The Italian Journal of Pediatrics/Italian journal of pediatrics,
Journal Year:
2024,
Volume and Issue:
50(1)
Published: Feb. 8, 2024
Delirium,
a
form
of
acute
cerebral
dysfunction,
is
common
complication
postoperative
cardiac
surgery
in
children.
It
strongly
associated
with
adverse
outcomes,
including
prolonged
hospitalization,
increased
mortality,
and
cognitive
dysfunction.
This
study
aimed
to
identify
risk
factors
incidence
delirium
after
children
facilitate
early
identification
provide
reference
for
the
implementation
effective
prevention
management.
A
systematic
literature
search
was
conducted
PubMed,
Web
Science,
Embase,
Cochrane
Library,
Scopus,
CNKI,
Sinomed,
Wanfang
studies
published
English
or
Chinese
from
inception
each
database
November
2023.
The
PRISMA
guidelines
were
followed
all
phases
this
review.
Risk
Bias
Assessment
Nonrandomized
Studies
tool
used
assess
methodological
quality.
total
twelve
included
analysis,
four
classified
as
overall
low
bias,
seven
moderate
one
high
bias.
reported
39
possible
predictors
delirium,
categorized
into
broad
groups:
intrinsic
parent-related
factors,
disease-related
treatment-related
clinical
scores
laboratory
parameters.
By
conducting
qualitative
synthesis
quantitative
meta-analysis,
we
identified
two
definite
32
unclear
related
delirium.
Definite
age
mechanical
ventilation
duration.
Possible
developmental
delay,
cyanotic
heart
disease,
cardiopulmonary
bypass
time,
pain
score.
With
only
few
high-quality
currently
available,
well-designed
more
extensive
prospective
are
still
needed
investigate
affecting
explore
strategies
high-risk
Anesthesiology,
Journal Year:
2020,
Volume and Issue:
133(2), P. 377 - 392
Published: May 12, 2020
Background
Dexmedetomidine
induces
a
sedative
response
that
is
associated
with
rapid
arousal.
To
elucidate
the
underlying
mechanisms,
authors
hypothesized
dexmedetomidine
increases
activity
of
dopaminergic
neurons
in
ventral
tegmental
area,
and
this
action
contributes
to
unique
properties
dexmedetomidine.
Methods
Only
male
mice
were
used.
The
area
dopamine
was
measured
by
genetically
encoded
Ca2+
indicator
patch-clamp
recording.
Dopamine
neurotransmitter
dynamics
medial
prefrontal
cortex
nucleus
accumbens
sensor.
Ventral
inhibited
or
activated
chemogenetic
approach,
depth
sedation
estimated
electroencephalography.
Results
signals
increased
after
intraperitoneal
injection
(40
μg/kg;
dexmedetomidine,
16.917
[14.882;
21.748],
median
[25%;
75%],
vs.
saline,
–0.745
[–1.547;
0.359],
normalized
data,
P
=
0.001;
n
6
mice).
transmission
10.812
[9.713;
15.104],
–0.498
[–0.664;
–0.355],
mice)
(dexmedetomidine,
8.543
[7.135;
11.828],
–0.329
[–1.220;
–0.047],
Chemogenetic
inhibition
activation
decreased
slow
waves,
respectively,
delta
wave:
two-way
repeated
measures
ANOVA,
F[2,
33]
8.016,
0.002;
12
mice;
theta
22.800,
<
0.0001;
Conclusions
activates
concentrations
related
forebrain
projection
areas.
This
mechanism
may
explain
arousability
upon
sedation.
Editor’s
Perspective
What
We
Already
Know
about
Topic
Article
Tells
Us
That
Is
New
European Journal of Anaesthesiology,
Journal Year:
2020,
Volume and Issue:
38(1), P. S9 - S17
Published: Oct. 28, 2020
BACKGROUND
Dexmedetomidine
is
known
to
be
a
sedative.
Recent
studies
suggest
that
administration
of
dexmedetomidine
can
prevent
postoperative
delirium
(POD)
which
has
been
confirmed
as
common
complication
after
major
surgery.
However,
its
effects
in
patients
undergoing
oesophagectomy
are
scarce.
OBJECTIVE
To
investigate
the
efficacy
and
safety
reducing
POD
elderly
transthoracic
with
total
intravenous
anaesthesia
(TIVA).
DESIGN
A
randomised,
double-blind,
placebo-controlled
trial.
SETTING
Single-centre,
tertiary
care
hospital,
November
2016
September
2018.
PATIENTS
Eligible
(
n
=
177)
were
randomly
assigned
receive
(TIVA,
87)
or
TIVA
(DEX-TIVA,
90).
INTERVENTIONS
Patients
receiving
DEX-TIVA
received
loading
dose
(0.4
μg
kg
−1
),
over
15
min,
followed
by
continuous
infusion
at
rate
0.1
h
until
1
before
end
physiological
saline
similar
protocol.
OUTCOME
MEASURES
The
primary
outcome
was
incidence
POD.
secondary
endpoints
emergence
agitation,
serum
interleukin-6
(IL-6)
levels
haemodynamic
profile.
RESULTS
All
randomised
included
planned
intention-to-treat
analyses
for
Delirium
occurred
(16.7%)
90
cases
given
dexmedetomidine,
32
(36.8%)
87
P
0.0036).
group
showed
less
frequent
agitation
than
(22.1
vs.
48.0%,
0.0058).
incremental
change
surgery-induced
IL-6
greater
<
0.0001).
CONCLUSION
Adding
peri-operative
anaesthetic
safely
reduces
open
oesophagectomy.
These
benefits
associated
reduction
circulating
pro-inflammatory
cytokine
stabilisation
TRIAL
REGISTRATION
Chinese
Clinical
Trials
Register
Identifier:
ChiCTR-IPR-17010881.
Current Neuropharmacology,
Journal Year:
2021,
Volume and Issue:
19(9), P. 1519 - 1544
Published: Jan. 19, 2021
Traumatic
brain
injury
(TBI)
can
initiate
a
very
complex
disease
of
the
central
nervous
system
(CNS),
starting
with
primary
pathology
inciting
trauma
and
subsequent
inflammatory
CNS
tissue
response.
Delirium
has
long
been
regarded
as
an
almost
inevitable
consequence
moderate
to
severe
TBI,
but
more
recently
recognized
organ
dysfunction
syndrome
potentially
mitigating
interventions.
The
diagnosis
delirium
is
independently
associated
prolonged
hospitalization,
increased
mortality
worse
cognitive
outcome
across
critically
ill
populations.
Investigation
unique
problems
management
challenges
TBI
patients
needed
reduce
burden
in
this
population.
In
narrative
review,
possible
etiologic
mechanisms
behind
post-traumatic
are
discussed,
including
structures
mediating
arousal
attention
secondary
due
progressive
destruction
parenchyma.
Other
potential
contributors
include
dysregulation
neurotransmission
intravenous
sedatives,
seizures,
failure,
sleep
cycle
disruption
or
other
risk
factors.
screening
be
accomplished
presence
portends
outcomes.
There
evidence
that
multi-component
care
bundles
analgesia-prioritized
sedation
algorithm,
regular
spontaneous
awakening
breathing
trials,
protocolized
assessment,
early
mobility
family
engagement
ICU
delirium.
aim
review
summarize
approach
emphasis
on
pathogenesis
management.
Emerging
CNS-active
drug
therapies
show
promise
preclinical
studies
highlighted.
The Italian Journal of Pediatrics/Italian journal of pediatrics,
Journal Year:
2024,
Volume and Issue:
50(1)
Published: Feb. 8, 2024
Delirium,
a
form
of
acute
cerebral
dysfunction,
is
common
complication
postoperative
cardiac
surgery
in
children.
It
strongly
associated
with
adverse
outcomes,
including
prolonged
hospitalization,
increased
mortality,
and
cognitive
dysfunction.
This
study
aimed
to
identify
risk
factors
incidence
delirium
after
children
facilitate
early
identification
provide
reference
for
the
implementation
effective
prevention
management.
A
systematic
literature
search
was
conducted
PubMed,
Web
Science,
Embase,
Cochrane
Library,
Scopus,
CNKI,
Sinomed,
Wanfang
studies
published
English
or
Chinese
from
inception
each
database
November
2023.
The
PRISMA
guidelines
were
followed
all
phases
this
review.
Risk
Bias
Assessment
Nonrandomized
Studies
tool
used
assess
methodological
quality.
total
twelve
included
analysis,
four
classified
as
overall
low
bias,
seven
moderate
one
high
bias.
reported
39
possible
predictors
delirium,
categorized
into
broad
groups:
intrinsic
parent-related
factors,
disease-related
treatment-related
clinical
scores
laboratory
parameters.
By
conducting
qualitative
synthesis
quantitative
meta-analysis,
we
identified
two
definite
32
unclear
related
delirium.
Definite
age
mechanical
ventilation
duration.
Possible
developmental
delay,
cyanotic
heart
disease,
cardiopulmonary
bypass
time,
pain
score.
With
only
few
high-quality
currently
available,
well-designed
more
extensive
prospective
are
still
needed
investigate
affecting
explore
strategies
high-risk
