [Accepted: 03/04/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND Perioperative neurocognitive disorders (POND) are common in older adults and are associated with adverse outcomes. This meta-analysis aimed to evaluate the efficacy and safety of esketamine for the prophylaxis of POND. METHODS Electronic databases were comprehensively searched from inception to April 1, 2024, to identify randomized controlled trials (RCTs) exploring the impact of perioperative esketamine on POND in adult patients. The primary outcomes were the incidence of POND and the level of postoperative cognitive function. The secondary outcomes included recovery characteristics (i.e., respiratory depression, extubation time, agitation, hallucinations, and nightmares) and inflammatory markers. Subgroup and meta-regression analyses were conducted to investigate the heterogeneity and effect of esketamine dosage. RESULTS A total of 24 RCTs (n = 2,130 patients), all conducted in China with relatively short follow-up periods (≤ 3 months), were included. Esketamine was found to significantly reduce the risk of POND (risk ratio:0.53, 95%confidence interval [CI]: 0.43-0.67) and improved cognitive function on postoperative day 1 (standardized mean difference [SMD]:1.22, 95%CI:0.85-1.59) and day 3 (SMD:0.94, 95%CI: 0.46-1.43) compared with controls, without impacting recovery characteristics. Furthermore, esketamine was associated with lower pain scores, reduced risk of postoperative nausea/vomiting, and decreased levels of inflammatory markers (IL-6, TNF-α, and S100β). Subgroup and meta-regression analyses revealed that age, quality of studies, type of esketamine administration, and esketamine dosage did not have a significant impact on cognitive outcomes. The evidence showed moderate certainty for POND risk, low certainty for POD 1 cognitive function and several complications (agitation, hallucinations, PONV, respiratory issues, nightmares) and biomarkers (TNF-α, s100β), and very low certainty for POD 3 cognition, extubation time, pain, and IL-6 levels. CONCLUSION Perioperative esketamine is potentially effective in reducing the risk of POND and improving cognitive function in adult patients, regardless of age and dosage. Nevertheless, the certainty of evidence was low to very low for several outcomes (e.g., cognitive function on POD 3). Given that all included studies were conducted in China with relatively short follow-up periods, further high-quality RCTs with diverse populations and longer follow-up are warranted to validate these findings.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung City, Taiwan
| | - Chia-Li Kao
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Chun-Ning Ho
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung City, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan City, Taiwan
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chien-Ming Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - I-Wen Chen
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung City, Taiwan.
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan.
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DiMaria S, Mangano N, Bruzzese A, Bartula B, Parikh S, Costa A. Genetic Variation and Sex-Based Differences: Current Considerations for Anesthetic Management. Curr Issues Mol Biol 2025; 47:202. [PMID: 40136457 PMCID: PMC11941548 DOI: 10.3390/cimb47030202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2025] [Revised: 02/27/2025] [Accepted: 03/05/2025] [Indexed: 03/27/2025] Open
Abstract
Biomedical sciences have made immense progress and numerous discoveries aimed at improving the quality of life and life expectancy in modern times. Anesthesiology is typically tailored to individual patients as its clinical effects depend on multiple factors, including a patient's physiological and pathological states, age, environmental exposures, and genetic variations. Sex differences are also paramount for a complete understanding of the effects of specific anesthetic medications on men and women. However, women-specific research and the inclusion of women in clinical trials, specifically during child-bearing years, remain disproportionately low compared to the general population at large. This review describes and summarizes genetic variations, including sex differences, that affect responses to common anesthetic medications such as volatile anesthetics, induction agents, neuromuscular blocking drugs, opioids, and local anesthetics. It also discusses the influence of genetic variations on anesthesia outcomes, such as postoperative nausea and vomiting, allergic reactions, pain, depth of anesthesia, awareness under anesthesia and recall, and postoperative delirium.
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Affiliation(s)
- Stephen DiMaria
- Department of Anesthesiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA; (S.D.); (N.M.); (S.P.)
| | - Nicholas Mangano
- Department of Anesthesiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA; (S.D.); (N.M.); (S.P.)
| | - Adam Bruzzese
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (A.B.); (B.B.)
| | - Benjamin Bartula
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (A.B.); (B.B.)
| | - Shruti Parikh
- Department of Anesthesiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA; (S.D.); (N.M.); (S.P.)
| | - Ana Costa
- Department of Anesthesiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA; (S.D.); (N.M.); (S.P.)
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Liang B, Wu R, Lou Y. Intravenous injection of 0.5 μg/kg dexmedetomidine during plasma resection of tonsil adenoids can reduce the incidence of delirium and hemodynamics in children. Am J Transl Res 2025; 17:2188-2196. [PMID: 40226004 PMCID: PMC11982874 DOI: 10.62347/twcy6801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 02/27/2025] [Indexed: 04/15/2025]
Abstract
OBJECTIVE To investigate the effects of different doses of dexmedetomidine on delirium and hemodynamics after plasma resection of adenoids in children. METHODS A retrospective analysis was conducted on the clinical data of 80 children who underwent plasma adenoidectomy of tonsil at the Pediatric Hospital of Fudan University from January 2022 to December 2023. The patients were divided into normal saline group, 0.1 μg/kg dexmedetomidine group, and 0.5 μg/kg dexmedetomidine group according to the dose of dexmedetomidine injected intravenously. Hemodynamic changes, modified Yale Preoperative Anxiety Scale (mYPAS-SF) scores, pharyngeal pain (at rest and during swallowing), coagulation function, and postoperative adverse reactions were compared at T0, 10 min after dexmedetomidine pumping (T1), extubation (T2), recovery (T3), 2 h after returning to ward (T4), 12 h after returning to ward (T5) and 24 h after returning to ward (T6), respectively. RESULTS There were no significant differences in extubation time, recovery time, or unguardianship time among the three groups (P>0.05). The incidence of postoperative delirium was significantly lower in the 0.1 μg/kg dexmedetomidine group and 0.5 μg/kg dexmedetomidine group compared to the normal saline group (P<0.05), with the 0.5 μg/kg group showing better results. At T2, heart rate (HR) and mean arterial pressure (MAP) levels were significantly lower in 0.1 μg/kg group and 0.5 μg/kg dexmedetomidine group than those in normal saline group (P<0.05). The mYPAS-SF score was significantly lower in the 0.1 μg/kg group and 0.5 μg/kg dexmedetomidine groups than that of the normal saline group at T3, T4 and T5 (P<0.05). The score of pharyngeal pain during swallowing was significantly lower in the 0.5 μg/kg dexmedetomidine group at T5 than that of the normal saline group and 0.1 μg/kg dexmedetomidine group (P<0.05). Coagulation values (PT, APTT, and TT) were significantly altered 36 hours post-surgery, with PT, APTT, and TT increasing, while fibrinogen (FIB) decreased (P<0.05). Postoperative nasopharyngeal hemorrhage occurred in one case and nausea/vomiting in two cases in the saline group. No anesthesia-related adverse reactions were observed in the dexmedetomidine group. CONCLUSION Intravenous injection of 0.5 μg/kg dexmedetomidine during plasma resection of tonsillar adenoids can reduce the incidence of postoperative delirium, stabilize hemodynamics, relieve postoperative anxiety and pharyngeal pain, with minimal impacts on coagulation function. Additionally, it reduces the incidence of adverse reactions, making it a promising option for clinical use.
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Affiliation(s)
- Bing Liang
- Department of Anesthesiology, Pediatric Hospital of Fudan UniversityShanghai 201102, China
| | - Ru Wu
- Department of Anesthesiology, Shanghai Geriatric Medical CenterShanghai 201102, China
| | - Yanfang Lou
- Department of Anesthesiology, Pediatric Hospital of Fudan UniversityShanghai 201102, China
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10
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Wang H, Chen J, Chen J, Chen Y, Qin Y, Liu T, Pan S, Xie Y. Predictors of postoperative delirium in patients undergoing radical prostatectomy: a prospective study. Support Care Cancer 2025; 33:260. [PMID: 40063281 DOI: 10.1007/s00520-025-09289-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 02/18/2025] [Indexed: 04/23/2025]
Abstract
BACKGROUND Analyze the risk factors for postoperative delirium (POD) in elderly patients undergoing radical prostatectomy, and built a predictive nomogram model for early identification of high-risk individuals. METHODS A total of 156 patients was recruited and categorized based on whether the development of POD within 7 days post-surgery. After identifying independent risk factors through univariate and multivariate logistic regression analyses, predictive models were established. The discrimination and calibration were determined by C-index and calibration curve, with five-fold cross-validation executed. A nomogram model representing the optimal model was constructed based on the results. RESULTS POD occurred in 24 (15.38%) patients. Significant differences were observed in age, anxiety, physical status, sleep disorders, blood glucose, age-adjusted Charlson comorbidity index (ACCI), anticholinergic, blood loss, postoperative infection, and postoperative pain assessed by the numerical rating scale (NRS). Logistic regression analyses showed that sleep disorders (OR:12.931, 95% CI:1.191-140.351, P = 0.035), ACCI (OR:2.608, 95% CI:1.143-5.950, P = 0.023), postoperative infection (OR:19.298, 95% CI:2.53-147.202, P = 0.04), and NRS (OR:4.033, 95% CI:1.062-15.324, P = 0.041) were independent risk factors for POD. Model 1 (postoperative infection, ACCI, preoperative sleep disorder, NRS) showed better diagnostic performance than the others, of which the area under the curve (AUC) was 0.973. The best diagnostic performance was found in model 1 through five-fold cross-validation, with a C-index of 0.963. CONCLUSIONS This prospective cohort study highlighted that ACCI, preoperative sleep disorder, postoperative pain, and postoperative infection were identified as independent risk factors for POD. Furthermore, the nomogram derived from model 1 proved to be effective in predicting POD in elderly patients undergoing radical prostatectomy.
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Affiliation(s)
- Hao Wang
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Jie Chen
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, China
- Department of Anesthesiology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530007, Guangxi, China
| | - Jing Chen
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Yanhua Chen
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Yinying Qin
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Tianxiao Liu
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, China
| | - Sining Pan
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, China.
| | - Yubo Xie
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, China.
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
- Department of Anesthesiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, 610041, Sichuan, China.
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11
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Schmidt AP, Bilotta F. Challenges in surgical and perioperative care for Brazil's aging population. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2025; 75:844586. [PMID: 39818416 PMCID: PMC11761882 DOI: 10.1016/j.bjane.2025.844586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2025]
Affiliation(s)
- Andre P Schmidt
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil; Santa Casa de Porto Alegre, Serviço de Anestesia, Porto Alegre, RS, Brazil; Hospital Nossa Senhora da Conceição, Serviço de Anestesia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Ciências Cirúrgicas, Porto Alegre, RS, Brazil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), Programa de Pós-Graduação em Anestesiologia, Ciências Cirúrgicas e Medicina Perioperatória, São Paulo, SP, Brazil.
| | - Federico Bilotta
- Sapienza University of Rome, Department of Anesthesiology, Critical Care and Pain Medicine, Rome, Italy
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Jing D, Weijing S, Yiyu Z. Patients' and family members' dyadic experience of post-operative delirium in the intensive care unit: A qualitative study. Nurs Crit Care 2025; 30:e13297. [PMID: 39957424 PMCID: PMC11831243 DOI: 10.1111/nicc.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 11/24/2024] [Accepted: 01/17/2025] [Indexed: 02/18/2025]
Abstract
BACKGROUND Post-operative delirium is a complication with long-lasting consequences for both patients and their families. This is particularly true for those transferred to the intensive care unit after surgery, where the incidence of post-operative delirium is high, and patient outcomes are often poor. Despite the acknowledged role of family engagement in delirium management, previous research has mainly focused on patients, with limited exploration of the shared experiences between patients and family members. AIM This study aims to explore the experiences of patients and family members during episodes of post-operative delirium in the intensive care unit to better understand their unmet needs. STUDY DESIGN A qualitative descriptive study was conducted at a tertiary general hospital. Eighteen pairs of patients, their family members and two other family members were interviewed. Data were collected through face-to-face semi-structured interviews within the first week after patients' discharge from the intensive care unit and analysed using thematic analysis. RESULTS Four major themes emerged: (1) the dyadic relationship between patients and family members must be understood in the context of their shared emotional and behavioural experiences; (2) family's history may predispose patients to post-operative delirium; (3) family engagement may prevent the development of post-operative delirium; and (4) inadequate communication between health care providers and patients or families may negatively affect post-operative delirium outcomes. CONCLUSIONS Post-operative delirium presents significant emotional and physical challenges for both patients and their families. Addressing these challenges requires improved communication between health care providers and families, as well as strategies that emphasize early family support and collaboration in care. RELEVANCE TO CLINICAL PRACTICE Patients and their families should be considered a unit during post-operative delirium management, and earlier family engagement is essential. Health care systems should adapt intensive care unit practices to meet the dynamic needs of families, promoting more comprehensive support during critical care.
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Affiliation(s)
- Dong Jing
- Nursing DepartmentZhejiang University School of Medicine Sir Run Run Shaw HospitalHangzhouChina
- School of MedicineZhejiang UniversityHangzhouChina
| | - Sui Weijing
- Nursing DepartmentZhejiang University School of Medicine Sir Run Run Shaw HospitalHangzhouChina
| | - Zhuang Yiyu
- Nursing DepartmentZhejiang University School of Medicine Sir Run Run Shaw HospitalHangzhouChina
- School of MedicineZhejiang UniversityHangzhouChina
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13
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Lammers-Lietz F, Spies C, Maggioni MA. The autonomous nervous system and the cholinergic anti-inflammatory reflex in postoperative neurocognitive disorders. Curr Opin Anaesthesiol 2025; 38:1-8. [PMID: 39585207 DOI: 10.1097/aco.0000000000001446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2024]
Abstract
PURPOSE OF REVIEW Postoperative delirium (POD) is a common and serious complication after surgery. It is associated with postoperative neurocognitive disorder (PNCD). The vagal cholinergic anti-inflammatory pathway (CAP) has been hypothesized to play a role in POD/PNCD and may be a target for interventions such as transcutaneous auricular stimulation (taVNS). We aim to review associations of heart rate variability (HRV) as an indicator of vagal function with POD and postoperative immune reaction as well as taVNS as a potential preventive intervention for POD. RECENT FINDINGS Autonomous nervous system (ANS) dysfunction was a common finding in studies analysing HRV in POD and postoperative cognitive dysfunction, but results were heterogeneous. There was no evidence from HRV analysis that vagal activity prevents overshooting postoperative immune activation, but HRV may help to identify patients at risk for postoperative infections. Animal studies and preliminary trials suggest that taVNS may be used to prevent POD/PNCD. SUMMARY Our review provides no evidence that CAP suppression is associated with POD/PNCD. Future studies should consider that high vagal tone may also mediate immunosuppression in surgical patients, yielding an increased risk for postoperative infections. Although taVNS is a promising approach to prevent POD/POCD, future studies should take these concerns into account.
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Affiliation(s)
- Florian Lammers-Lietz
- Charité-Universitätsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Augustenburger Platz 1, 13353 Berlin
| | - Claudia Spies
- Charité-Universitätsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Augustenburger Platz 1, 13353 Berlin
| | - Martina A Maggioni
- Charité-Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milano, Italy
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14
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Wu CR, Chang KM, Tranyor V, Chiu HY. Global incidence and prevalence of delirium and its risk factors in medically hospitalized older patients: A systematic review and meta-analysis. Int J Nurs Stud 2025; 162:104959. [PMID: 39602991 DOI: 10.1016/j.ijnurstu.2024.104959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 10/16/2024] [Accepted: 11/11/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND Delirium is a common complication among older medical patients that can lead to undesirable outcomes. OBJECTIVES This study systematically investigated the incidence, prevalence, and risk factors of delirium to improve its recognition, prevention, and management in medically hospitalized older patients. METHODS The study protocol was registered at PROSPERO on April 29, 2024 (registration number: CRD42024536624). We searched the PubMed, Embase, and ProQuest databases for relevant articles published between database inception and September 25, 2024. We included observational studies reporting the prevalence, incidence, and risk factors of delirium among medically hospitalized older patients. Two independent reviewers extracted the data. A random-effects model was used for data analysis. RESULTS A total of 35 studies encompassing 12,097 participants met the inclusion criteria, yielding a 23.6 % pooled prevalence of delirium (95 % confidence interval = 19 % to 29 %) and a 13.5 % pooled incidence of delirium (n = 32, 95 % confidence interval = 11 % to 17 %) among medically hospitalized older patients. Study quality and country were significant moderators for explaining the heterogeneity observed in the prevalence and incidence of delirium, respectively (both P < 0.001). The risk factors of delirium included frailty (odds ratio = 2.05), physical restraints (5.01), prior falls (1.99), severe illness (1.32) (evaluated using the Acute Physiology and Chronic Health Evaluation II), and cognitive impairment (2.61). Older age increased delirium risk, whereas years of education mitigated it (B = 1.69 and 0.92, respectively). CONCLUSION Our findings considerably enhance the understanding of the prevalence of delirium and its influencing factors in medically hospitalized older patients. The insights this study provides can enable health-care providers to apply quick and effective assessment tools and can thereby support the implementation of interventions to prevent delirium. REGISTRATION The study protocol has been prospectively registered on PROSPERO (registration no. CRD42024536624).
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Affiliation(s)
- Chia-Rung Wu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Kai-Mei Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
| | - Victoria Tranyor
- School of Health, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD 4556, Australia; Warrigal, 2 Pine Street, Albion Park Rail, NSW 2527, Australia
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei City, Taiwan.
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Li D, Gu P, Wang Y, Yao Y, Fan D. The association between preoperative lacunar infarcts and postoperative delirium in elderly patients undergoing major abdominal surgery: a prospective cohort study. Aging Clin Exp Res 2025; 37:35. [PMID: 39878919 PMCID: PMC11779751 DOI: 10.1007/s40520-024-02909-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Accepted: 12/11/2024] [Indexed: 01/31/2025]
Abstract
OBJECTIVE The primary goal was to investigate whether the presence of preoperative lacunar infarcts (LACI) was associated with postoperative delirium (POD) in elderly patients undergoing elective major abdominal surgery. DESIGN A prospective cohort study. SETTING AND PARTICIPANTS Patients aged ≥ 65 years from a tertiary level A hospital in China. METHODS The POD was assessed once daily within the first postoperative 3 days using the Confusion Assessment Method. Neurocognitive tests using the Mini-mental State Examination (MMSE) and the Beijing version of the Montreal Cognitive Assessment scales were carried out within 3 days before surgery and 4-7 days after surgery. Regional cerebral oxygen saturation (rScO2) was recorded in the operating room. Logistic regression analysis was used to evaluate the impact of preoperative LACI on POD and to explore the risk factors for POD. RESULTS A total of 369 participants were analyzed, 161 in the preoperative LACI-positive group (P group), and 208 in the preoperative LACI-negative group (N group), respectively. The incidence of POD was 32.7% in our study. The incidence of POD was significantly higher in the P group than in the N group (39.1 vs 27.9%, risk ratio, 1.66; 95% CI 1.07-2.58; P = 0.022). Furthermore, the P group exhibited lower mean rScO2 values during the procedure (P < 0.001). In exploratory analysis, the advanced age (P = 0.005), sex (P = 0.038), and lower preoperative MMSE score (P = 0.019) were independent risk factors for POD in patients undergoing major abdominal surgery. CONCLUSIONS AND IMPLICATIONS Preoperative LACI was common, and constituted a risk factor for POD in older patients undergoing abdominal surgery. Despite the frequent subclinical nature, the preoperative LACI led to lower mean rScO2 during the procedure. These findings could help early identification of high-risk POD patients.
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Affiliation(s)
- Danni Li
- Department of Anesthesiology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610000, Sichuan, China
- Department of Anesthesiology, The Second People's Hospital of Meishan City, Meishan, 620000, Sichuan, China
| | - Pan Gu
- Department of Anesthesiology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610000, Sichuan, China
| | - Yuhao Wang
- State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yuchen Yao
- Department of Anesthesiology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610000, Sichuan, China
| | - Dan Fan
- Department of Anesthesiology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610000, Sichuan, China.
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Berger-Estilita J, Bilotta F. The fine line between relief and risk: new insights into postoperative delirium. Br J Anaesth 2025; 134:14-18. [PMID: 39756851 DOI: 10.1016/j.bja.2024.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 10/04/2024] [Accepted: 10/11/2024] [Indexed: 01/07/2025] Open
Abstract
There is a complex association between postoperative pain and postoperative delirium, which highlights the need for a more balanced approach to pain management that considers various risk factors. We emphasise the importance of comprehensive documentation and standardised monitoring to improve detection and management of postoperative delirium, ultimately enhancing patient outcomes. We advocate for a precision anaesthesia approach, which tailors care to individual patient profiles, as a potential solution to address these challenges.
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Affiliation(s)
- Joana Berger-Estilita
- Institute for Medical Education, University of Bern, Bern, Switzerland; Institute of Anaesthesiology and Intensive Care, Salemspital, Hirslanden Medical Group, Bern, Switzerland; CINTESIS@RISE-Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Federico Bilotta
- Department of Anaesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
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Moellmann HL, Alhammadi E, Olbrich P, Frohnhofen H. Relevance of Preoperative Cognitive Impairment for Predicting Postoperative Delirium in Surgical Medicine: A Prospective Cohort Study. Geriatrics (Basel) 2024; 9:155. [PMID: 39727814 DOI: 10.3390/geriatrics9060155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 11/22/2024] [Accepted: 12/04/2024] [Indexed: 12/28/2024] Open
Abstract
BACKGROUND Post-operative delirium is a dreaded complication after surgery in older patients. The identification of risk factors for delirium and comprehensive geriatric assessment is an extensive part of recent research. However, the preoperative assessment of risk factors, such as impaired cognition, is frequently not standardized. METHODS A comprehensive preoperative assessment was performed in 421 surgical patients to investigate the impact of preoperative cognitive impairment (PCI) on the risk of delirium and to evaluate appropriate screening tools (Six-item screener (SIS) and clock-drawing test (CDT)). RESULTS Both screening tools showed a significantly increased risk of delirium with p < 0.001 (OR 12.5, 95% [6.42; 24.4]) in SIS and p = 0.042 (OR 2.02, 95%CI [1.02; 4.03]) in CDT for existing cognitive impairment. A higher level of care (p < 0.001) and statutory care (p < 0.001, OR 5.42, 95%CI [2.34; 12.6]) also proved to be significant risk factors. The ROC curves of the two tests show AUC values of 0.741 (SIS) and 0.630 (CDT). The COP values for the SIS are 4 points with a Youden index of 0.447; for the CDT, the COP is 2 (Youden index = 0.177). CONCLUSIONS The recording of PCI should be a central component of the preoperative geriatric assessment. The tools used are simple yet effective and can be easily implemented in routine clinical practice. By reliably identifying patients at risk, the available resources can be personalized and used in a targeted approach.
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Affiliation(s)
- Henriette Louise Moellmann
- Cranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Eman Alhammadi
- Cranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
- Dubai Health, Dubai P.O. Box 1853, United Arab Emirates
| | - Philipp Olbrich
- Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - Helmut Frohnhofen
- Orthopedics and Trauma Surgery, University Hospital Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
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Bidoul T, Momeni M, Khalifa C. Screening of patients at risk of postoperative delirium using specific neuropsychological testing. Anaesthesia 2024; 79:1374-1376. [PMID: 39286856 DOI: 10.1111/anae.16437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2024] [Indexed: 09/19/2024]
Affiliation(s)
- Thomas Bidoul
- Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Mona Momeni
- Cliniques universitaires Saint-Luc, Brussels, Belgium
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Zhang W, Wang D, Li S, Chen Y, Bi C. Effect of esketamine on postoperative delirium in general anesthesia patients undergoing elective surgery: a meta-analysis of randomized controlled trials. BMC Anesthesiol 2024; 24:442. [PMID: 39609668 PMCID: PMC11603621 DOI: 10.1186/s12871-024-02833-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 11/21/2024] [Indexed: 11/30/2024] Open
Abstract
BACKGROUND Postoperative delirium is a common neurological complication, especially in older patients undergoing surgery, which is closely related to the poor prognosis of patients. The objective was to investigate the effects of esketamine on postoperative delirium in patients with general anesthesia. METHODS The databases of PubMed, Embase, Cochrane Library and the Chinese National Knowledge Infrastructure were searched for all available randomised controlled trials on the effects of esketamine induction on postoperative delirium in patients undergoing elective general anesthesia from inception until April 21, 2024. We used RevMan5.4 software for data analysis. Dichotomous data was analyzed by risk ratios(RR) with a 95% confidence interval(CI), and continuous data by mean differences(MD). We also evaluated the risk of literature bias using the Cochrane Bias Risk Assessment tool. RESULTS We included a total of 17 randomized controlled trials, including 1286 patients undergoing elective general anesthesia. In 17 studies, esketamine significantly reduced the incidence of postoperative delirium (RR: 0.43; 95%CI: 0.33 ~ 0.57; p < 0.001). Five studies examined the incidence of postoperative adverse events (nausea, vomiting, dizziness and resporatory depression) and showed no statistically significant difference between the esketamine group and the control group (normal saline or dexmedetomidine) (RR: 0.82; 95%CI: 0.65 ~ 1.03; p = 0.08). In addition, this study found that the esketamine group had a lower incidence of hypotension (RR: 0.24; 95%CI: 0.12 ~ 0.48; p < 0.001) and a lower score on the visual analogue scale 24 h after surgery (MD: -0.44; 95%CI: -0.54 ~ -0.33; p < 0.001). CONCLUSION According to our meta-analysis, the use of esketamine during anesthesia induction significantly reduced the incidence of postoperative delirium in patients undergoing elective general anesthesia without increasing the incidence of postoperative adverse reactions.
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Affiliation(s)
- Wenhui Zhang
- Department of Anesthesiology, Central Hospital of Dalian University of Technology, No. 826 Southwest Road, Shahekou District, Dalian, Liaoning Province, China
- China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, China
| | - Di Wang
- Department of Anesthesiology, Central Hospital of Dalian University of Technology, No. 826 Southwest Road, Shahekou District, Dalian, Liaoning Province, China
- Dalian Medical University, No. 9 West Section Lvshun South Road, Dalian, Liaoning Province, China
| | - Siru Li
- Department of Anesthesiology, Central Hospital of Dalian University of Technology, No. 826 Southwest Road, Shahekou District, Dalian, Liaoning Province, China
- Dalian Medical University, No. 9 West Section Lvshun South Road, Dalian, Liaoning Province, China
| | - Yutao Chen
- Department of Anesthesiology, Central Hospital of Dalian University of Technology, No. 826 Southwest Road, Shahekou District, Dalian, Liaoning Province, China
- Dalian Medical University, No. 9 West Section Lvshun South Road, Dalian, Liaoning Province, China
| | - Congjie Bi
- Department of Anesthesiology, Central Hospital of Dalian University of Technology, No. 826 Southwest Road, Shahekou District, Dalian, Liaoning Province, China.
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Fan Y, Liu X, Li Z, Xiang D. Effects of Surgery on Hemodynamics and Postoperative Delirium in Stanford Type A Aortic Dissection. J Multidiscip Healthc 2024; 17:5353-5362. [PMID: 39588487 PMCID: PMC11586451 DOI: 10.2147/jmdh.s493917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 11/08/2024] [Indexed: 11/27/2024] Open
Abstract
Objective To investigate the impact of surgical intervention on hemodynamic parameters and postoperative delirium in Stanford Type A aortic dissection patients. Methods A retrospective analysis was conducted on 139 patients who underwent surgery for Stanford Type A aortic dissection from February 2022 to February 2024. Hemodynamic parameters, including maximum ascending aortic diameter (MAAD), left ventricular end-diastolic diameter (LVEDd), and ejection fraction (LVEF), were compared pre- and post-surgery. Patients were divided into two groups based on delirium occurrence postoperatively: Group A (n=49, with delirium) and Group B (n=90, without delirium). Differences in surgical factors and intensive care conditions were analyzed, and risk factors for postoperative delirium were identified. Group sizes differ due to retrospective categorization based on observed outcomes rather than controlled sampling. Results ① Hemodynamic parameters: Postoperative MAAD and LVEDd were significantly reduced, while LVEF increased compared to preoperative levels (P < 0.05). ② Surgical and postoperative conditions: Group A had longer surgery, cardiopulmonary bypass, and deep hypothermic circulatory arrest times than Group B (P < 0.05). ③ Univariate analysis of baseline data: Group A had higher rates of patients aged ≥60, hypertension, history of stroke, and elevated preoperative D-dimer levels (P < 0.05). ④ Multivariate logistic analysis: Independent risk factors for postoperative delirium included age ≥60, hypertension, history of stroke, surgery time >6 hours, cardiopulmonary bypass time >3 hours, and deep hypothermic circulatory arrest time >40 minutes (OR > 1, P < 0.05). Conclusion Surgical treatment of Stanford Type A aortic dissection has a good effect, significantly improving long-term cardiac function. However, the incidence of postoperative delirium is relatively high and is closely related to factors such as age, hypertension, history of stroke, surgery time, cardiopulmonary bypass time, and deep hypothermic circulatory arrest time.
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Affiliation(s)
- Yongfeng Fan
- Department of Cardiac Surgery, Guizhou Provincial People’s Hospital, Guizhou, 550499, People’s Republic of China
| | - Xiulun Liu
- Department of Cardiac Surgery, Guizhou Provincial People’s Hospital, Guizhou, 550499, People’s Republic of China
| | - Zhongkui Li
- Department of Cardiac Surgery, Guizhou Provincial People’s Hospital, Guizhou, 550499, People’s Republic of China
| | - Daokang Xiang
- Department of Cardiac Surgery, Guizhou Provincial People’s Hospital, Guizhou, 550499, People’s Republic of China
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21
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Yang Y, Chen J, Wen Q, Jin G, Liu F, Yu L, He J. Effects of preoperative neoadjuvant chemotherapy on postoperative delirium in patients with gynecological tumor surgery: an observational study. J Cancer Res Clin Oncol 2024; 150:497. [PMID: 39542945 PMCID: PMC11564223 DOI: 10.1007/s00432-024-06006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 10/17/2024] [Indexed: 11/17/2024]
Abstract
PURPOSE To investigate whether neoadjuvant chemotherapy (NACT) increases the incidence of postoperative delirium (POD) in patients with gynecological tumors undergoing radical hysterectomy. METHODS This study included 60 patients in the neoadjuvant chemotherapy exposure group and 60 in the non-exposure group. Preoperative cognitive function, the incidence of POD and other physiological parameters were assessed on preoperative day 1 (POD-1), postoperative day 1 (POD1), postoperative day 2 (POD2), and postoperative day 3 (POD3). Additionally, preoperative olfactory function was evaluated using an olfactory detection kit on POD-1. The primary outcome was the incidence of POD within three days after surgery. RESULTS The incidence of POD was 28.33% in the exposed group and 8.33% in the non-exposed group (P = 0.005). Compared to the non-exposed group, the exposed group had a higher rate of cognitive dysfunction (33.33% vs 13.33%; P = 0.010), and a higher rate of olfactory dysfunction (OD) (25.00% vs 10.00%; P = 0.031). A restricted cubic spline analysis revealed a non-linear relationship between olfactory test scores and Montreal Cognitive Assessment Scale (MoCA) scores (P for overall < 0.001, P for nonlinear = 0.001). Logistic regression identified NACT, mild and moderate cognitive dysfunction, OD, and depression as independent risk factors for POD, with all factors showing significant associations (P < 0.05). The area under the curve (AUC) of OD for predicting POD was 0.783 (95%CI 0.656-0.909). CONCLUSIONS This single-blind observational study suggests that NACT increases the incidence of POD in patients with gynecological tumors undergoing radical hysterectomy. Moreover, the results indicate that preoperative OD may reflect preoperative cognitive dysfunction, and have predictive value for the incidence of POD.
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Affiliation(s)
- Yiwen Yang
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jiahui Chen
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Qian Wen
- Department of Anesthesiology, Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, No. 42, Baiziting, Xuanwu District, Nanjing, 210000, Jiangsu, China
| | - Guangshan Jin
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Fuqiang Liu
- Department of Anesthesiology, Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, No. 42, Baiziting, Xuanwu District, Nanjing, 210000, Jiangsu, China
| | - Ling Yu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, No. 100, Cross Street, Hongshan Road, Nanjing, 210000, China.
| | - Jianhua He
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China.
- Department of Anesthesiology, Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, No. 42, Baiziting, Xuanwu District, Nanjing, 210000, Jiangsu, China.
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22
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Zeng M, Zheng M, Wang J, Li S, Ji N, Peng Y. Effect of perioperative dexmedetomidine on postoperative delirium in patients with brain tumours: a protocol of a randomised controlled trial. BMJ Open 2024; 14:e084380. [PMID: 39515867 PMCID: PMC11552596 DOI: 10.1136/bmjopen-2024-084380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 09/30/2024] [Indexed: 11/16/2024] Open
Abstract
INTRODUCTION Neurosurgery is a risk factor for postoperative delirium. Dexmedetomidine has a potential effect on reducing postoperative delirium. We aim to test the primary hypothesis that perioperative administration of dexmedetomidine reduces the incidence of postoperative delirium in patients undergoing neurosurgical resections of temporal glioma. METHODS This is a single-centre, randomised, blinded and parallel-group controlled trial. A total of 366 patients will be randomised to either dexmedetomidine group (n=183) or placebo group (n=183). Subjects assigned to dexmedetomidine group will be given a continuous infusion at 0.4 µg/kg/h after anaesthesia induction until dural closure and then immediately receive an infusion of dexmedetomidine at 0.08 µg/kg/h by intravenous analgesia pump during the first 48 hours postoperatively. Patients in the placebo group will be given comparable volumes of normal saline, and intravenous analgesia pumps contain equal amounts of sufentanil and antiemetics, but no dexmedetomidine. The primary outcome is the incidence of postoperative delirium, which will be assessed with the Confusion Assessment Method two times per day during the first five postoperative days. ETHICS AND DISSEMINATION The protocol (V.1.1) has been approved by the medical ethics committee of Beijing Tiantan Hospital, Capital Medical University (KY2023-186-02). The findings of this study will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT06164314.
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Affiliation(s)
- Min Zeng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China
| | - Maoyao Zheng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China
| | - Jie Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China
| | - Shu Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China
| | - Yuming Peng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China
- Department of Outcome Research, Cleveland Clinic, Cleveland, Ohio, USA
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23
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Shi HJ, Zhuang MY, Hu JH, Long YQ, Gao YP, Zheng Z, Feng XM, Ji FH, Peng K. Use of dexmedetomidine during light versus deep anaesthesia on postoperative delirium among elderly patients undergoing major non-cardiac surgery: protocol for a multicentre randomised factorial trial. BMJ Open 2024; 14:e083312. [PMID: 39486831 PMCID: PMC11529680 DOI: 10.1136/bmjopen-2023-083312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 10/11/2024] [Indexed: 11/04/2024] Open
Abstract
INTRODUCTION Elderly patients are at a high risk of postoperative delirium (POD), leading to increased postoperative morbidity and mortality. The use of dexmedetomidine and depth of anaesthesia may influence POD. This study aims to determine the effects of dexmedetomidine infusion versus normal saline placebo during light versus deep anaesthesia on POD among elderly patients undergoing major non-cardiac surgery. METHODS AND ANALYSIS This prospective, multicentre, randomised, controlled, factorial trial will be conducted at three tertiary hospitals in Jiangsu, China. We will recruit a total of 420 patients who are at least 60 years old and undergoing major non-cardiac surgery (thoracic, abdominal, urology, orthopaedic and spine surgery) under general anaesthesia. Patients will be randomised (1:1:1:1) to receive one of four anaesthesia regimens: (1) dexmedetomidine and light anaesthesia, (2) dexmedetomidine and deep anaesthesia, (3) placebo and light anaesthesia or (4) placebo and deep anaesthesia. Dexmedetomidine will be infused at 0.5 µg/kg/h throughout surgery, and intraoperative bispectral index target will be 55 for light anaesthesia and 40 for deep anaesthesia. The primary outcome is the occurrence of POD during the first 7 days postoperatively or until hospital discharge, assessed using the 3-min Confusion Assessment Method two times per day. The secondary outcomes include days with POD, type of POD, pain scores at rest and on movement at 24 and 48 hours postoperatively, patient-controlled intravenous fentanyl consumption during 0-24 and 24-48 hours postoperatively, hypotension, bradycardia, postoperative nausea and vomiting, non-delirium complications, length of postoperative hospital stay, 30-day cognitive function and 30-day mortality. Data will be analysed on a modified intention-to-treat basis. ETHICS AND DISSEMINATION This trial was approved by the Ethics Committee of the First Affiliated Hospital of Soochow University and each participating centre. The trial results will be published in a peer-reviewed journal. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2300073271).
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Affiliation(s)
- Hai-Jing Shi
- Department of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anaesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Min-Yuan Zhuang
- Department of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anaesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Jing-Hui Hu
- Department of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anaesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Yu-Qin Long
- Department of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anaesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Yan-Ping Gao
- Department of Anaesthesiology, Zhangjiagang First People's Hospital, Zhangjiagang, Jiangsu, China
| | - Zhong Zheng
- Department of Anaesthesiology, First Peoples of Hospital of Taicang, Taicang, Jiangsu, China
| | - Xiao-Mei Feng
- Department of Anaesthesiology, University of Utah Health, Salt Lake City, Utah, USA
| | - Fu-Hai Ji
- Department of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anaesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Ke Peng
- Department of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anaesthesiology, Soochow University, Suzhou, Jiangsu, China
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Soares MR, Mahanna Gabrielli E, Manjarrez EC. The Geriatric Patient: Frailty, Prehabilitation, and Postoperative Delirium. Med Clin North Am 2024; 108:1101-1117. [PMID: 39341616 DOI: 10.1016/j.mcna.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Historically and for ease of classification, the geriatric patient has received a chronologic definition of a person 65 years and older. Chronologic age remains an independent risk of postoperative complications and adverse surgical outcomes. Frailty is an expression of an individual's biological age and as such a more reliable determination of their vulnerabilities or resilience to stress. The concept of prehabilitation has shown promise as a proactive approach to optimize a patient's functional, cognitive, nutritional, and emotional in preparation for surgical interventions. Postoperative delirium is the most common neuropsychological complication after surgery.
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Affiliation(s)
| | - Elizabeth Mahanna Gabrielli
- Division Neuroanesthesiology, Critical Care Medicine, Neurocritical Care and Geriatric Anesthesiology, University of Miami Miller School of Medicine
| | - Efrén C Manjarrez
- Division of Hospital Medicine, University of Miami Miller School of Medicine. https://twitter.com/drefrenm
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Hindman BJ, Olinger CR, Woodroffe RW, Zanaty M, Streese CD, Zacharias ZR, Houtman JCD, Wendt LH, Eyck PPT, O’Connell-Moore DJ, Ray EJ, Lee SJ, Waldschmidt DF, Havertape LG, Nguyen LB, Chen PF, Banks MI, Sanders RD, Howard MA. Exploratory Randomised Trial of Tranexamic Acid to Decrease Postoperative Delirium in Adults Undergoing Lumbar Fusion: A trial stopped early. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.10.16.24315638. [PMID: 39484259 PMCID: PMC11527054 DOI: 10.1101/2024.10.16.24315638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2024]
Abstract
Background Postoperative delirium may be mediated by perioperative systemic- and neuro-inflammation. By inhibiting the pro-inflammatory actions of plasmin, tranexamic acid (TXA) may decrease postoperative delirium. To explore this hypothesis, we modified an ongoing randomised trial of TXA, adding measures of postoperative delirium, cognitive function, systemic cytokines, and astrocyte activation. Methods Adults undergoing elective posterior lumbar fusion randomly received intraoperative intravenous TXA (n=43: 10 mg kg-1 loading dose, 2 mg kg-1 h-1 infusion) or Placebo (n=40). Blood was collected pre- and at 24 h post-operatively (n=32) for biomarkers of systemic inflammation (cytokines) and astrocyte activation (S100B). Participants had twice daily delirium assessments using the 3-minute diagnostic interview for Confusion Assessment Method (n=65). Participants underwent 4 measures of cognitive function preoperatively and during post-discharge follow-up. Results Delirium incidence in the TXA group (7/32=22%) was not significantly less than in the Placebo group (11/33=33%); P=0.408, absolute difference=11%, relative difference=33%, effect size = -0.258 (95% CI -0.744 to 0.229). In the Placebo group (n=16), delirium severity was associated with the number of instrumented vertebral levels (P=0.001) and with postoperative interleukin -8 and -10 concentrations (P=0.00008 and P=0.005, respectively) and these associations were not significantly modified by TXA. In the Placebo group, delirium severity was associated with S100B concentration (P=0.0009) and the strength of the association was decreased by TXA (P=0.002). Conclusions A potential 33% relative decrease in postoperative delirium incidence justifies an adequately powered clinical trial to determine if intraoperative TXA decreases delirium in adults undergoing lumbar fusion.
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Affiliation(s)
- Bradley J. Hindman
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Catherine R. Olinger
- Department of Orthopedics and Rehabilitation, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Royce W. Woodroffe
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Mario Zanaty
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | - Zeb R. Zacharias
- Human Immunology Core Laboratory, University of Iowa, Iowa City, Iowa, USA
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jon C. D. Houtman
- Human Immunology Core Laboratory, University of Iowa, Iowa City, Iowa, USA
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Department of Microbiology and Immunology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Linder H. Wendt
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, 52242, USA
| | - Patrick P. Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, 52242, USA
| | - Debra J. O’Connell-Moore
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, 52242, USA
| | - Emanuel J. Ray
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Sarah J. Lee
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Daniel F. Waldschmidt
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, 52242, USA
| | - Lauren G. Havertape
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, 52242, USA
| | - Lanchi B. Nguyen
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, 52242, USA
| | - Pei-fu Chen
- Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan City, 320315, Taiwan
| | - Matthew I. Banks
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Robert D. Sanders
- Central Clinical School and National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, Australia
- Department of Anaesthetics and Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Matthew A. Howard
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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Zhang Y, Chen R, Tang S, Sun T, Yu Y, Shi R, Wang K, Zeng Z, Liu X, Meng Q, Xia Z. Diurnal variation of postoperative delirium in elderly patients undergoing esketamine anesthesia for elective noncardiac surgery: a randomized clinical trial. Int J Surg 2024; 110:5496-5504. [PMID: 39275772 PMCID: PMC11392167 DOI: 10.1097/js9.0000000000001642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/06/2024] [Indexed: 09/16/2024]
Abstract
BACKGROUND Postoperative delirium (POD) is a serious and common complication. The aim of present study is to investigate the diurnal variation of POD and the effects of esketamine in elderly patients. METHODS A randomized, double-blind, placebo-controlled clinical trial with factorial design was conducted. Patients (aged 65 to 85 years) with normal Mini-Mental State Examination (MMSE) score were stratified by age (≤70 vs. >70) and American Society of Anesthesiologists physical status classification (Ⅱ vs. Ⅲ), then randomly assigned to either morning (08:00-12:00) or afternoon (14:00-18:00) noncardiac operation under general anesthesia with or without esketamine administration (0.2 mg/kg). The primary outcome was the incidence of POD (3-Minute Diagnostic Interview for Confusion Assessment Method-defined Delirium, 3D-CAM) on postoperative days 1, 3, and 7. The secondary outcomes were the scores of MMSE and Hospital Anxiety and Depression Scale. The intention-to-treat analysis of the outcomes were performed by generalized estimating equation. RESULTS Six patients who did not receive an intervention because of canceled operation were excluded after randomization. The datasets containing 426 cases were analyzed following the intention-to-treat principle after handling missing data via multiple imputation method. The incidence of POD declined from about 55% on postoperative day 1 to 31 and 18% on postoperative days 3 and 7, respectively. Afternoon operation [B=-0.583, OR (95% CI) 0.558 (0.319-0.976); P=0.041], but not esketamine, significantly decreased the incidence of POD. Both esketamine and operation time failed to significantly affect MMSE, HAD, and NRS score. There was no interaction among operation time, esketamine, and follow up time. CONCLUSION Elderly patients undergoing elective noncardiac surgery in the afternoon displayed lower POD incidence than those operated in the morning. A single low-dose of esketamine before general anesthesia induction failed to significantly decrease the risk of POD but decrease the risk of intraoperative hypotension and emergence agitation.
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Affiliation(s)
- Yuan Zhang
- Department of Anesthesiology, Renmin Hospital of Wuhan University
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Rong Chen
- Department of Anesthesiology, Renmin Hospital of Wuhan University
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Shan Tang
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Tao Sun
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Yanli Yu
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Ruoshi Shi
- Department of Anesthesiology, Renmin Hospital of Wuhan University
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Kai Wang
- Department of Anesthesiology, Renmin Hospital of Wuhan University
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Zi Zeng
- Department of Anesthesiology, Renmin Hospital of Wuhan University
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Xinhang Liu
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Qingtao Meng
- Department of Anesthesiology, Renmin Hospital of Wuhan University
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Zhongyuan Xia
- Department of Anesthesiology, Renmin Hospital of Wuhan University
- Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
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Yoshikai S, Ueda M, Ikeda K. Effect of Morphine Used to Relieve Dyspnea Due to Heart Failure on Delirium. J Palliat Med 2024; 27:1184-1190. [PMID: 38916066 DOI: 10.1089/jpm.2023.0704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
Background: Delirium management is crucial in palliative care. Morphine effectively relieves dyspnea due to heart failure. However, the effect of morphine, which is used to relieve dyspnea due to heart failure, on the incidence of delirium has not been examined to date. Objective: To evaluate the effect of morphine, which is used to relieve dyspnea due to heart failure, on delirium. Design: Retrospective observational study. Setting/Subjects: Subjects were identified from Osaka University Hospital records, located in Japan, from January 1, 2010, to September 30, 2021. The case group consisted of admissions for heart failure or cardiomyopathy registered in electronic medical records. Morphine was administered to relieve dyspnea due to heart failure, and no surgeries or procedures were performed. The control group consisted of admissions for heart failure or cardiomyopathy in the Diagnosis Procedure Combination (DPC) database, which did not include administration of morphine, oxycodone, or fentanyl during the hospitalization period and patients did not undergo surgery or any other procedure. Measurements: The incidence of delirium was assessed. Results: The odds ratios for morphine in the multivariate logistic regression analysis with propensity score and univariate logistic regression analysis after propensity score matching were 1.406 (95% confidence interval (CI) [0.249-7.957]) and 1.034 (95% CI [0.902-1.185]), respectively. Conclusions: Morphine, which is used to relieve dyspnea due to heart failure, had minimal effect on the incidence of delirium. This information is likely to be beneficial for the future use of morphine in the management of dyspnea in patients with heart failure.
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Affiliation(s)
- Shoichi Yoshikai
- Department of Clinical Pharmacy Research and Education, Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Japan
| | - Mikiko Ueda
- Department of Clinical Pharmacy Research and Education, Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Japan
| | - Kenji Ikeda
- Department of Clinical Pharmacy Research and Education, Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Japan
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Fu W, Li Y, Liu R, Li J. Incidence and Risk Factors of Delirium Following Brain Tumor Resection: A Retrospective National Inpatient Sample Database Study. World Neurosurg 2024; 189:e533-e543. [PMID: 38936612 DOI: 10.1016/j.wneu.2024.06.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the occurrence and factors predisposing to delirium following brain tumor resection. METHODS Data from patients who underwent brain tumor resection surgery from 2016 to 2019 were extracted from the National Inpatient Sample database and retrospectively analyzed. The difference between the 2 groups was compared by Wilcoxon rank test or χ2 test was used. Univariate and multivariate logistic regression analyses were used to identify the risk factors of delirium after brain tumor resection. RESULTS From 2016 to 2019, 28,340 patients who underwent brain tumor resection were identified in the National Inpatient Sample database, with the incidence of delirium being 4.79% (1357/28,340). It was found that increased incidence of delirium was significantly associated with age over 75 years and males (all P < 0.001). Besides, patients with delirium were more likely to have multiple comorbidities and to receive elective surgery (all P < 0.001). The results of logistic regression analysis showed that self-pay (odds ratio [OR] = 0.51; confidence interval [CI] = 0.31-0.83; P = 0.007), elective admission (OR = 0.53; CI = 0.47-0.60; P < 0.001), obesity (OR = 0.77; CI = 0.66-0.92; P = 0.003), females (OR = 0.79; CI = 0.71-0.88; P < 0.001), and private insurance (OR = 0.80; CI = 0.67-0.95; P = 0.012) were associated with lower occurrence of delirium. Besides, delirium was related to extra total hospital charges (P < 0.001), increased length of stay (P < 0.001), higher inpatient mortality (P = 0.001), and perioperative complications (including heart failure, acute renal failure, urinary tract infection, urinary retention, septicemia, pneumonia, blood transfusion, and cerebral edema) (P < 0.001). CONCLUSIONS Many factors were associated with the occurrence of delirium after brain tumor resection. Therefore, clinicians should identify high-risk patients prone to delirium in a timely manner and take effective management measures to reduce adverse outcomes.
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Affiliation(s)
- Wei Fu
- Department of Anesthesiology, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yi Li
- Department of Anesthesiology, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Rui Liu
- Department of Anesthesiology, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Jingjing Li
- Department of Neurosurgery, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China.
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Song SS, Lin L, Li L, Han XD. Influencing factors and risk prediction model for emergence agitation after general anesthesia for primary liver cancer. World J Gastrointest Surg 2024; 16:2194-2201. [PMID: 39087110 PMCID: PMC11287673 DOI: 10.4240/wjgs.v16.i7.2194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/16/2024] [Accepted: 06/13/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND General anesthesia is commonly used in the surgical management of gastrointestinal tumors; however, it can lead to emergence agitation (EA). EA is a common complication associated with general anesthesia, often characterized by behaviors, such as crying, struggling, and involuntary limb movements in patients. If treatment is delayed, there is a risk of incision cracking and bleeding, which can significantly affect surgical outcomes. Therefore, having a proper understanding of the factors influencing the occurrence of EA and implementing early preventive measures may reduce the incidence of agitation during the recovery phase from general anesthesia, which is beneficial for improving patient prognosis. AIM To analyze influencing factors and develop a risk prediction model for EA occurrence following general anesthesia for primary liver cancer. METHODS Retrospective analysis of clinical data from 200 patients who underwent hepatoma resection under general anesthesia at Wenzhou Central Hospital (January 2020 to December 2023) was conducted. Post-surgery, the Richmond Agitation-Sedation Scale was used to evaluate EA presence, noting EA incidence after general anesthesia. Patients were categorized by EA presence postoperatively, and the influencing factors were analyzed using logistic regression. A nomogram-based risk prediction model was constructed and evaluated for differentiation and fit using receiver operating characteristics and calibration curves. RESULTS EA occurred in 51 (25.5%) patients. Multivariate analysis identified advanced age, American Society of Anesthesiologists (ASA) grade III, indwelling catheter use, and postoperative pain as risk factors for EA (P < 0.05). Conversely, postoperative analgesia was a protective factor against EA (P < 0.05). The area under the curve of the nomogram was 0.972 [95% confidence interval (CI): 0.947-0.997] for the training set and 0.979 (95%CI: 0.951-1.000) for the test set. Hosmer-Lemeshow test showed a good fit (χ 2 = 5.483, P = 0.705), and calibration curves showed agreement between predicted and actual EA incidence. CONCLUSION Age, ASA grade, catheter use, postoperative pain, and analgesia significantly influence EA occurrence. A nomogram constructed using these factors demonstrates strong predictive accuracy.
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Affiliation(s)
- Shu-Shu Song
- Department of Anesthesia and Surgery, Wenzhou Central Hospital, Wenzhou 325099, Zhejiang Province, China
| | - Li Lin
- Department of Anesthesia and Surgery, Wenzhou Central Hospital, Wenzhou 325099, Zhejiang Province, China
| | - Li Li
- Department of Anesthesia and Surgery, Wenzhou Central Hospital, Wenzhou 325099, Zhejiang Province, China
| | - Xiao-Dong Han
- Department of Anesthesia and Surgery, Wenzhou Central Hospital, Wenzhou 325099, Zhejiang Province, China
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Guttenthaler V, Fidorra J, Wittmann M, Menzenbach J. Predictiveness of preoperative laboratory values for postoperative delirium. Health Sci Rep 2024; 7:e2219. [PMID: 38952405 PMCID: PMC11215531 DOI: 10.1002/hsr2.2219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 07/03/2024] Open
Abstract
Background Postoperative delirium (POD) is a common postoperative complication, especially in patients over 60 years, with an incidence ranging from 15% to 50%. In most cases, POD manifests in the first 5 days after surgery. Multiple contributing risk factors for POD have been detected. Besides the predisposing factors such as higher age, cognitive impairment, high blood pressure, atrial fibrillation, and past stroke, pathophysiological mechanisms like neuroinflammation are also considered as contributing factors. Methods In a subanalysis of the "PRe- Operative Prediction of postoperative DElirium by appropriate SCreening" (PROPDESC) study, the preoperative laboratory values of sodium, potassium, total protein, hemoglobin concentration (Hgb), and white blood cells as well as the biomarkers creatinine, HbA1c, NT-pro-BNP, high sensitive Troponin T (hsTnT), and C-reactive protein (CRP) were assessed to investigate a possible relationship to the occurrence of POD. Results After correction for age, physical status classification, surgery risk after Johns Hopkins, and operative discipline (cardiac surgery vs. noncardiac surgery), male patients with a Hgb <13 g/dL had significantly higher odds for POD (p = 0.025). Furthermore, patients with CRP ≥ 10 mg/L, HbA1c value ≥ 8.5% as well as patients with hypernatraemia (>145 mmol/L) presented significantly higher odds to develop POD (p = 0.011, p < 0.001, and p = 0.021, respectively). A raised (>14-52 ng/L) or high (>52 ng/L) hsTnT value was also associated with a significantly higher chance for POD compared to the patient group with hsTnT <14 ng/L (p < 0.001 and p = 0.016, respectively). Conclusions Preoperative Hgb, CRP, HbA1c, sodium, and hsTnT could be used to complement and refine the preoperative screening for patients at risk for POD. Further studies should track these correlations to investigate the potential of targeted POD protection and enabling hospital staff to initiate POD-preventing measures in time.
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Affiliation(s)
- Vera Guttenthaler
- Clinic of Anaesthesia and Intensive Care MedicineUniversity BonnBonnGermany
| | - Jacqueline Fidorra
- Clinic of Anaesthesia and Intensive Care MedicineUniversity BonnBonnGermany
- Asklepios Clinic North HeidbergClinic for Internal Medicine Department IHamburgGermany
| | - Maria Wittmann
- Clinic of Anaesthesia and Intensive Care MedicineUniversity BonnBonnGermany
| | - Jan Menzenbach
- Clinic of Anaesthesia and Intensive Care MedicineUniversity BonnBonnGermany
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Liu K, Lin N, Jin T, Xiang Y, Li J, Lai D, Xu H. Association between pediatric postoperative delirium and regional cerebral oxygen saturation: a prospective observational study. BMC Psychiatry 2024; 24:367. [PMID: 38750494 PMCID: PMC11097584 DOI: 10.1186/s12888-024-05832-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Postoperative delirium (POD) represents a prevalent and noteworthy complication in the context of pediatric surgical interventions. In recent times, a hypothesis has emerged positing that cerebral ischemia and regional cerebral oxygen desaturation might serve as potential catalysts in the pathogenesis of POD. The primary aim of this study was to methodically examine the potential relationship between POD and regional cerebral oxygen saturation (rSO2) and to assess the predictive and evaluative utility of rSO2 in the context of POD. METHODS This prospective observational study was conducted at the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China, spanning the period from November 2020 to March 2021. The research cohort comprised children undergoing surgical procedures within this clinical setting. To measure rSO2 dynamics, cerebral near-infrared spectroscopy (NIRS) was used to monitor rSO2 levels both before and after surgery. In addition, POD was assessed in the paediatric patients according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria. The analysis of the association between the rSO2 index and the incidence of POD was carried out through the application of either the independent samples t-test or the nonparametric rank-sum test. To ascertain the threshold value of the adjusted rSO2 index for predictive and evaluative purposes regarding POD in the pediatric population, the Receiver Operating Characteristics (ROC) curve was employed. RESULTS A total of 211 cases were included in this study, of which 61 (28.9%) developed POD. Participants suffering delirium had lower preoperative rSO2mean, lower preoperative rSO2min, and lower postoperative rSO2min, higher ∆rSO2mean, higher amount of ∆rSO2mean, lower ∆rSO2min (P < 0.05). Preoperative rSO2mean (AUC = 0.716, 95%CI 0.642-0.790), ∆rSO2mean (AUC = 0.694, 95%CI 0.614-0.774), amount of ∆rSO2mean (AUC = 0.649, 95%CI 0.564-0.734), preoperative rSO2min (AUC = 0.702, 96%CI 0.628-0.777), postoperative rSO2min (AUC = 0.717, 95%CI 0.647-0.787), and ∆rSO2min (AUC = 0.714, 95%CI 0.638-0.790) performed well in sensitivity and specificity, and the best threshold were 62.05%, 1.27%, 2.41%, 55.68%, 57.36%, 1.29%. CONCLUSIONS There is a close relationship between pediatric POD and rSO2. rSO2 could be used as an effective predictor of pediatric POD. It might be helpful to measure rSO2 with NIRS for early recognizing POD and making it possible for early intervention.
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Affiliation(s)
- Kexian Liu
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
- Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Nan Lin
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
- Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
| | - Ting Jin
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
| | - Yujun Xiang
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
| | - Jiahuan Li
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
| | - Dengming Lai
- Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China.
| | - Hongzhen Xu
- Nursing Department, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China.
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Rössler J, Shah K, Medellin S, Turan A, Ruetzler K, Singh M, Sessler DI, Maheshwari K. Development and validation of delirium prediction models for noncardiac surgery patients. J Clin Anesth 2024; 93:111319. [PMID: 37984177 DOI: 10.1016/j.jclinane.2023.111319] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/20/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
STUDY OBJECTIVE Postoperative delirium is associated with morbidity and mortality, and its incidence varies widely. Using known predisposing and precipitating factors, we sought to develop postoperative delirium prediction models for noncardiac surgical patients. DESIGN Retrospective prediction model study. SETTING Major quaternary medical center. PATIENTS Our January 2016 to June 2020 training dataset included 51,677 patients of whom 2795 patients had delirium. Our July 2020 to January 2022 validation dataset included 14,438 patients of whom 912 patients had delirium. INTERVENTIONS None. MEASUREMENTS We trained and validated two static prediction models and one dynamic delirium prediction model. For the static models, we used random survival forests and traditional Cox proportional hazard models to predict postoperative delirium from preoperative variables, or from a combination of preoperative and intraoperative variables. We also used landmark modeling to dynamically predict postoperative delirium using preoperative, intraoperative, and postoperative variables before onset of delirium. MAIN RESULTS In the validation analyses, the static random forest model had a c-statistic of 0.81 (95% CI: 0.79, 0.82) and a Brier score of 0.04 with preoperative variables only, and a c-statistic of 0.86 (95% CI: 0.84, 0.87) and a Brier score of 0.04 when preoperative and intraoperative variables were combined. The corresponding Cox models had similar discrimination metrics with slightly better calibration. The dynamic model - using all available data, i.e., preoperative, intraoperative and postoperative data - had an overall c-index of 0.84 (95% CI: 0.83, 0.85). CONCLUSIONS Using preoperative and intraoperative variables, simple static models performed as well as a dynamic delirium prediction model that also included postoperative variables. Baseline predisposing factors thus appear to contribute far more to delirium after noncardiac surgery than intraoperative or postoperative variables. Improved postoperative data capture may help improve delirium prediction and should be evaluated in future studies.
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Affiliation(s)
- Julian Rössler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Karan Shah
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic, OH, USA
| | - Sara Medellin
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Kurt Ruetzler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Mriganka Singh
- Division of Geriatrics and Palliative Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Center on Innovation-Long Term Services and Supports, Providence Veterans Administration Medical Center, Providence, RI, USA
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Kamal Maheshwari
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
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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] [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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Sun M, Liu M, Zhang F, Sang L, Song Y, Li P, Liu S, Yang H, Ma L, Cao J, Mi W, Ma Y. Triglyceride-glucose index predicts postoperative delirium in elderly patients with type 2 diabetes mellitus: a retrospective cohort study. Lipids Health Dis 2024; 23:107. [PMID: 38622624 PMCID: PMC11017528 DOI: 10.1186/s12944-024-02084-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/20/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Postoperative delirium (POD) is more prevalent among elderly patients with type 2 diabetes mellitus (T2DM). Insulin resistance (IR) can be assessed using the triglyceride-glucose (TyG) index, a novel biomarker. This study aims to investigate the predictive potential of the TyG index for POD in elderly patients with T2DM. MATERIALS AND METHODS Elderly patients (≥ 65) with T2DM who underwent non-neurosurgery and non-cardiac surgery were enrolled. Univariate and multivariate logistic regression analyses were conducted to assess the association between the TyG index and POD. Additionally, subgroup analyses were performed to compare the sex-specific differences in the predictive ability of the TyG index for POD. RESULTS A total of 4566 patients were included in this retrospective cohort. The receiver operating characteristic (ROC) curve analysis determined the optimal cut-off value for the TyG index to be 8.678. In the univariate model, a TyG index > 8.678 exhibited an odds ratio (OR) of 1.668 (95% CI: 1.210-2.324, P = 0.002) for predicting POD. In the multivariate regression models, the ORs were 1.590 (95% CI: 1.133-2.252, P < 0.008), 1.661 (95% CI: 1.199-2.325, P < 0.003), and 1.603 (95% CI: 1.137-2.283, P = 0.008) for different models. Subgroup analyses demonstrated that the predictive ability of the TyG index was more pronounced in females compared to males. CONCLUSION The TyG index shows promise as a novel biomarker for predicting the occurrence of POD in elderly surgical patients with T2DM.
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Affiliation(s)
- Miao Sun
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100730, China
- Nation Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100730, China
| | - Min Liu
- Nation Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100730, China
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Faqiang Zhang
- Nation Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100730, China
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China
| | - Lijuan Sang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100730, China
| | - Yuxiang Song
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100730, China
| | - Peng Li
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100730, China
| | - Siyuan Liu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100730, China
| | - Huikai Yang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100730, China
| | - Libin Ma
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100730, China
| | - Jiangbei Cao
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100730, China
| | - Weidong Mi
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100730, China.
- Nation Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100730, China.
| | - Yulong Ma
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100730, China.
- Nation Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100730, China.
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Wang Y, Zhu H, Xu F, Ding Y, Zhao S, Chen X. The effect of anesthetic depth on postoperative delirium in older adults: a systematic review and meta-analysis. BMC Geriatr 2023; 23:719. [PMID: 37932677 PMCID: PMC10629190 DOI: 10.1186/s12877-023-04432-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) is an important complication for older patients and recent randomised controlled trials have showed a conflicting result of the effect of deep and light anesthesia. METHODS We included randomised controlled trials including older adults that evaluated the effect of anesthetic depth on postoperative delirium from PubMed, Embase, Web of Science and Cochrane Library. We considered deep anesthesia as observer's assessment of the alertness/ sedation scale (OAA/S) of 0-2 or targeted bispectral (BIS) < 45 and the light anesthesia was considered OAA/S 3-5 or targeted BIS > 50. The primary outcome was incidence of POD within 7 days after surgery. And the secondary outcomes were mortality and cognitive function 3 months or more after surgery. The quality of evidence was assessed via the grading of recommendations assessment, development, and evaluation approach. RESULTS We included 6 studies represented 7736 patients aged 60 years and older. We observed that the deep anesthesia would not increase incidence of POD when compared with the light anesthesia when 4 related studies were pooled (OR, 1.40; 95% CI, 0.63-3.08, P = 0.41, I2 = 82%, low certainty). And no significant was found in mortality (OR, 1.12; 95% CI, 0.93-1.35, P = 0.23, I2 = 0%, high certainty) and cognitive function (OR, 1.13; 95% CI, 0.67-1.91, P = 0.64, I2 = 13%, high certainty) 3 months or more after surgery between deep anesthesia and light anesthesia. CONCLUSIONS Low-quality evidence suggests that light general anesthesia was not associated with lower POD incidence than deep general anesthesia. And High-quality evidence showed that anesthetic depth did not affect the long-term mortality and cognitive function. SYSTEMATIC REVIEW REGISTRATION CRD42022300829 (PROSPERO).
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Affiliation(s)
- Yafeng Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
| | - Hongyu Zhu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
- Department of Anesthesiology, Linhe District People's Hospital, Bayannur City, 015000, China
| | - Feng Xu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
| | - Yuanyuan Ding
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
| | - Shuai Zhao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China.
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Schubert M, Ausserhofer D, Schaffert-Witvliet B, Radtke FM, Neuner B. [Prevention of Post-operative Delirium]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:482-493. [PMID: 37725990 DOI: 10.1055/a-2065-3748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Postoperative delirium (POD) is an adverse but often preventable complication of surgery and surgery-related anaesthesia, and increasingly prevalent. This article provides an overview on non-pharmacological preventive measures, divided into individualized and non-individualized measures. Non-individualized measures, such as the most minimally invasive surgical procedure, avoidance of unnecessary fasting before surgery, and the most tolerable anaesthesia are used to minimize the risk of POD in all patients. Based on the results of preoperative screenings for risk factors such as frailty or cognitive impairment, individualized measures may encompass prehabilitation, treatment of specific risk factors, operation room companionship or cognitive, motor, and sensory stimulation as well as social support. This article additionally lists several examples of best practice approaches already implemented in German-speaking countries and websites for further readings.
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Karageorgos V, Mevorach L, Silvetti M, Bilotta F. Preoperative Risk Factors Associated with Increased Incidence of Postoperative Delirium: Systematic Review of Qualified Clinical Studies. Geriatrics (Basel) 2023; 8:24. [PMID: 36826366 PMCID: PMC9956273 DOI: 10.3390/geriatrics8010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/20/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Postoperative delirium (POD) is an acute alteration of mental state, characterized by reduced awareness and attention, occurring up to five postoperative days after recovery from anesthesia. Several original studies and reviews have identified possible perioperative POD risk factors; however, there is no comprehensive review of the preoperative risk factors in patients diagnosed with POD using only validated diagnostic scales. The aim of this systematic review was to report the preoperative risk factors associated with an increased incidence of POD in patients undergoing non-cardiac and non-brain surgery. The reviewed studies included original research papers that used at least one validated diagnostic scale to identify POD occurrence for more than 24 h. A total of 6475 references were retrieved from the database search, with only 260 of them being suitable for further review. Out of the 260 reviewed studies, only 165 that used a validated POD scale reported one or more preoperative risk factors. Forty-one risk factors were identified, with various levels of statistical significance. The extracted risk factors could serve as a preoperative POD risk assessment workup. Future studies dedicated to the further evaluation of the specific preoperative risk factors' contributions to POD could help with the development of a weighted screening tool.
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Affiliation(s)
| | - Lior Mevorach
- Department of Anesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I Teaching Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Melissa Silvetti
- Department of Anesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I Teaching Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I Teaching Hospital, Sapienza University of Rome, 00185 Rome, Italy
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Wang JH, Liu T, Bai Y, Chen YQ, Cui YH, Gao XY, Guo JR. The effect of parecoxib sodium on postoperative delirium in elderly patients with hip arthroplasty. Front Pharmacol 2023; 14:947982. [PMID: 37025488 PMCID: PMC10072322 DOI: 10.3389/fphar.2023.947982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 02/15/2023] [Indexed: 04/08/2023] Open
Abstract
Objective: This study aimed to clarify the effect of parecoxib sodium on the occurrence of postoperative delirium and to investigate its possible mechanism. Methods: A total of 80 patients who underwent elective hip arthroplasty in our hospital between December 2020 and December 2021 were selected and randomly divided into two groups: a parecoxib sodium group (group P, n = 40) and a control group (group C, n = 40). Patients in group P were intravenously injected with 40 mg of parecoxib sodium 30 min before anesthesia and at the end of the surgery. Patients in group C were intravenously injected with the same volume of normal saline at the same time points. The primary endpoint was the incidence of POD, and the secondary endpoints were the levels of inflammatory factors (tumor necrosis factor- α [TNF-α], interleukin [IL]-1β, IL-6, and IL-10), nerve injury-related factors (brain-derived neurotrophic factor [BDNF], S-100β protein, neuron-specific enolase [NSE], and neurofilament light chain [NfL]), and antioxidant factors (heme oxygenase-1 [HO-1]), as well as the Visual Analogue Scale (VAS) and Confusion Assessment Method-Chinese Reversion (CAM-CR) scores. Results: The incidence of POD was 10% in group P and 27.5% in group C. Intergroup comparison revealed that the levels of TNF-α, IL-1β, S-100β, NfL, and NSE were lower, and BDNF was higher, in group P than in group C at each postoperative time point. The levels of IL-6 were lower, and the levels of IL-10 and HO-1 were higher, in group P than in group C at 1 h and 1 day postoperatively (p < 0.05). Three days after surgery, the differences in the levels of IL-6, IL-10, and HO-1 were not statistically significant between the two groups (p > 0.05). The VAS and CAM-CR scores were lower at each postoperative time point in group P than in group C (p < 0.05). Conclusion: Parecoxib sodium could reduce postoperative pain, decrease the plasma levels of inflammatory and nerve injury-related factors, upregulate HO-1 levels, and reduce the incidence of POD. The results of this study suggest that parecoxib sodium may reduce the occurrence of POD through the effects of anti-inflammation, analgesia, and antioxidants.
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Affiliation(s)
- Jin-Huo Wang
- Department of Anesthesiology and Perioperative Medicine, Gongli Hospital, Naval Military Medical University, Shanghai, China
| | - Tong Liu
- Department of Anesthesiology and Perioperative Medicine, Gongli Hospital, Naval Military Medical University, Shanghai, China
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Yu Bai
- Department of Anesthesiology and Perioperative Medicine, Gongli Hospital, Naval Military Medical University, Shanghai, China
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Yong-Quan Chen
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Ying-Hui Cui
- Department of Anesthesiology and Perioperative Medicine, Gongli Hospital, Naval Military Medical University, Shanghai, China
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Xin-Yue Gao
- Department of Anesthesiology and Perioperative Medicine, Gongli Hospital, Naval Military Medical University, Shanghai, China
- *Correspondence: Xin-Yue Gao, Jian-Rong Guo,
| | - Jian-Rong Guo
- Department of Anesthesiology and Perioperative Medicine, Gongli Hospital, Naval Military Medical University, Shanghai, China
- *Correspondence: Xin-Yue Gao, Jian-Rong Guo,
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Liu J, Liu M, Li J, Rong J. Clinical risk analysis of postoperative delirium in elderly patients undergoing thoracic and abdominal surgery: study protocol of a single-centre observational cohort study. BMJ Open 2022; 12:e062648. [PMID: 36581418 PMCID: PMC9806005 DOI: 10.1136/bmjopen-2022-062648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Postoperative delirium (POD) acts as a common complication in older patients after surgery, accompanied by longer recovery time, prolonged hospital stay, increased hospitalisation costs, etc. Therefore, it is urgent to reduce POD by implementing some intervention strategies. Early identification of associated risk factors was regarded as an effective method to lower the incidence of POD. Currently, the incidence and risk factors of POD have been widely investigated in orthopaedic and cardiac surgery, while remain scarce in thoracic and abdominal surgery. We will perform an observational cohort study to explore the incidence and potential risk variables of POD in thoracic and abdominal surgery, mainly focusing on some prognostic indicators including age-adjusted Charlson Comorbidity Index (ACCI), Prognostic Nutrition Index (PNI) and Fibrinogen to Albumin Ratio (FAR). In addition, we will further develop a predictive model based on related data to provide a novel method for preventing POD. METHODS AND ANALYSIS A single-centre observational study is conducted among patients aged ≥60 years old undergoing thoracic and abdominal surgery from 28 February 2022 to 31 December 2022. The patients will be divided into POD group and non-POD group following the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Related variables mainly including ACCI, PNI and FAR will be analysed by univariate and multivariate logistic regression analyses. Besides, a predictive model will be established according to associated risk factors, and the receiver operating characteristic curve will be used to further evaluate the accuracy of the predictive model. ETHICS AND DISSEMINATION The study has been approved by the Medical Ethics Committee of Hebei General Hospital (approval number 2022021) and will intend to be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR2200057126).
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Affiliation(s)
- Jing Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
- Graduate Faculty, Hebei North University, Zhangjiakou, Hebei, China
| | - Meinv Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Junfang Rong
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
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Liu J, Li J, He J, Zhang H, Liu M, Rong J. The Age-adjusted Charlson Comorbidity Index predicts post-operative delirium in the elderly following thoracic and abdominal surgery: A prospective observational cohort study. Front Aging Neurosci 2022; 14:979119. [PMID: 36062155 PMCID: PMC9428551 DOI: 10.3389/fnagi.2022.979119] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background Post-operative delirium (POD) presents as a serious neuropsychiatric syndrome in the elderly undergoing thoracic and abdominal surgery, which is mostly associated with poor prognosis. The Age-adjusted Charlson Comorbidity Index (ACCI) has been widely recognized as an independently predictive factor for overall survival rate and mortality in various surgeries. However, no studies demonstrated the potential relationship between ACCI and POD. The current study was to explore the correlation between ACCI and POD, and determine the predictive effect of ACCI on POD in the elderly after thoracic and abdominal surgery. Materials and methods Total 184 patients (≥60 years) who underwent thoracic and abdominal surgery from 2021.10 to 2022.5 were enrolled in this prospective observational cohort study. ACCI was calculated by weighting comorbidities and age. POD was diagnosed using Confusion Assessment Method (CAM) twice a day in the first 3 days after surgery. The Visual Analog Scale (VAS) was applied to measure pre-operative and post-operative pain at rest and in motion. All demographic and perioperative data were compared in patients with POD and without POD. ACCI and other variables were analyzed by univariate and multivariate logistic regression analysis. The characteristic curve of receiver operating characteristic (ROC) was used to further evaluate the accuracy of ACCI to predict POD. Results Post-operative delirium was diagnosed in 36 of 184 patients included in our study. The prevalence of POD in the elderly after thoracic and abdominal surgery was 19.6%. The outcomes by multivariate regression analysis showed the independent risk factors for POD were ACCI (OR: 1.834; 95%CI: 1.434–2.344; P < 0.001), pre-operative Mini-Mental State Examination (MMSE) scores (OR: 0.873; 95%CI: 0.767–0.994; P = 0.040), serum albumin (OR: 0.909; 95%CI: 0.826–1.000; P = 0.049) and pain scores in the post-operative third day (OR: 2.013; 95%CI: 1.459–2.778; P < 0.001). ACCI can predict POD more accurately with the largest area under curve (AUC) of 0.794 and sensitivity of 0.861, respectively. Conclusion Age-adjusted Charlson Comorbidity Index, pre-operative MMSE scores, serum albumin and post-operative pain were independently associated with POD in geriatric patients following thoracic and abdominal surgery. Moreover, ACCI may become an accurate indicator to predict POD early.
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Affiliation(s)
- Jing Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
- Graduate Faculty, Hebei North University, Zhangjiakou, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
- *Correspondence: Jianli Li,
| | - Jinhua He
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Meinv Liu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Junfang Rong
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
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