Sleep, Pain, and Cognition: Modifiable Targets for Optimal Perioperative Brain Health

2021 ◽  
Author(s):  
Brian P. O’Gara ◽  
Lei Gao ◽  
Edward R. Marcantonio ◽  
Balachundhar Subramaniam
Keyword(s):  
Risk Factors ◽  
Best Practices ◽  
Postoperative Delirium ◽  
Strong Predictor ◽  
Perioperative Period ◽  
Multimodal Analgesia ◽  
Neurocognitive Disorders ◽  
Brain Health ◽  
Multiple Risk Factors ◽  
Preventative Approach

The prevention of perioperative neurocognitive disorders is a priority for patients, families, clinicians, and researchers. Given the multiple risk factors present throughout the perioperative period, a multicomponent preventative approach may be most effective. The objectives of this narrative review are to highlight the importance of sleep, pain, and cognition on the risk of perioperative neurocognitive disorders and to discuss the evidence behind interventions targeting these modifiable risk factors. Sleep disruption is associated with postoperative delirium, but the benefit of sleep-related interventions is uncertain. Pain is a risk factor for postoperative delirium, but its impact on other postoperative neurocognitive disorders is unknown. Multimodal analgesia and opioid avoidance are emerging as best practices, but data supporting their efficacy to prevent delirium are limited. Poor preoperative cognitive function is a strong predictor of postoperative neurocognitive disorder, and work is ongoing to determine whether it can be modified to prevent perioperative neurocognitive disorders.

scholarly journals Incidence of delirium in postoperative patients treated with total knee and hip arthroplasty

2017 ◽  
Vol 63 (3) ◽  
pp. 248-251 ◽  
Author(s):  
Felipe de Santana Bosmak ◽  
Patrick Teller Gibim ◽  
Sandra Guimarães ◽  
Adriano Luiz Ammirati
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Intensive Care ◽  
Hip Arthroplasty ◽  
Medical Records ◽  
Postoperative Delirium ◽  
Descriptive Study ◽  
Multiple Risk Factors ◽  
Total Knee ◽  
Knee And Hip Arthroplasty

Summary Introduction: Delirium is a common disorder that can potentiate mortality and comorbidity rates of patients hospitalized in intensive care units. Patients undergoing major orthopedic surgeries, such as knee and hip arthroplasty, are particularly vulnerable as they often have multiple risk factors for this disorder. Method: Descriptive study of the incidence of delirium in patients treated with total knee and hip arthroplasty, given the advanced age and comorbidities in this population. We evaluated the medical records of patients who had previously undergone the designated surgeries for identification of postoperative delirium. Results: We observed in this study an incidence of 8.92% of delirium, mostly affecting females with a mean age of 73 years and hypertension. Conclusion: The incidence of delirium in our study is similar to that observed in the general population, according to the literature. We found no correlation with sleep disorders, smoking or diabetes mellitus in this study, even though the importance of these factors for the onset of delirium is well-established in the literature.

scholarly journals Perioperative Sleep Disorder: A Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Dandan Lin ◽  
Xiao Huang ◽  
Yi Sun ◽  
Changwei Wei ◽  
Anshi Wu
Keyword(s):  
Risk Factors ◽  
Sleep Disorders ◽  
Perioperative Period ◽  
Perioperative Outcomes ◽  
Personal Factors ◽  
Multiple Risk Factors ◽  
Operative Outcomes ◽  
Push Forward ◽  
Potential Risk Factors ◽  
Therapeutic Prevention

Patients in the perioperative period usually present with different types and degrees of sleep disorders, which can severely affect their post-operative outcomes. Multiple risk factors may lead to the occurrence of perioperative sleep disorders, including personal factors, psychological factors, surgery factors, and environmental factors. In this review, we summarize the potential risk factors for perioperative sleep disorders during hospitalization. And it also provides an overview of perioperative outcomes and potential therapeutic prevention of perioperative sleep disorders. However, the further search is necessary to investigate the effectiveness and safety of preventions in the clinical practice and push forward the therapies.

scholarly journals Nutritional Vulnerability: The Complexity of Preparing Older Veterans for Surgery

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 773-773
Author(s):  
Kathyrn Starr ◽  
Nancy Loyack ◽  
Shelley McDonald ◽  
Mitchell Heflin ◽  
Sandhya Lagoo-deenadayalan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Best Practices ◽  
Perioperative Period ◽  
Nutritional Risk ◽  
Interprofessional Team ◽  
Poor Nutritional Status ◽  
History Of ◽  
Risk Situation ◽  
High Risk Situation ◽  
History Of Depression

Abstract Poor nutritional status leads to postoperative complications, infections, poor healing, and increased mortality, creating a high-risk situation for older adults undergoing surgery. Psychosocial and environmental factors, including socioeconomic disadvantage, disability, social isolation and depression, are known precipitators of nutritional risk. However, these potentially modifiable concerns are rarely taken into consideration preoperatively. In 736 older Veterans preparing for surgery, we found 42% reported it was hard/somewhat hard to pay for basic needs, 6% reported sometimes/often times not having enough to eat, 24% reported living along, 47% reported needing assistance with 1 or more IADLs, and 42% reported a history of depression. Findings from older, Veterans, illustrate the prevalence of psychosocial and environmental risk factors prior to surgery. Best practices for identifying these factors, the importance of an interprofessional team for intervening, and specific resources that can be utilized throughout the perioperative period to improve outcomes will be presented.

A Strategy for Analysing Multiple Risk Factors with Application to Cervical Pain Syndrome

1989 ◽  
Vol 28 (01) ◽  
pp. 14-19 ◽  
Author(s):  
J. F. Dartigues ◽  
Ph. Peytour ◽  
E. Puymirat ◽  
P. Henry ◽  
M. Gagnon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Power ◽  
Head Trauma ◽  
Pain Syndrome ◽  
Psychological Status ◽  
Confounding Factors ◽  
Cervical Pain ◽  
Extreme Form ◽  
Explanatory Variables ◽  
Multiple Risk Factors

Abstract:When studying the possible effects of several factors in a given disease, two major problems arise: (1) confounding, and (2) multiplicity of tests. Frequently, in order to cope with the problem of confounding factors, models with multiple explanatory variables are used. However, the correlation structure of the variables may be such that the corresponding tests have low power: in its extreme form this situation is coined by the term “multicollinearity”. As the problem of multiplicity is still relevant in these models, the interpretation of results is, in most cases, very hazardous. We propose a strategy - based on a tree structure of the variables - which provides a guide to the interpretation and controls the risk of erroneously rejecting null hypotheses. The strategy was applied to a study of cervical pain syndrome involving 990 subjects and 17 variables. Age, sex, head trauma, posture at work and psychological status were all found to be important risk factors.

scholarly journals Incidence of and risk factors for postoperative delirium in older adult patients undergoing noncardiac surgery: a prospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Arissara Iamaroon ◽  
Titima Wongviriyawong ◽  
Patumporn Sura-arunsumrit ◽  
Nattikan Wiwatnodom ◽  
Nichakarn Rewuri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Older Adult ◽  
Postoperative Delirium ◽  
Noncardiac Surgery ◽  
Adult Patients ◽  
A Prospective Study

scholarly journals Leiomyosarcoma of the Tracheostomy Site in a Patient with History of Laryngeal Squamous Cell Carcinoma

2021 ◽  
pp. 912-917
Author(s):  
Zainub Ajmal ◽  
Abdul Moiz Khan ◽  
Lezah McCarthy ◽  
Allison Lupinetti ◽  
Syed Mehdi
Keyword(s):  
Risk Factors ◽  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
English Literature ◽  
Neck Region ◽  
Multiple Risk Factors ◽  
History Of ◽  
Rare Malignancy

Leiomyosarcoma (LMS) of the trachea is an extremely rare malignancy with only a few reported cases in English literature. As such the diagnosis can be frequently missed or delayed. We present a case of a 69-year-old male who underwent tracheostomy for airway obstruction secondary to glottic squamous cell carcinoma and treated definitely with radiation therapy. Subsequently, the patient developed LMS of the tracheostomy site. The case further details multiple risk factors that could contribute to development of LMS including radiation exposure, prior malignancy, and chronic inflammation. These risk factors have been well established for LMS in other sites but less so in the head and neck region, which is the subject of our discussion. We also review the current guidelines for head and neck as well as limb sarcomas and discussed role of surgery or radiation and their accompanying challenges in management of this rare malignancy.

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