scholarly journals Early Treatment with Risperidone for Subsyndromal Delirium after On-pump Cardiac Surgery in the Elderly

2012 ◽  
Vol 116 (5) ◽  
pp. 987-997 ◽  
Author(s):  
Sameh M. Hakim ◽  
Ahmed I. Othman ◽  
Dina O. Naoum
Keyword(s):  
Cardiac Surgery ◽  
Placebo Group ◽  
Elderly Patients ◽  
Primary Outcome ◽  
The Elderly ◽  
Early Administration ◽  
Subsyndromal Delirium ◽  
Surgery In The Elderly ◽  
To Receive ◽  
Risperidone Group

Background The aim of this randomized, parallel-arm trial was to study the effect of treating subsyndromal delirium with risperidone on the incidence of clinical delirium in elderly patients who underwent on-pump cardiac surgery. Methods One hundred one patients aged 65 yr or older who experienced subsyndromal delirium after on-pump cardiac surgery were randomized using a computer-generated list to receive 0.5 mg risperidone (n = 51) or placebo (n = 50) every 12 h by mouth. Patients were assessed at 8 h by a blinded observer using the Intensive Care Delirium Screening Checklist, and those scoring more than 3 were evaluated by a blinded psychiatrist to confirm delirium. Patients in either group who experienced delirium were treated according to the same algorithm. Initially, risperidone was administered and if symptoms were not controlled, haloperidol was administered. The primary outcome was the proportion of patients who experienced delirium in either group. Results Seven (13.7%) patients in the risperidone group experienced delirium versus 17 (34%) in the placebo group (P = 0.031) Competing-risks regression analysis showed that failure to treat subsyndromal delirium with risperidone was an independent risk factor for delirium (subhazard ratio, 3.83; 95% CI, 1.63-8.98; P = 0.002). Two (3.9%) patients in the risperidone group experienced extrapyramidal manifestations versus one (2%) in the placebo group (P = 1.0). Conclusion Administration of risperidone to elderly patients who experienced subsyndromal delirium after on-pump cardiac surgery was associated with significantly lower incidence of delirium. Larger studies are required to determine whether early administration of risperidone during the subsyndromal phase of delirium would influence the clinical course of such patients.

scholarly journals Cardiac surgery in the elderly: Analysis of outcome in patients with mitral regurgitation

1996 ◽  
Vol 27 (2) ◽  
pp. 281 ◽  
Author(s):  
Maurice E. Sarano ◽  
Robert L. Frye ◽  
Hartzell V. Schaff ◽  
Thomas A. Orszulak ◽  
A.Jamil Tajik
Keyword(s):  
Cardiac Surgery ◽  
Mitral Regurgitation ◽  
The Elderly ◽  
Surgery In The Elderly

Cardiac Surgery in the Elderly

2001 ◽  
pp. 460-470
Author(s):  
Margarita T. Camacho ◽  
Konstadinos A. Plestis ◽  
Jeffrey P. Gold
Keyword(s):  
Cardiac Surgery ◽  
The Elderly ◽  
Surgery In The Elderly

scholarly journals Cardiac surgery in the elderly: What goals of care?

2017 ◽  
Vol 87 (2) ◽  
Author(s):  
Alessandra Pratesi ◽  
Francesco Orso ◽  
Camilla Ghiara ◽  
Aldo Lo Forte ◽  
Anna Chiara Baroncini ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
The Elderly ◽  
Risk Scores ◽  
Frailty Phenotype ◽  
Mortality And Morbidity ◽  
Geriatric Cardiology ◽  
Patient Reported ◽  
Short Term Mortality ◽  
Surgery In The Elderly

<p>At present, the majority of cardiac surgery interventions have been performed in the elderly with successful short-term mortality and morbidity, however significant difficulties must to be underlined about our capacity to predict long-term outcomes such as disability, worsening quality of life and loss of functional capacity.<br />The reason probably resides on inability to capture preoperative frailty phenotype with current cardiac surgery risk scores and consequently we are unable to outline the postoperative trajectory of an important patients’ centered outcome such as disability free survival. In this perspective, more than one geriatric statements have stressed the systematic underuse of patient reported outcomes in cardiovascular trials even after taking account of their relevance to older feel and wishes. Thus, in the next future is mandatory for geriatric cardiology community closes this gap of evidences through planning of trials in which patients’ centered outcomes are considered as primary goals of therapies as well as cardiovascular ones.</p>

Cardiac Surgery in the Elderly

2011 ◽  
pp. 649-660
Author(s):  
Margarita T. Camacho ◽  
Pooja R. Raval
Keyword(s):  
Cardiac Surgery ◽  
The Elderly ◽  
Surgery In The Elderly

scholarly journals Elevated Procalcitonin as a Risk Factor for Postoperative Delirium in the Elderly after Cardiac Surgery—A Prospective Observational Study

2020 ◽  
Vol 9 (12) ◽  
pp. 3837
Author(s):  
Anna Kupiec ◽  
Barbara Adamik ◽  
Natalia Kozera ◽  
Waldemar Gozdzik
Keyword(s):  
Cardiac Surgery ◽  
Depressive Symptoms ◽  
Elderly Patients ◽  
Odds Ratio ◽  
Postoperative Delirium ◽  
Prospective Observational Study ◽  
Reference Range ◽  
The Elderly ◽  
Daily Functioning ◽  
Multivariable Logistic Regression Model

One of the most common complications after cardiac surgery with cardiopulmonary bypass (CBP) is delirium. The purpose of this study was to prospectively investigate the risk of developing postoperative delirium in a group of elderly patients using a multivariate assessment of preoperative and intraoperative risk factors. A total of 149 elderly patients were included. Thirty patients (20%) developed post-operative delirium. Preoperative procalcitonin (PCT) above the reference range (>0.05 ng/mL) was recorded more often in patients who postoperatively developed delirium than in the non-delirium group (50% vs. 27%, p = 0.019). After surgery, PCT was significantly higher in the delirium than the non-delirium group: ICU admission after surgery: 0.08 ng/mL vs. 0.05 ng/mL p = 0.011), and for consecutive days (day 1: 0.59 ng/mL vs. 0.25 ng/mL, p = 0.003; day 2: 1.21 ng/mL vs. 0.36 ng/mL, p = 0.006; day 3: 0.76 ng/mL vs. 0.34 ng/mL, p = 0.001). Patients with delirium were older (74 vs. 69 years, p = 0.038), more often had impaired daily functioning (47% vs. 28%, p = 0.041), depressive symptoms (40% vs. 17%, p = 0.005), and anemia (43% vs. 19%, p = 0.006). In a multivariable logistic regression model, preoperative procalcitonin (odds ratio (OR) = 3.05), depressive symptoms (OR = 5.02), age (OR = 1.14), impaired daily functioning (OR = 0.76) along with CPB time (OR = 1.04) were significant predictors of postoperative delirium.

scholarly journals Do prices reflect the costs of cardiac surgery in the elderly?

2017 ◽  
Vol 36 (1) ◽  
pp. 35-41
Author(s):  
Pedro Coelho ◽  
Vanessa Rodrigues ◽  
Luís Miranda ◽  
José Fragata ◽  
Pedro Pita Barros
Keyword(s):  
Cardiac Surgery ◽  
The Elderly ◽  
Surgery In The Elderly
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