scholarly journals Case Scenario: Postoperative Delirium in Elderly Surgical Patients

2010 ◽  
Vol 112 (1) ◽  
pp. 189-195 ◽  
Author(s):  
Jean Mantz ◽  
Hugh C. Hemmings ◽  
Jacques Boddaert
Keyword(s):  
Postoperative Delirium ◽  
Surgical Patients ◽  
Case Scenario

A polysomnography study examining the association between sleep and postoperative delirium in older hospitalized cardiac surgical patients

2021 ◽  
Author(s):  
Reine Ibala ◽  
Jennifer Mekonnen ◽  
Jacob Gitlin ◽  
Eunice Y. Hahm ◽  
Breanna R. Ethridge ◽  
...  
Keyword(s):  
Postoperative Delirium ◽  
Surgical Patients

scholarly journals Preoperative Frailty in Older Surgical Patients Is Associated with Early Postoperative Delirium

2011 ◽  
Vol 112 (5) ◽  
pp. 1199-1201 ◽  
Author(s):  
Jacqueline M. Leung ◽  
Tiffany L. Tsai ◽  
Laura P. Sands
Keyword(s):  
Postoperative Delirium ◽  
Surgical Patients

Postoperative Delirium is Associated with Postoperative Cognitive Dysfunction at One Week after Cardiac Surgery with Cardiopulmonary Bypass

2009 ◽  
Vol 105 (3) ◽  
pp. 921-932 ◽  
Author(s):  
Judith A. Hudetz ◽  
Alison J. Byrne ◽  
Kathleen M. Patterson ◽  
Paul S. Pagel ◽  
David C. Warltier
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Cognitive Impairment ◽  
Cardiopulmonary Bypass ◽  
Cognitive Dysfunction ◽  
Postoperative Delirium ◽  
Postoperative Cognitive Dysfunction ◽  
Surgical Patients ◽  
Nonverbal Memory ◽  
Surgery Group

Postoperative delirium with cognitive impairment frequently occurs after cardiac surgery. It was hypothesized that delirium is associated with residual postoperative cognitive dysfunction in patients after surgery using cardiopulmonary bypass. Male cardiac surgical patients ( M age = 66 yr., SD = 8; M education = 13 yr., SD = 2) and nonsurgical controls ( M age = 62, SD = 7; M education = 12, SD = 2) 55 years of age or older were balanced on age and education. Delirium was assessed by the Intensive Care Delirium Screening Checklist preoperatively and for up to 5 days postoperatively. Recent verbal and nonverbal memory and executive functions were assessed (as scores on particular tests) before and 1 wk. after surgery. In 56 patients studied ( n = 28 Surgery; n=28 Nonsurgery), nine patients from the Surgery group developed delirium. In the Surgery group, the proportion of patients having postoperative cognitive dysfunction was significantly greater in those who experienced delirium (89%) compared with those who did not (37%). The odds of developing this dysfunction in patients with delirium were 14 times greater than those who did not. Postoperative delirium is associated with scores for residual postoperative cognitive dysfunction 1 wk. after cardiac surgery.

scholarly journals Postoperative Delirium in a Substudy of Cardiothoracic Surgical Patients in the BAG-RECALL Clinical Trial

2014 ◽  
Vol 118 (4) ◽  
pp. 809-817 ◽  
Author(s):  
Elizabeth L. Whitlock ◽  
Brian A. Torres ◽  
Nan Lin ◽  
Daniel L. Helsten ◽  
Molly R. Nadelson ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Postoperative Delirium ◽  
Surgical Patients

scholarly journals A Processed EEG based Brain Anesthetic Resistance Index Predicts Postoperative Delirium in Older Adults: A Dual Center Study

2021 ◽  
Author(s):  
Mary Cooter ◽  
Thomas Bunning ◽  
Sarada S. Eleswarpu ◽  
Mitchell T. Heflin ◽  
Shelley McDonald ◽  
...  
Keyword(s):  
Older Adults ◽  
Predictive Value ◽  
Postoperative Delirium ◽  
Multivariable Analysis ◽  
Surgical Patients ◽  
Anticholinergic Drugs ◽  
Derivation Cohort ◽  
Anesthetic Drugs ◽  
Processed Eeg ◽  
Combined Estimation

Background: Some older adults show exaggerated responses to drugs that act on the brain, such as increased delirium risk in response to anticholinergic drugs. The brain's response to anesthetic drugs is often measured clinically by processed electroencephalogram (EEG) indices. Thus, we developed a processed EEG based-measure of the brain's neurophysiologic resistance to anesthetic dose-related changes, and hypothesized that it would predict postoperative delirium. Methods: We defined the Duke Anesthesia Resistance Scale (DARS) as the average BIS index divided by the quantity 2.5 minus the average age-adjusted end-tidal MAC (aaMAC) inhaled anesthetic fraction. The relationship between DARS and postoperative delirium was analyzed in derivation (Duke; N=69), validation (Mt Sinai; N=70), and combined estimation cohorts (N=139) of older surgical patients (age >/= 65). In the derivation cohort, we identified a threshold relationship between DARS and for delirium and identified an optimal cut point for prediction. Results: In the derivation cohort, the optimal DARS threshold for predicting delirium was 27.0. The delirium rate was 11/49 (22.5%) vs 11/20 (55.0%) and 7/57 (12.3%) vs 6/13 (46.2%) for those with DARS >/= 27 vs those with DARS < 27 in the derivation and validation cohorts respectively. In the combined estimation cohort, multivariable analysis found a significant association of DARS <27.0 with postoperative delirium (OR=4.7; 95% CI: 1.87, 12.0; p=0.001). In the derivation cohort, the DARS had an AUC of 0.63 with sensitivity of 50%, specificity of 81%, positive predictive value of 0.55, and negative predictive value of 0.78. The DARS remained a significant predictor of delirium after accounting for opioid, midazolam, propofol, non-depolarizing neuromuscular blocker, phenylephrine and ketamine dosage, and for nitrous oxide and epidural usage. Conclusions: These results, if confirmed by larger future studies, suggest than an intraoperative processed EEG-based measure of lower brain anesthetic resistance (i.e. DARS <27) could be used in older surgical patients as an independent predictor of postoperative delirium risk.

scholarly journals KIBRA, MTNR1B, and FKBP5 genotypes are associated with decreased odds of incident delirium in elderly post-surgical patients

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Mark Terrelonge ◽  
Sara C. LaHue ◽  
Christopher Tang ◽  
Irina Movsesyan ◽  
Clive R. Pullinger ◽  
...  
Keyword(s):  
Older Adults ◽  
Postoperative Delirium ◽  
Case Control Study ◽  
Case Control ◽  
Surgical Patients ◽  
Primary Study ◽  
Diverse Populations ◽  
Nucleotide Polymorphisms ◽  
Single Nucleotide ◽  
Control Study

AbstractDespite the association between cognitive impairment and delirium, little is known about whether genetic differences that confer cognitive resilience also confer resistance to delirium. To investigate whether older adults without postoperative delirium, compared with those with postoperative delirium, are more likely to have specific single nucleotide polymorphisms (SNPs) in the FKBP5, KIBRA, KLOTHO, MTNR1B, and SIRT1 genes known to be associated with cognition or delirium. This prospective nested matched exploratory case–control study included 94 older adults who underwent orthopedic surgery and screened for postoperative delirium. Forty-seven subjects had incident delirium, and 47 age-matched controls were not delirious. The primary study outcome was genotype frequency for the five SNPs. Compared with participants with delirium, those without delirium had higher adjusted odds of KIBRA SNP rs17070145 CT/TT [vs. CC; adjusted odds ratio (aOR) 2.80, 95% confidence interval (CI) 1.03, 7.54; p = 0.04] and MTNR1B SNP rs10830963 CG/GG (vs. CC; aOR 4.14, 95% CI 1.36, 12.59; p = 0.01). FKBP5 SNP rs1360780 CT/TT (vs. CC) demonstrated borderline increased adjusted odds of not developing delirium (aOR 2.51, 95% CI 1.00, 7.34; p = 0.05). Our results highlight the relevance of KIBRA, MTNR1B, and FKBP5 in understanding the complex relationship between delirium, cognition, and sleep, which warrant further study in larger, more diverse populations.

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