Exploratory Randomised Trial of Tranexamic Acid to Decrease Postoperative Delirium in Adults Undergoing Lumbar Fusion: A trial stopped early DOI Creative Commons
Bradley J. Hindman, Catherine R. Olinger, Royce W. Woodroffe

et al.

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 17, 2024

Abstract Background Postoperative delirium may be mediated by perioperative systemic- and neuro-inflammation. By inhibiting the pro-inflammatory actions of plasmin, tranexamic acid (TXA) decrease postoperative delirium. To explore this hypothesis, we modified an ongoing randomised trial TXA, adding measures delirium, cognitive function, systemic cytokines, astrocyte activation. Methods Adults undergoing elective posterior lumbar fusion randomly received intraoperative intravenous TXA (n=43: 10 mg kg -1 loading dose, 2 h infusion) or Placebo (n=40). Blood was collected pre- at 24 post-operatively (n=32) for biomarkers inflammation (cytokines) activation (S100B). Participants had twice daily assessments using 3-minute diagnostic interview Confusion Assessment Method (n=65). underwent 4 function preoperatively during post-discharge follow-up. Results Delirium incidence in group (7/32=22%) not significantly less than (11/33=33%); P =0.408, absolute difference=11%, relative difference=33%, effect size = −0.258 (95% CI −0.744 to 0.229). In (n=16), severity associated with number instrumented vertebral levels ( =0.001) interleukin −8 −10 concentrations =0.00008 =0.005, respectively) these associations were TXA. group, S100B concentration =0.0009) strength association decreased =0.002). Conclusions A potential 33% justifies adequately powered clinical determine if decreases adults fusion.

Language: Английский

Delirium is associated with loss of feedback cortical connectivity DOI Creative Commons

Klevest Gjini,

Cameron Casey, David Kunkel

et al.

Alzheimer s & Dementia, Journal Year: 2023, Volume and Issue: 20(1), P. 511 - 524

Published: Sept. 11, 2023

Abstract INTRODUCTION Post‐operative delirium (POD) is associated with increased morbidity and mortality but bereft of treatments, largely due to our limited understanding the underlying pathophysiology. We hypothesized that reflects a disturbance in cortical connectivity leads altered predictions sensory environment. METHODS High‐density electroencephalogram recordings during an oddball auditory roving paradigm were collected from 131 patients. Dynamic causal modeling (DCM) analysis facilitated inference about neuronal inhibition–excitation dynamics auditory‐evoked responses. RESULTS Mismatch negativity amplitudes smaller patients POD. DCM showed was decreased left‐sided superior temporal gyrus (l‐STG) cortex feedback connectivity. Feedback also negatively correlated severity systemic inflammation. Increased inhibition l‐STG, consequent decreases feed‐forward feed‐back connectivity, occurred for tones delirium. DISCUSSION Delirium possibly resulting intrinsic inhibitory tone. Highlights amplitude reduced Patients postoperative had feedforward before surgery. diminished left‐side left primary area inversely inflammation severity.

Language: Английский

Citations

12
Clinical biomarkers of perioperative neurocognitive disorder: initiation and recommendation DOI
Jianhui Liu, Cheng Li, Junyan Yao

et al.

Science China Life Sciences, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 22, 2025

Language: Английский

Citations

0
Brain Structural and Functional Changes Associated With Postoperative Neurocognitive Disorders: Research Update DOI Creative Commons
Huimin Wu,

Yaseen Ahammed,

Shouyuan Tian

et al.

Anesthesia & Analgesia, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 19, 2025

Postoperative neurocognitive disorders (PNDs) are frequent and serious perioperative complications in the elderly, associated with increased morbidity mortality, length of hospital stay, need for long-term care. At present, pathogenesis PND is not completely clear, there various risk factors including surgical trauma stress mediating systemic inflammation towards neuroinflammation development which causes brain structural functional changes namely PND. For elderly patients, neurological monitoring may provide insights into function status. Monitoring also help clinicians identify potential risks would ultimately allow timely effective intervention better safety prognosis patients. In this review, we summarize mechanisms PND, discuss preliminary evidence regarding application electroencephalography, near-infrared spectroscopy, magnetic resonance, positron emission tomography imaging central nervous system during postoperative period.

Language: Английский

Citations

0
Solving the enigma of burst suppression DOI
Jyun-you Liou,

M Bruce MacIver,

Jamie Sleigh

et al.

British Journal of Anaesthesia, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 1, 2025

Language: Английский

Citations

0
Relationship between preoperative high arterial blood lactate level and delirium after deep brain stimulation surgery in Parkinson’s disease DOI Creative Commons
Wenbin Lu,

Malathi Rao,

Liangliang Lu

et al.

Frontiers in Aging, Journal Year: 2025, Volume and Issue: 6

Published: March 25, 2025

Introduction: We performed the retrospective study to investigate relationship between preoperative arterial blood lactate level and postoperative delirium (POD) in Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) surgery. Methods: Perioperative data of DBS surgery under total intravenous anesthesia were collected study. In addition, mini-mental state exam score for assessing cognitive function confusion assessment method perioperative PD collected. The POD was analyzed using binary logistic regression analysis. Results: A 156 included, whom 29 (17.6%) developed POD. Multivariable analysis showed that independently associated with regarding continuous variable [odds ratio (OR) = 12.46, 95% confidence interval (CI)=3.12–49.71, P<0.001] or categorical (OR= 3.58, CI =1.20–10.65, P=0.022 lactate≥1.41). Receiver operating characteristic curve a significant predictive biomarker POD, an area 0.708(95%CI=0.606–0.809, P<0.05). Subgroup indicated high levels independent risk factor after (OR=10.71,95%CI=1.17–97.87, P=0.036) female patients. Discussion: Preoperative is disease.

Language: Английский

Citations

0
Artificial intelligence in drug development for delirium and Alzheimer’s disease DOI Creative Commons
Ruixue Ai, Xianglu Xiao,

Shuling Deng

et al.

Acta Pharmaceutica Sinica B, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Language: Английский

Citations

0
Exploratory randomised trial of tranexamic acid to decrease postoperative delirium in adults undergoing lumbar fusion—a trial stopped early DOI
Bradley J. Hindman, Catherine R. Olinger, Royce W. Woodroffe

et al.

BJA Open, Journal Year: 2025, Volume and Issue: 14, P. 100403 - 100403

Published: April 14, 2025

Language: Английский

Citations

0
Neurophysiological patterns reflecting vulnerability to delirium subtypes: a resting-state EEG and event-related potential study DOI Creative Commons
Monique S Boord, Daniel Feuerriegel, Scott Coussens

et al.

Brain Communications, Journal Year: 2024, Volume and Issue: 6(5)

Published: Jan. 1, 2024

Abstract Delirium is a common and acute neurocognitive disorder in older adults associated with increased risk of dementia death. Understanding the interaction between brain vulnerability stressors key to delirium pathophysiology, but neurophysiology not well defined. This study aimed identify pre-operative resting-state EEG event-related potential markers incident its subtypes undergoing elective cardiac procedures. prospective observational included 58 participants (mean age = 75.6 years, SD 7.1; 46 male/12 female); COVID-19 restrictions limited recruitment. Baseline assessments were conducted weeks before procedures 4-min recording (2-min eyes open 2-min closed), 5-min frequency auditory oddball paradigm recording, cognitive depression examinations. Periodic peak power, bandwidth measures, aperiodic offsets exponents derived from data. Event-related potentials measured as mean component amplitudes (first positive component, first negative early third mismatch negativity) following standard deviant stimuli. Incident occurred 21 participants: 10 hypoactive, 6 mixed, 5 hyperactive. hyperactive was higher (P 0.045, d 1.0) closed 0.036, offsets. mixed significantly larger deviants 0.037, standards 0.025, 0.041, 0.9). Other statistically non-significant moderate-to-large effects observed relation all subtypes. We report evidence neurophysiological prior adults. Despite being underpowered due COVID-19–related recruitment impacts, these findings indicate dysfunction neural excitation/inhibition balance different warrant further investigation on scale.

Language: Английский

Citations

1
Association of preoperative to postoperative change in cerebrospinal fluid fibrinogen with postoperative delirium DOI Creative Commons
Thomas Payne, Jennifer Taylor, David Kunkel

et al.

BJA Open, Journal Year: 2024, Volume and Issue: 12, P. 100349 - 100349

Published: Oct. 5, 2024

Language: Английский

Citations

1
Cardiac surgery with valve replacement temporarily disrupts the hippocampal memory network DOI Creative Commons

Yue Yao,

Hongan Shao,

Jayne Masters

et al.

British Journal of Anaesthesia, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 1, 2024

Systemic inflammation after heart valve replacement surgery commonly results in complications including cognitive impairment. This study was designed to investigate whether valvular disease itself and affects cognition the related functional connectivity (FC) of hippocampal memory network.

Language: Английский

Citations

1