scholarly journals Effects of dexmedetomidine on postoperative delirium and expression of IL-1, IL-6, and TNF-α in elderly patients after hip fracture operation

2020 ◽  
Author(s):  
Wenchao Zhang ◽  
Tianlong Wang ◽  
Geng Wang ◽  
Minghui Yang ◽  
Yan Zhou ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
Early Stage ◽  
Surgical Complication ◽  
Controlled Trial ◽  
Venous Blood ◽  
Inflammatory Factors ◽  
Double Blind ◽  
Tnf Α

Abstract Background: Postoperative delirium (POD) is a common surgical complication in elderly patients. This study investigated the effects of dexmedetomidine on POD and inflammatory factors in elderly patients with hip fracture.Methods: The randomized, double-blind, controlled trial enrolled patients aged ≥65 years who underwent operation for hip fracture in the Department of Anesthesiology in Beijing JiShuiTan Hospital from October 2016 to January 2017. The patients were divided into the DEX group and the NS group and were intravenously infused with dexmedetomidine or an equal volume of normal saline, respectively. After surgery, the incidence of delirium at postoperative day 1 (T1), day 2 (T2) and day 3 (T3) were assessed using the Ramsay score and Confusion Assessment Method (CAM) delirium scale. Interleukin (IL)-1, IL-6 and tumor necrosis factor (TNF)-α concentrations in the venous blood of the two groups of patients were detected at T0 (before surgery), T1 and T3.Results: Data from 218 patients were analyzed with 110 patients in the DEX group and 108 in the NS group. Dexmedetomidine decreased POD incidence (18.2% vs. 30.6%, P=0.033). Compared to T0, all three inflammatory factors increased at T1 and then decreased at T3 and changes with time were significant (all P<0.001). IL-6 (P<0.001) and TNF-α (P=0.003) levels were lower in the DEX group, but IL-1 levels were similar. The rate of adverse events was similar in the two groups.Conclusions: Dexmedetomidine reduced the incidence of POD in elderly patients with hip fracture at an early stage, and reduced short-term IL-6 and TNF-α concentrations.

The effect of pre-operative methylprednisolone on postoperative delirium in elderly patients undergoing gastrointestinal surgery: a randomized, double-blind, placebo-controlled trial

2021 ◽  
Author(s):  
Xiao-bing Xiang ◽  
Hao Chen ◽  
Ying-li Wu ◽  
Ke Wang ◽  
Xiang Yue ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Heparan Sulfate ◽  
Postoperative Delirium ◽  
Controlled Trial ◽  
Gastrointestinal Surgery ◽  
Assessment Method ◽  
Endothelial Glycocalyx ◽  
Double Blind ◽  
Tnf Α ◽  
Circulating Markers

Abstract Background Pre-operative administration of methylprednisolone reduced circulating markers of endothelial activation. This randomized, double-blind was to evaluate whether a single pre-operative dose of methylprednisolone reduced the rate of postoperative delirium (POD) in older patients undergoing gastrointestinal surgery, and its association with the shedding of endothelial glycocalyx markers. Methods 168 patients, aged 65–80 years and scheduled for laparoscopic gastrointestinal surgery, were randomized to 2 mg·kg -1 methylprednisolone (Group M, n = 84); or equivalent dose of placebo (Group C, n = 84). The primary outcome was the incidence of delirium during the first 5 days after surgery, assessed by the confusion assessment method (CAM). POD severity was rated daily using CAM-Severity (CAM-S). Level of syndecan-1, heparan sulfate, tumor necrosis factor-α(TNF-α), and brain-derived neurotrophic factor (BDNF) were measured at baseline, 1-day, and 3-day after surgery. Results Compared with placebo, methylprednisolone greatly reduced the incidence of delirium at 72 h following surgery [9(10.7%) versus 20(23.8%), P =0.03, OR=2.22(95%CI 1.05-4.59)]. No between-group difference was found in the cumulative CAM-S score (P=0.14). The levels of heparan sulfate, syndecan-1, and TNF-α in Group M were lower than that in Group C (P &lt;0.05 and P &lt;0.01), while the level of BDNF in Group M was higher than that in Group C (P &lt;0.01). Conclusions Pre-operative administration of methylprednisolone does not reduce the severity of POD, but may reduce the incidence of delirium after gastrointestinal surgery in elderly patients, which may be related to a reduction in circulating markers of endothelial degradation, followed by the increase of BNDF level.

scholarly journals Melatonin for prevention of postoperative delirium after lower limb fracture surgery in elderly patients (DELIRLESS): study protocol for a multicentre randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e053908
Author(s):  
Stéphanie Sigaut ◽  
Camille Couffignal ◽  
Marina Esposito-Farèse ◽  
Vincent Degos ◽  
Serge Molliex ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Lower Limb ◽  
Postoperative Delirium ◽  
Controlled Trial ◽  
Functional Decline ◽  
Assessment Method ◽  
Phase Iii ◽  
Double Blind ◽  
Prolonged Length ◽  
Surgery In Elderly

IntroductionPostoperative delirium (POD) is one of the most frequent complication after surgery in elderly patients, and is associated with increased morbidity and mortality, prolonged length of stay, cognitive and functional decline leading to loss of autonomy, and important additional healthcare costs. Perioperative inflammatory stress is a key element in POD genesis. Melatonin exhibits antioxidative and immune-modulatory proprieties that are promising concerning delirium prevention, but in perioperative context literature are scarce and conflicting. We hypothesise that perioperative melatonin can reduce the incidence of POD.Methods and analysisThe DELIRLESS trial is a prospective, national multicentric, phase III, superiority, comparative randomised (1:1) double-blind clinical trial. Among patients aged 70 or older, hospitalised and scheduled for surgery of a severe fracture of a lower limb, 718 will be randomly allocated to receive either melatonin 4 mg per os or placebo, every night from anaesthesiologist preoperative consultation and up to 5 days after surgery. The primary outcome is POD incidence measured by either the French validated translation of the Confusion Assessment Method (CAM) score for patients hospitalised in surgery, or CAM-ICU score for patients hospitalised in ICU (Intensive Care Unit). Daily delirium assessment will take place during 10 days after surgery, or until the end of hospital stay if it is shorter. POD cumulative incidence function will be compared at day 10 between the two randomised arms in a competing risks framework, using the Fine and Grey model with death as a competing risk of delirium.Ethics and disseminationThe DELIRLESS trial has been approved by an independent ethics committee the Comité de Protection des Personnes (CPP) Sud-Est (ref CPP2020-18-99 2019-003210-14) for all study centres. Participant recruitment begins in December 2020. Results will be published in international peer-reviewed medical journals.Trial registration numberNCT04335968, first posted 7 April 2020.Protocol version identifierN°3–0, 3 May 2021.

scholarly journals Supplementation with a juice powder concentrate and exercise decrease oxidation and inflammation, and improve the microcirculation in obese women: randomised controlled trial data

2013 ◽  
Vol 110 (9) ◽  
pp. 1685-1695 ◽  
Author(s):  
Manfred Lamprecht ◽  
Georg Obermayer ◽  
Kurt Steinbauer ◽  
Gerhard Cvirn ◽  
Lidija Hofmann ◽  
...  
Keyword(s):  
Blood Flow ◽  
Controlled Trial ◽  
Relative Concentration ◽  
Venous Blood ◽  
Low Grade ◽  
Obese Women ◽  
Total Oxidation ◽  
Double Blind ◽  
Redox Biology ◽  
Tnf Α

Obesity and sedentary lifestyle are associated with increased oxidative stress, inflammation and vessel dysfunction. Previous research has shown that an encapsulated fruit/berry/vegetable juice powder (FBV) supplement or controlled exercise training improve the markers of redox biology, low-grade inflammation and circulation. The aim of the present study was to assess the effects of 8 weeks of supplementation with FBV or placebo, and a single bout of controlled walking on the markers of oxidation, inflammation and skin capillary microcirculation in forty-two obese pre-menopausal women (41 (sd 5) years, non-smokers and BMI 34·5 (sd 3·8) kg/m2) using a randomised, double-blind, placebo-controlled design. All assessments were made before and after 8 weeks of capsule supplementation, and pre- and post-30 min of controlled treadmill walking at 70 % of VO2max. Venous blood was collected for the determination of carbonyl proteins (CP), oxidised LDL (ox-LDL), total oxidation status (TOS) of lipids, malondialdehyde, TNF-α and IL-6. Capillary blood flow, O2 saturation of Hb (SO2Hb) and the relative concentration of Hb (rHb) were assessed at a 2 mm skin depth. Following 8 weeks of supplementation, compared with placebo, the FBV group had a significant (P< 0·05) reduction in CP, ox-LDL, TOS and TNF-α, and a significant increase in blood flow, SO2Hb and rHb. Independent of supplementation, moderate exercise significantly increased blood flow and rHb, with a trend towards increased SO2Hb. Compared with placebo, 8 weeks of supplementation with FBV decreased the markers of systemic oxidation and inflammation. Both FBV supplementation and a single walking bout improved the markers of the microcirculation in these obese women.

scholarly journals Design considerations of a randomized controlled trial of sedation level during hip fracture repair surgery: a strategy to reduce the incidence of postoperative delirium in elderly patients

2017 ◽  
Vol 14 (3) ◽  
pp. 299-307 ◽  
Author(s):  
Tianjing Li ◽  
L Susan Wieland ◽  
Esther Oh ◽  
Karin J Neufeld ◽  
Nae-Yuh Wang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Bispectral Index ◽  
Postoperative Delirium ◽  
Controlled Trial ◽  
Fracture Repair ◽  
Lessons Learned ◽  
Design Considerations ◽  
Randomized Controlled

Background Delirium is an acute change in mental status characterized by sudden onset, fluctuating course, inattention, disorganized thinking, and abnormal level of consciousness. The objective of the randomized controlled trial “A STrategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients” (STRIDE) is to assess the effectiveness of light versus heavy sedation on delirium and other outcomes in elderly patients undergoing hip fracture repair surgery. Our goal is to describe the design considerations and lessons learned in planning and implementing the STRIDE trial. Methods Discussed are challenges encountered including (1) how to ensure that we quickly identify, assess the eligibility of, and randomize traumatic hip fracture patients; (2) how to implement interventions that involve continuous monitoring and adjustment during the surgery; and (3) how to measure and ascertain the primary outcome, delirium. Results To address the first challenge, we monitored the operating room schedule more actively than anticipated. We constructed and organized eligibility assessment data collection forms by purpose and by source of information needed to complete them. We decided that randomization needs to take place in the operating room. To address the second challenge, we designed and implemented a treatment protocol and covered the bispectral index monitor to prevent the Anesthesiologist/Anesthetist from being influenced by the bispectral index reading while administering the intervention. Finally, clinical assessment of delirium consisted of standardized interviews of the patient using validated instruments, interviews of those caring for the patient, and review of the medical record. A consensus panel made the final determination of a delirium diagnosis. We note that STRIDE is a single-center trial. The decisions we took may have different implications for multi-center trials. Conclusions Lessons learned are likely to provide useful information to others designing trials in emergency and surgical setting and for those who are interested in unbiased assessment of delirium.

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