Anesthesia, General/adverse effects* ; Delirium/etiology* ; Humans ; Postoperative Complications/etiology*

BACKGROUND: Desflurane has lower solubility and shows a more rapid induction and recovery than sevoflurane, although it often induces increased cardiovascular response, emergence delirium, and respiratory complications. The change of anesthetic agent from sevoflurane to desflurane after induction may provide a smooth induction and rapid emergence. The aim of this study was to evaluate the effect of changing sevoflurane to desflurane after induction on the cardiovascular response, emergence delirium, and recovery characteristics during pediatric strabismus surgery. METHODS: For the study, 135 children scheduled for strabismus surgery were randomly divided into three groups: the S group (n = 45) and D group (n = 45) received sevoflurane or desflurane, respectively, for induction and maintenance, while the C group (n = 45) received sevoflurane for induction and desflurane for maintenance. Cardiovascular responses, pediatric anesthesia emergence delirium (PAED) scale scores, post-anesthesia care unit (PACU) length of stay, and the incidence of postoperative complications were compared between groups. RESULTS: The blood pressure of the D group was significantly different from that of the S and C groups (P < 0.05). The time to extubation and first crying were significantly longer in the S group (P < 0.001). There were no significant differences in PAED score, PACU length of stay, and the incidence of postoperative complications, except for cough, among the three groups. CONCLUSIONS: The change of desflurane after sevoflurane induction in pediatric strabismus surgery provided rapid emergence compared with sevoflurane, and attenuated cardiovascular responses and lesser respiratory complications as compared to desflurane. The emergence delirium was not influenced by either inhalational anesthetic.
Anesthesia* ; Blood Pressure ; Child ; Cough ; Crying ; Delirium* ; Humans ; Incidence ; Length of Stay ; Postoperative Complications ; Solubility ; Strabismus*

Thiopental 6.7mg/kg and ketamine 0.9mg/kg was given for induction of general anesthesia and effect of the drugs on the bioparameters such as the time required for loss of consciousness, the occurance of arrhythmias, the amount of bronchial secretion, changes in blood pressure and pulse rate, and the postoperative complications were investigated in this study. The results were as follows. 1) The time required for loss of consciousness was 28 seconds in the ketamine group and 32 seconds in the thiopental group. 2) The occurance of arrhythmias was less in ketamine group than in thiopental group. 3) The degree of bronchial secretion was similar in both groups. 4) Ketamine did not increase the pulse rate greater anymore thiopental. 5) Blood pressure was significantly lowered after 10 minutes in the thiopental group but not changed in the ketamine group. 6) There was no hallucination or delirium in the two groups.
Anesthesia* ; Anesthesia, General ; Arrhythmias, Cardiac ; Blood Pressure ; Delirium ; Hallucinations ; Heart Rate ; Ketamine* ; Postoperative Complications ; Thiopental* ; Unconsciousness

OBJECTIVETo evaluate incidence of postoperative delirium after hip surgery in elderly patients by meta-analysis.

METHODSFrom January 1, 2014 to December 31, 2013, clinical literatures about postoperative delirium after hip surgery in elderly patients,were searched from the Pubmed. Literature extract table were formed according to inclusion and exclusion criteria. Stata-12.0 was applied for Meta-analysis. P was used to test heterogeneity of study, random-effect model was performed when I2 > 50%. Subgroup analysis was used according to stage of age, assessment scale of delirium and statistical area of literature. Begg test was used to test publication bias.

RESULTSTwenty-one literatures were included. Incidence of postoperative delirium after hip surgery in elderly patients by weighted and combination was 17% [95% CI (16%, 18%)]. Incidence of postoperative delirium after optional hip surgery was decreased more than emergency operation in included 5 literatures [OR = 0.32, 95% CI (0.22, 0.45)]. Incidence of postoperative delirium in patients less than 80 years old was 21% [95% CI (19%, 23%)], while 21% [95% CI (19%, 24%)] in patients more than 80 years old. Incidence of postoperative delirium in CAM evaluation scale was 23% [95% CI (21%, 26%)], while 19% [95% CI (17%, 21%)] in other evaluation scales. Incidence of postoperative delirium in Asian area was 17% [95% CI (15%, 20%)], while 23% [95% CI (21%, 25%)] in European and American area. There was no publication bias tested by Begg test (P < 0.05).

CONCLUSIONIncidence of postoperative delirium after hip surgery in elderly patients increases higher, especially in emergency operation. A standardizing research method is benefit for evaluate incidence of postoperative delirium after hip surgery in elderly patients, decreasing heterogeneity and publication bias.

Aged ; Delirium ; epidemiology ; Hip Fractures ; surgery ; Humans ; Incidence ; Postoperative Complications ; epidemiology ; Publication Bias

Delirium can be defined as an ‘acute brain dysfunction.’ Compared to dementia, which is a disease that deteriorates the brain function chronically, delirium shows very similar symptoms but is mostly ameliorated when the causative factors are normalized. Due to the heterogeneity in etiologies and symptoms, people including health care workers often mistake delirium for dementia or other psychiatric disorders. Delirium has attracted global interest increasingly and a vast amount of research on its management has been conducted. Experts in the field have constantly suggested that systematic intervention should be implemented through a team-based multicomponent approach aimed to reduce the incidence and duration of delirium. Surgery involves many health care workers with different expertise who are not familiar with delirium. For a team-based approach on the management of delirium, it is vital that all medical personnel concerned have a common understanding of delirium and keep in constant communication. Postoperative delirium is a common complication and exerts an enormous burden on patients, their families, hospitals, and public resources. To alleviate this burden, this article aimed to review general features and the latest evidence-based knowledge of delirium with a focus on postoperative delirium.
Brain ; Delirium ; Delivery of Health Care ; Dementia ; Humans ; Incidence ; Population Characteristics ; Postoperative Complications ; Prognosis ; Risk Factors

OBJECTIVE: To investigate the incidence and risk factors of delirium after spinal surgery in elderly patients. METHODS: A retrospective analysis was performed on 436 patients with spinal surgery from January 2016 to November 2018. According to delirium occurrancy after the operation, 436 cases were divided into two groups:delirium group and non-delirium group. Body mass index(BMI), history of diabetes, history of coronary heart disease, history of chronic obstructive pulmonary disease (COPD), preoperative white blood cell count, preoperative erythrocyte volume, preoperative hemoglobin level, operation mode, operation time, anesthesia time, American Association of Anesthesiologists(ANA)(ASA) score, cardiac function grading(NYHA), intraoperative blood loss, intraoperative blood transfusion, intraoperative fentanyl, propofol and Dizocine dosage, postoperative white blood cell count, postoperative erythrocyte volume, postoperative hemoglobin level, postoperative electrolytes (sodium, potassium) and univariate logistic regression analysis were used to analyze the risk factors. The independent risk factors were further investigated by multivariate Logistic regression analysis. RESULTS: Among 436 cases, 112 elderly patients had postoperative delirium, the incidence of delirium was about 25.68%. The age, preoperative leukocyte count, erythrocyte specific volume, postoperative hemoglobin level in delirium group and non-delirium group were measured. There were significant differences in the postoperative sodium concentration, anesthesia time, ASA score, cardiac function grading, blood loss during operation, postoperative use of Dizocine, history of diabetes, history of coronary heart disease and history of COPD (<0.05). Multivariate logistic regression analysis showed that the age, ASA score, postoperative Dizocine volume, and COPD history were independent risk factors for the occurrence of delirium after spinal surgery in elderly patients. CONCLUSIONS The elderly patients over 72 years old, the ASA score>2, the use of Dizocine analgesic and the patients with COPD are the independent risk factors of postoperative delirium.
Aged ; Delirium ; Humans ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Risk Factors

INTRODUCTION: Post-anaesthesia care unit (PACU) delirium is a potentially preventable condition that results in a significant long-term effect. In a multicentre prospective cohort study, we investigate the incidence and risk factors of postoperative delirium in elderly patients undergoing major non-cardiac surgery. METHODS: Patients were consented and recruited from 4 major hospitals in Singapore. Research ethics approval was obtained. Patients older than 65 years undergoing non-cardiac surgery >2 hours were recruited. Baseline perioperative data were collected. Preoperative baseline cognition was obtained. Patients were assessed in the post-anaesthesia care unit for delirium 30-60 minutes after arrival using the Nursing Delirium Screening Scale (Nu-DESC). RESULTS Ninety-eight patients completed the study. Eleven patients (11.2%) had postoperative delirium. Patients who had PACU delirium were older (74.6±3.2 versus 70.6±4.4 years, P=0.005). Univariate analysis showed those who had PACU delirium are more likely to be ASA 3 (63.6% vs 31.0%, P=0.019), had estimated glomerular filtration rate (eGFR) of >60mL/min/1.73m2 (36.4% vs 10.6%, P=0.013), higher HbA1C value (7.8±1.2 vs 6.6±0.9, P=0.011), raised random blood glucose (10.0±5.0mmol/L vs 6.5±2.4mmol/L, P=0.0066), and moderate-severe depression (18.2% vs 1.1%, P=0.033). They are more likely to stay longer in hospital (median 8 days [range 4-18] vs 4 days [range 2-8], P=0.049). Raised random blood glucose is independently associated with increased PACU delirium on multivariate analysis.
Aged ; Anesthesia ; Anesthesia Recovery Period ; Delirium/etiology* ; Humans ; Incidence ; Postoperative Complications/etiology* ; Prospective Studies ; Risk Factors

BACKGROUND: Emergence delirium (ED) is a kind of delirium that occured in the immediate post-anesthesia period. Lower body temperature on post-anesthesia care unit (PACU) admission was an independent risk factor of ED. The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery. METHODS: This study was a secondary analysis of a prospective observational study. Taking baseline body temperature as a reference, intraoperative absolute and relative temperature changes were calculated. The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference. ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge. RESULTS: A total of 874 patients were analyzed with a mean age of 71.8 ± 5.3 years. The incidence of ED was 38.4% (336/874). When taking 36.0°C, 35.5°C, and 35.0°C as thresholds, the incidences of absolute hypothermia were 76.7% (670/874), 38.4% (336/874), and 17.5% (153/874), respectively. In multivariable logistic regression analysis, absolute hypothermia (lowest value <35.5°C) and its cumulative duration were respectively associated with an increased risk of ED after adjusting for confounders including age, education, preoperative mild cognitive impairment, American Society of Anesthesiologists grade, duration of surgery, site of surgery, and pain intensity. Relative hypothermia (decrement >1.0°C from baseline) and its cumulative duration were also associated with an increased risk of ED, respectively. When taking the relative increment >0.5°C as a threshold, the incidence of relative hyperthermia was 21.7% (190/874) and it was associated with a decreased risk of ED after adjusting above confounders. CONCLUSIONS: In the present study, we found that intraoperative hypothermia, defined as either absolute or relative hypothermia, was associated with an increased risk of ED in elderly patients after non-cardiac surgery. Relative hyperthermia, but not absolute hyperthermia, was associated with a decreased risk of ED. REGISTRATION Chinese Clinical Trial Registry (No. ChiCTR-OOC-17012734).
Humans ; Aged ; Body Temperature ; Emergence Delirium ; Hypothermia ; Postoperative Complications/epidemiology* ; Prospective Studies

OBJECTIVES: To study the risk factors for postoperative delirium (POD) in children with congenital heart disease. METHODS: A prospective nested case-control study was performed on children with congenital heart disease who underwent surgery in Fuwai Hospital, Chinese Academy of Medical Sciences, from December 2020 to June 2021. The clinical data were compared between the POD group (n=114) and non-POD group (n=102). A multivariate unconditional logistic regression analysis was used to investigate the risk factors for POD in children with congenital heart disease. RESULTS: The multivariate logistic regression analysis showed that age (OR=0.951, P<0.001), gender (OR=2.127, P=0.049), number of invasive catheters per day (OR=1.490, P=0.017), degree of postoperative pain (OR=5.856, P<0.001), and preoperative parental anxiety level (OR=1.025, P=0.010) were independent risk factors for POD in children with congenital heart disease. CONCLUSIONS The risk of POD increases in children with congenital heart disease who are younger, male, have higher number of invasive catheters per day, higher degree of postoperative pain, or higher preoperative parental anxiety level.
Case-Control Studies ; Child ; Delirium/complications* ; Heart Defects, Congenital/surgery* ; Humans ; Male ; Postoperative Complications/etiology* ; Prospective Studies ; Risk Factors

BACKGROUNDDelirium is a common and deleterious complication in critically ill patients after surgery. The purpose of this study was to determine the incidence and risk factors of delirium in critically ill patients after non-cardiac surgery, and to investigate the relationship between the serum cortisol level and the occurrence of postoperative delirium.

METHODSIn a prospective cohort study, 164 consecutive patients who were admitted to the surgical intensive care unit after non-cardiac surgery were enrolled. Baseline characteristics and perioperative variables were collected. Blood samples were obtained on the first postoperative day and serum cortisol concentrations were measured. Delirium was assessed using the Nursing Delirium Screening Scale until the seventh postoperative day or the disappearance of delirious symptoms.

RESULTSPostoperative delirium occurred in 44.5% of patients (73 of 164). The median time to first onset of delirium is 0 (range 0 to 5 days) and the median duration of delirium is 3 (1 to 13) days. Independent risk factors of postoperative delirium included increasing age (odds ratio (OR) 2.646, 95% confidence interval (CI) 1.431 to 4.890, P = 0.002), a history of previous stroke (OR 4.499, 95%CI 1.228 to 16.481, P = 0.023), high Acute Physiology and Chronic Health Evaluation II score on surgical intensive care unite admission (OR 1.391, 95%CI 1.201 to 1.612, P < 0.001), and high serum cortisol level on the 1st postoperative day (OR 3.381, 95%CI 1.690 to 6.765, P = 0.001). The development of delirium was linked to higher incidence of postoperative complications (28.8% vs. 7.7%, P < 0.001), and longer duration of hospitalization (18 (7 to 74) days vs. 13 (3 to 48) days, P < 0.001).

CONCLUSIONSDelirium was a frequent complication in critically ill patients after non-cardiac surgery. High serum cortisol level was associated with increased incidence of postoperative delirium.

Aged ; Critical Illness ; Delirium ; epidemiology ; etiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Postoperative Complications ; Prospective Studies ; Risk Factors