Delirium in cardiac surgery - risk factors and prevention DOI Open Access

Mihaela Preveden,

Andrej Preveden, Ranko Zdravković

et al.

Medicinski pregled, Journal Year: 2022, Volume and Issue: 75(3-4), P. 133 - 137

Published: Jan. 1, 2022

Introduction. Delirium is defined as an acute change in mental status that leads to disturbance perception, thinking, memory, attention, emotional status, well sleep rhythm disorders and most often reversible. Postoperative delirium disorder develops after cardiovascular surgery with incidence of 20 - 50% operated patients. This complication associated a longer hospitalization, stay the intensive care unit, increased morbidity mortality. Risk Factors. The risk factors are divided into preoperative, intraoperative postoperative. common preoperative older age, stenosis carotid arteries, previous cerebral diseases, depression, diabetes, hypertension, low ejection fraction left ventricle, heart disorders. Intraoperative include type surgery, anesthesia, duration extracorporeal circulation, aortic clamp. important postoperative use psychoactive drugs, prolonged pain, opioid mechanical ventilation, length unit. Prevention. Prevention very aspect focused on precipitating factors. Preventive treatment includes pharmacological non-pharmacological methods. main recommendation refers avoiding routine antipsychotics. Conclusion. Continuous infusion dexmedetomidine compared propofol reduces delirium. Nonpharmacological approach consists series procedures carried out postoperatively, such protocol monitoring Awakening, Breathing, Coordination, Delirium, Early mobility, Family engagement.

Language: Английский

My Patient in the PACU Is Not Making Any Sense DOI Creative Commons

Joy Steadman

Perioperative Medicine, Journal Year: 2025, Volume and Issue: unknown, P. 514 - 521

Published: Jan. 1, 2025

Language: Английский

Citations

0
Enhancing circadian rhythms—the circadian MEGA bundle as novel approach to treat critical illness DOI Open Access
Meghan Prin,

Júlia Bertazzo,

Lori A. Walker

et al.

Annals of Translational Medicine, Journal Year: 2023, Volume and Issue: 11(9), P. 319 - 319

Published: June 1, 2023

Abstract: Circadian rhythms are essential to physiological homeostasis, but often disrupted in the intensive care unit (ICU) due absence of natural zeitgebers and exposure treatments which affect circadian regulators. This is increasingly recognized as a contributor morbidity mortality across variety medical conditions including critical illness. Maintenance particularly relevant critically ill patients, who restricted not only ICU environment bed bound. have been evaluated several studies, effective therapies maintain, restore, or amplify fully established yet. entrainment amplitude enhancement integral patients' overall health well-being, likely even more important during response recovery from In fact, studies shown that enhancing cycles has significant beneficial effects on wellbeing. this review, we discuss up-to-date literature novel mechanism could restore enhance illness by using MEGA bundle consisting intense light therapy each morning, cyclic nutrition support, timed physical therapy, nighttime melatonin administration, morning administration rhythm enhancers, temperature control nocturnal sleep hygiene bundle.

Language: Английский

Citations

10
Delirium in the ICU: Pathophysiology, Diagnosis and Management DOI
Neil J. Glassford,

R. E. Olver,

Yahya Shehabi

et al.

Published: Jan. 1, 2025

Language: Английский

Citations

0
The Efficacy of Dexmedetomidine alone or with Melatonin on Delirium after Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial DOI Open Access
Fatemeh Javaherforooshzadeh,

Abbas Babazadeh Dezfoli,

Amal Saki Malehi

et al.

Anesthesiology and Pain Medicine, Journal Year: 2023, Volume and Issue: 13(4)

Published: Aug. 22, 2023

One of the most common cognitive disorders after major surgery is delirium which can increase morbidity and mortality. This study compared effect dexmedetomidine with or without melatonin to reduce following coronary artery bypass graft (CABG) surgery.This trial was a double-blind, randomized, controlled clinical trial. Eighty patients in two different groups administration alone undergoing CABG Golestan Hospital, Ahvaz, 2022 - 2023, were randomly allocated. evaluated occurrence, onset, length delirium, haloperidol, time required for weaning, duration stays intensive care unit (ICU) hospital.The occurrence lower melatonin/dexmedetomidine group (15%) than (30 %) (P = 0.09). Additionally, had significantly (1.95 (0, 20) 8.46 40) P 0.04). However, no significant difference observed onset between 0.25). The hospital shorter (7.53 (7, 10) 8.60 15), 0.03). demonstrated extubation 0.38) ICU stay 0.19).The reduced incidence post-cardiac shortened its duration, decreased impact many risk factors those not receiving added melatonin.

Language: Английский

Citations

5
Melatonin and Melatonin Agonists for Prevention of Delirium in the Cardiac Surgical ICU: A Meta-analysis DOI Open Access
Subhrashis Guha Niyogi, Chandrima Naskar, Avneet Singh

et al.

Indian Journal of Critical Care Medicine, Journal Year: 2023, Volume and Issue: 27(11), P. 837 - 844

Published: Oct. 27, 2023

Delirium is highly prevalent in the immediate postoperative period following cardiac surgery and adversely impacts outcomes. Melatonin has been increasingly used pharmacological prevention of delirium. We aimed to synthesize available evidence concerning role melatonin agonists preventing delirium patients after surgery.PubMed, Google Scholar, Web Science databases were searched for relevant randomized non-randomized trials adults undergoing investigating prevent Studies incorporating transplants, preoperative organ support, prophylactic antipsychotics, or children excluded. Risk-of-bias was assessed using Cochrane ROB 2.0 ROBINS-I tools. A systematic review meta-analysis conducted, calculating pooled odds ratio (OR) incidence a random effects model with Mantel-Haenszel method restricted maximum-likelihood estimator. Trial sequential analysis also carried out primary outcome.Six one trial involving 1,179 included. Incidence 16.7 29.6% intervention comparator groups respectively, indicating OR 0.44 [95% confidence interval (CI) 0.27 - 0.71, p = 0.04] favoring melatonin. Two studies had high risk bias, I2 statistics indicated significant heterogeneity. However, publication bias insignificant, significance attained effect size.Based on studies, perioperative use significantly decreases adult surgery. quality low, larger standardization nonpharmacological interventions, high-risk cohorts, exploring various dosages regimens should be out.Niyogi SG, Naskar C, Singh A, Kumar B, Grover S. Agonists Prevention Cardiac Surgical ICU: Meta-analysis. Indian J Crit Care Med 2023;27(11):837-844.

Language: Английский

Citations

4
Pharmacological Management of Sleep–Wake Disturbances in Delirium DOI
Erik A. Levinsohn, Varsha Radhakrishnan,

Haley Euting

et al.

The Journal of Clinical Pharmacology, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 16, 2024

Abstract Delirium is a heterogeneous syndrome primarily characterized by fluctuations in attention and awareness. Sleep–wake disturbances are common significant feature of delirium can manifest as circadian rhythm inversion, sleep fragmentation, reduced rapid eye movement (REM) slow‐wave sleep. Some literature suggests that the relationship between disruption reciprocal wherein two reinforce one another may share an underlying etiology. As there no FDA‐approved medications for or delirium‐related disturbances, management focused on addressing medical concerns promoting physiologic patterns with non‐pharmacological behavioral interventions. In practice, however, often used, albeit limited evidence to support their use. This review explores pharmacology pharmacokinetics several investigating use delirium: melatonin, ramelteon, dual orexin receptor antagonists (DORAs), dexmedetomidine. Current possible benefit ramelteon dexmedetomidine patients ICU setting, DORAs therapeutic options re‐regulation sleep–wake cycle delirium. We discuss pertinent pharmacokinetic pharmacodynamic factors influence clinical decision‐making regarding these

Language: Английский

Citations

1
Preventive Effects of Ramelteon, Suvorexant, and Lemborexant on Delirium in Hospitalized Patients With Physical Disease DOI

R. Henmi,

Tomoyuki Nakamura,

Masaya Mashimoto

et al.

Journal of Clinical Psychopharmacology, Journal Year: 2024, Volume and Issue: unknown

Published: May 31, 2024

Abstract Background New sleep-inducing drugs (eg, ramelteon, suvorexant, and lemborexant) have been shown to prevent delirium in high-risk groups. However, no single study has simultaneously evaluated the delirium-preventing effects of all novel hospitalized patients. Therefore, this aimed clarify relationship between prevention patients general medical-surgical settings for nonpsychiatric conditions who underwent liaison interventions insomnia. Methods This retrospective cohort included treated with consultation-liaison psychiatry consult Delirium was diagnosed by fully certified psychiatrists using Diagnostic Statistical Manual Mental Disorders 5 th edition. The following items were retrospectively examined from medical records as factors related development: type drugs, age, sex, risk factors. development calculated adjusted odds ratios (aORs) via multivariate logistic regression analysis. Results Among 710 analyzed, 257 (36.2%) developed delirium. Suvorexant (aOR, 0.61; 95% confidence interval [CI], 0.40–0.94; P = 0.02) lemborexant 0.23; CI, 0.14–0.39; < 0.0001) significantly reduced developing Benzodiazepines 1.90; 1.15–3.13; 0.01) increased risk. Ramelteon 1.30; 0.84–2.01; 0.24) Z-drugs 1.27; 0.81–1.98; 0.30) not associated development. Conclusions use suvorexant may a wide range conditions.

Language: Английский

Citations

0
Opportunities of cerebroprotection in children in cardiac surgery (review of literature) DOI Creative Commons
A. A. Ivkin, Д. Г. Балахнин, D. N. Borisenko

et al.

Messenger of Anesthesiology and Resuscitation, Journal Year: 2023, Volume and Issue: 20(1), P. 89 - 96

Published: Feb. 28, 2023

The analysis of the literature in main search scientific systems was carried out to identify current means cerebroprotection. assessment is given both familiar methods that have become «traditional» for cardiac surgery (hypothermia, etc.) and pharmacological approaches are less common clinical practice: use melatonin, ketamine. characteristics some drugs promising solving this problem also given.

Language: Английский

Citations

1
POSTOPERATIVE DELIRIUM IN CARDIAC SURGERY DOI
Anastasiia V. Alekseeva, Ф.В. Орлов,

Irina A. Vedeneeva

et al.

Acta medica Eurasica, Journal Year: 2023, Volume and Issue: 2, P. 85 - 100

Published: June 26, 2023

Currently, cardiovascular diseases remain the leading ones in mortality among other causes. Increasingly, interventional methods are used their treatment. In postoperative period, complications form of somatogenic psychoses, including delirium, not uncommon. The purpose review is to study prevalence, pathophysiological hypotheses and mechanisms as well risk factors outcomes associated with development this complication cardiac surgery. Materials methods. Information was searched PubMed database by Key words: cognitive dysfunction, search yielded a total 57 results. During titles abstracts, 47 articles were selected for detailed consideration. Results. There three forms delirium: hyperactive, hypoactive, mixed. frequency confused mental state after heart surgery 26-52%, its hypoactive dominates. Delirium considered an acutely developing, reversible nonspecific syndrome multifactorial etiology, characterized combined disorder consciousness attention, perception, thinking, memory, sleep–wake rhythm, psychomotor disorders alternating hypo- hyperactivity. influencing onset delirium include increased inflammatory response, changes concentration neurotransmitters (especially acetylcholine), electrolyte metabolic hemodynamic disorders, presence genetic predisposition. number preoperative, intraoperative patients such adverse mortality, stroke risk, sepsis development, more frequent repeated hospitalizations persistent severe impairment during 1 year Differential diagnosis carried out depression, dementia, psychogenic psychoses organic lesions central nervous system. treatment aimed at eliminating underlying cause; it includes supportive therapy, correction agitation, elimination water-electrolyte provoking (discontinuation causal drug), replenishment nutritional deficiencies, vitamins B12 or B1 (thiamine) adequate dietary regimen fluid intake. Conclusions. Taking into consideration that dangerous condition develops following main provisions important: 1) eliminate correctable every period surgical intervention outpatient inpatient settings; 2) carry drug prevention and, if necessary, therapy; 3) increase alertness regarding occurrence episodes period; 4) conduct screening over age 65 assess development.

Language: Английский

Citations

1
Letter to Editor: Melatonin as a Cardio-Protectant: Postoperative Insights DOI
Muhammad Hamza Shafiq, Maham Jabeen, Izza Shakeel

et al.

Current Problems in Cardiology, Journal Year: 2023, Volume and Issue: 49(1), P. 102142 - 102142

Published: Oct. 18, 2023

Language: Английский

Citations

1