Awareness and Perspectives among Asian Anesthesiologists on Postoperative Delirium: A Multinational Survey

Postoperative delirium (POD) is a common perioperative complication. Although POD is preventable in up to 40% of patients, it is frequently overlooked. The objective of the survey is to determine the level of knowledge and clinical practices related to POD among anesthesiologists in different Asian countries. A questionnaire of 22 questions was designed by members of the Asian focus group for the study of POD, and it was sent to anesthesiologists in Singapore, Thailand, and South Korea from 1 April 2019 through 17 September 2019. In total, 531 anesthesiologists (Singapore: 224, Thailand: 124, Korea: 183) responded to the survey. Half the respondents estimated the incidence of POD to be 11–30% and believed that it typically occurs in the first 48 h after surgery. Among eight important postoperative complications, POD was ranked fifth. While 51.4% did not perform any test for POD, only 13.7% monitored the depth of anesthesia in all their patients. However, 83.8% preferred depth of anesthesia monitoring if they underwent surgery themselves. The results suggest that Asian anesthesiologists underestimate the incidence and relevance of POD. Because it increases perioperative mortality and morbidity, there is an urgent need to educate anesthesiologists regarding the recognition, prevention, detection, and management of POD.

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11 / Monitoring depth of anesthesia decreased the incidence of postoperative delirium in surgical patients receiving intravenous patient-controlled analgesia postoperatively.

10.26226/morressier.5aeb0ac507b0d6001a79a00b ◽

2018 ◽

Author(s):

Chen Jen-Yin

Keyword(s):

Postoperative Delirium ◽

Surgical Patients ◽

Depth Of Anesthesia ◽

Patient Controlled Analgesia

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Prevalence and predictors of adverse outcomes in neonatal seizures

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-200499 ◽

2021 ◽

pp. 1-7

Author(s):

K. Famra ◽

P. Barta ◽

A. Aggarwal ◽

B.D. Banerjee

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Birth Asphyxia ◽

Adverse Outcomes ◽

Neonatal Seizures ◽

Clinical Practices ◽

Inborn Errors ◽

Mortality And Morbidity ◽

Low Birth Weight Babies

OBJECTIVES: Neonatal seizures are significant cause of neonatal mortality and morbidity. Current study was planned to study prevalence of adverse outcomes in neonatal seizures and identify its predictors. METHODS: This observational descriptive study was carried out on 220 neonates with seizures. Neonates who succumbed to illness/ death before investigations, or whose maternal records were incomplete were excluded. Blood sugar, serum calcium, serum electrolytes, and USG skull were done in all patients. CT scan, MRI and inborn errors of metabolism profile were done as and when indicated. Adverse outcomes were defined as death, phenobarbitone non responders, or abnormal examination at discharge. Antenatal, perinatal and neonatal predictors of adverse outcomes in neonatal seizures were evaluated. RESULTS: Out of 220 neonates with seizures 76(34.5%) had adverse outcomes. Very low birth weight babies (≤1500 gm) [OR 1.27(CI 0.57–2.84)], microcephaly [OR 5.93 (CI 0.55–64.41)], Apgar score≤3 at 5 minutes [OR 11.28(CI 14.18–30.45)], seizure onset within 24 hours [OR 5.99(CI 12.43–14.78)], meningitis [OR 2.63(CI 0.08–6.39)], septicemia [OR1.22(CI 0.45–3.31)] and abnormal cranial USG [OR 7.95(CI 12.61–24.22)] were significant predictors of adverse outcomes in neonates with seizures. CONCLUSION: Prematurity, very low birth weight, birth asphyxia, meningitis, septicemia and abnormal USG could predict adverse outcomes in neonatal seizures. Improved antenatal and neonatal clinical practices may help reduce adverse outcomes in these patients.

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Depth of Anesthesia Monitoring

Anesthesiology Clinics ◽

10.1016/j.anclin.2021.04.004 ◽

2021 ◽

Author(s):

David Roche ◽

Padraig Mahon

Keyword(s):

Depth Of Anesthesia ◽

Anesthesia Monitoring

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Depth of Anesthesia Monitoring Method Based on EEG Microstate Analysis and Hidden Markov Model

10.1109/prml52754.2021.9520709 ◽

2021 ◽

Author(s):

Lichengxi Si ◽

Zhian Liu ◽

Gang Wang

Keyword(s):

Markov Model ◽

Hidden Markov Model ◽

Hidden Markov ◽

Depth Of Anesthesia ◽

Monitoring Method ◽

Anesthesia Monitoring ◽

Microstate Analysis

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C125 A critical analysis of perioperative mortality and morbidity from radical cystectomy

European Urology Supplements ◽

10.1016/s1569-9056(09)75150-4 ◽

2009 ◽

Vol 8 (8) ◽

pp. 699 ◽

Cited By ~ 1

Author(s):

B. Braticevici ◽

V. Ambert ◽

D. Damian ◽

S. Andrei ◽

I. Chira ◽

...

Keyword(s):

Radical Cystectomy ◽

Critical Analysis ◽

Perioperative Mortality ◽

Mortality And Morbidity

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Early Mobilization Post–Hip Fracture Surgery

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459319826431 ◽

2019 ◽

Vol 10 ◽

pp. 215145931982643 ◽

Cited By ~ 9

Author(s):

Timothy Kenyon-Smith ◽

Eric Nguyen ◽

Tarandeep Oberai ◽

Ruurd Jarsma

Keyword(s):

Hip Fracture ◽

Postoperative Complications ◽

Subgroup Analysis ◽

Postoperative Delirium ◽

Early Mobilization ◽

Complication Rates ◽

Hip Fracture Surgery ◽

Level 1 ◽

Level 1 Trauma Center ◽

Fracture Surgery

Introduction: Early mobilization after hip fracture surgery is a widely practiced component of postoperative care. However, there is little evidence to suggest that early mobilization post–hip fracture surgery is beneficial in reducing postoperative complications. This study aims to investigate the effect of early mobilization following hip fracture surgery on postoperative complications. Materials and Methods: This study retrospectively included 240 patients (female = 165, male = 75, mean age: 82.2 years) admitted to a level 1 trauma center in Adelaide, Australia, for hip fracture surgery. The effect of early mobilization on postoperative complications was assessed along with premorbid status. Subgroup analysis of patients stratified by premorbid health was subsequently analyzed to reduce confounding. Results: The odds of developing a complication were 1.9 times higher if the patient remained bedbound compared to mobilizing. Early mobilization was favorable to delayed mobilization. On average, complication-free patients mobilized earlier (mean [M] = 29 hours) compared to patients who experienced complications (M = 38 hours). In particular, rates of delirium was significantly reduced in patients who mobilized compared to remaining bedbound. However, premorbid status varied greatly. Early mobilizers had significantly better premorbid health than patients who remained bedbound. Overall subgroup analysis of patients with similar premorbid health showed mobilization was not associated with a reduction in complications. With an exception of patients with poor premorbid health, who experienced a reduction in complications following early mobilization. Discussion: In general, early mobilization was associated with the same complication rates as delayed mobilization and remaining bedbound. Patients with poor premorbid health benefited most from early mobilization with reduced complication rates. Conclusion: Postoperative delirium and premorbid health were better indicators of postoperative outcomes than time to mobilization.

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Comparing Perioperative Mortality and Morbidity of Minimally Invasive Esophagectomy Versus Open Esophagectomy for Esophageal Cancer

Annals of Surgery ◽

10.1097/sla.0000000000003500 ◽

2019 ◽

Vol Publish Ahead of Print ◽

Cited By ~ 9

Author(s):

Takashi Sakamoto ◽

Michimasa Fujiogi ◽

Hiroki Matsui ◽

Kiyohide Fushimi ◽

Hideo Yasunaga

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Perioperative Mortality ◽

Mortality And Morbidity ◽

Invasive Esophagectomy ◽

Open Esophagectomy

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Clinical Electroencephalography for Anesthesiologists

Anesthesiology ◽

10.1097/aln.0000000000000841 ◽

2015 ◽

Vol 123 (4) ◽

pp. 937-960 ◽

Cited By ~ 227

Author(s):

Patrick L. Purdon ◽

Aaron Sampson ◽

Kara J. Pavone ◽

Emery N. Brown

Keyword(s):

Neural Circuits ◽

Brain State ◽

Anesthesia Care ◽

Depth Of Anesthesia ◽

State Monitoring ◽

Inhaled Anesthetics ◽

Anesthesia Monitoring ◽

Brain States ◽

Index Value ◽

The Brain

Abstract The widely used electroencephalogram-based indices for depth-of-anesthesia monitoring assume that the same index value defines the same level of unconsciousness for all anesthetics. In contrast, we show that different anesthetics act at different molecular targets and neural circuits to produce distinct brain states that are readily visible in the electroencephalogram. We present a two-part review to educate anesthesiologists on use of the unprocessed electroencephalogram and its spectrogram to track the brain states of patients receiving anesthesia care. Here in part I, we review the biophysics of the electroencephalogram and the neurophysiology of the electroencephalogram signatures of three intravenous anesthetics: propofol, dexmedetomidine, and ketamine, and four inhaled anesthetics: sevoflurane, isoflurane, desflurane, and nitrous oxide. Later in part II, we discuss patient management using these electroencephalogram signatures. Use of these electroencephalogram signatures suggests a neurophysiologically based paradigm for brain state monitoring of patients receiving anesthesia care.

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Acoustic neuroma (schwannoma) surgery 1978–1990

The Journal of Laryngology & Otology ◽

10.1017/s0022215100115270 ◽

1991 ◽

Vol 105 (3) ◽

pp. 165-173 ◽

Cited By ~ 25

Author(s):

J. E. M. Dutton ◽

R. T. Ramsden ◽

R. H. Lye ◽

K. Morris ◽

A. O. Keith ◽

...

Keyword(s):

Tumour Size ◽

Hearing Preservation ◽

Royal Infirmary ◽

Perioperative Mortality ◽

Neurophysiological Mechanism ◽

Mortality And Morbidity ◽

Number Of Patients ◽

Normal Functional ◽

Unusual Type ◽

The Ideal

AbstractA series of 151 patients with 154 acoustic schwannomas have been operated upon in Manchester Royal Infirmary by a joint Otological and Neurosurgical team, employing either the translabynnthine or the sub-occipital approach. The perioperative mortality rate was 3 per cent. Anatomical preservation of the facial nerve was achieved in 89 per cent of tumour removals and a good to normal functional result in 79 per cent of cases. Attempts at hearing preservation have been unsuccessful, largely because of the small number of patients in the series in whom useful hearing was present preoperatively. Complications included major brain stem ischaemia (1.2 per cent), CSF fistula (5 per cent) and facial dysaesthesia (7 per cent). The incidence of mortality and morbidity is directly related to tumour size and to the experience of the surgeons. A number of patients experienced an unusual type of post-operative dreamlike state which appeared to be a form of hypnagogic hallucination, and the possible neurophysiological mechanism responsible for this phenomenon is discussed. The continuing failure to attain the ideal of early diagnosis is lamented, and the importance of a flexible bidisciplinary surgical approach emphasized.

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