The Prevention and Treatment of Postoperative Delirium in the Elderly: A Narrative Systematic Review of Reviews

Journal of Patient Safety, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 29, 2025

Objectives: Postoperative delirium (POD) is a common complication after major surgeries, posing significant challenges to patient recovery and outcomes, particularly among the elderly. A narrative systematic review was conducted assess clinical effectiveness safety of interventions aimed at preventing treating POD. Methods: literature from 2017 September 29, 2023, using MEDLINE, EMBASE, CINAHL. Systematic reviews, with or without meta-analyses, as well practice guidelines, were included. Participants adults, ≥60 years. The methodological quality included reviews appraised AMSTAR 2. Results: After search strategy identified 2295 references, 36 studies selected. Multicomponent interventions, incorporating both pharmacological nonpharmacological approaches, demonstrate promise, in hip fracture patients. Notably, dexmedetomidine emerges potential preventive measure, showing notable reduction incidence following cardiac surgery. While several show potential, evidence remains inconclusive, necessitating further investigation. Similarly, varying anesthesia type monitoring methods has mixed outcomes on prevention. Despite variations appraisal limitations, this underscores importance multicomponent efficacy mitigating Integration evidence-based protocols into advocated improve outcomes. However, complex interplay between intervention components calls for research optimize management strategies. Conclusions: strength associated use should require genuine commitment health care institutions support their integration efficient strategies prevent treat Ongoing vital uncover full refine protocols, ultimately enhancing

Language: Английский

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Trifluoroacetic Acid Induced a Cyclophilin D-Dependent Cognitive Impairment in Mice

Aging and Disease, Journal Year: 2025, Volume and Issue: unknown, P. 0 - 0

Published: Jan. 1, 2025

Studies have linked inhalation anesthesia and surgery to increased cognitive impairment, particularly in the elderly. Our previous research showed that isoflurane, but not desflurane, affected function mice by modulating cyclophilin D (CypD), a key regulator of mitochondrial permeability transition pore (mPTP) function. Both anesthetics metabolize into trifluoroacetic acid (TFA), which is associated with deficits. However, specific role CypD TFA-induced dysfunction impairments unclear. This study aims explore interaction between TFA, CypD, neurons mice. TFA was administered 2-3-month-old wild-type (WT) knockout (KO) female male at 120 μg/kg primary cultured from these 10 μM. Immunofluorescence staining Western blot analyses assessed impact on levels voltage-dependent anion channel (VDAC), adenine nucleotide translocase (ANT), reactive oxygen species (ROS), caspase-3 activation neurons, along assessments The data present demonstrated following treatment. Elevated ROS were observed post-TFA exposure, alongside WT Notably, absence significantly mitigated effects. findings suggest dysfunction, activation, subsequent rely expression, hippocampus illuminates molecular pathways influenced anesthesia-related compound its

Language: Английский

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Cognitive impairment after major surgical operations

S S Korsakov Journal of Neurology and Psychiatry, Journal Year: 2025, Volume and Issue: 125(4), P. 74 - 74

Published: May 27, 2025

Objective. To study the characteristics of cognitive impairment after extensive surgical operations various profiles, to develop tactics cerebroprotection, as well personalized prevention (CI). Material and methods. The included 277 patients who underwent elective cardiac surgery (coronary bypass surgery, prosthetics aortic heart valve) oncological (for malignant neoplasms thoracic or abdominal cavities) profile. All a comprehensive clinical, laboratory, instrumental examination (including neuropsychological testing using MoCA, FAB scales) in preoperative intraoperative periods, 10 days surgery. Results. Deferred CI was diagnosed 30—36% patients, 31% patients. incidence acute clinical types postoperative cerebral dysfunction also had no statistically significant differences: perioperative stroke (2—4% 2%), symptomatic delirium early period (14—17% 11%, respectively). Postoperative brain 44% surgeries 34% oncosurgical operations. Risk factors for deferred coronary surgery: age over 65 years; stenotic atherosclerosis brachiocephalic arteries. During valve replacement, risk are: total cholesterol >5.1 mmol/L; very low-density lipoproteins >1.2 >3.2 platelet count<220×109/L; hematocrit<28%. In oncosurgery, delayed >70 years, lack work specialty; Charlson’s index comorbidity score >5 points; ASA physical status >Class III; MoCA test scores<20 points. Conclusion. Most are preoperative, which allows ahead additional assessment possibility modifying technique accompanying therapy, designing cerebroprotection impairment.

Language: Английский

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Advances in research on the pathogenesis and signaling pathways associated with postoperative delirium (Review)

Molecular Medicine Reports, Journal Year: 2025, Volume and Issue: 32(2), P. 1 - 21

Published: June 3, 2025

Postoperative delirium (POD) is a common postoperative complication, characterized by acute, transient and fluctuating declines in consciousness attention, with an incidence that increases age. POD associated various adverse outcomes, including prolonged hospital stays, higher medical costs increased morbidity mortality rates. Moreover, it has been suggested POD, as early manifestation of cognitive impairment, may serve precursor to long‑term dysfunction. Given its considerable clinical impact, the prevention management are critical importance. However, mechanisms underlying remain insufficiently understood. Current hypotheses primarily implicate neuroinflammation, oxidative stress, neurotransmitter dysregulation pathological protein changes, such β‑amyloid deposition tau hyperphosphorylation. Disruptions sleep‑wake cycle, electroencephalographic burst suppression, microbiota‑gut‑brain axis, olfactory‑brain axis genetic susceptibility also contribute occurrence. Multiple signaling pathways involved Wnt/β‑catenin, PI3K/AKT, brain‑derived neurotrophic factor/tropomyosin receptor kinase B, toll‑like NF‑κB pathways. These findings not only elucidate potential but highlight essential therapeutic targets theoretical foundations for management. due complexity multifactorial nature pathogenesis no comprehensive or widely accepted measures have yet established treatment. Both non‑pharmacological pharmacological interventions role Non‑pharmacological strategies currently prioritized, training, Hospital Elder Life Program geriatric assessment. Pharmacological include dexmedetomidine, melatonin non‑steroidal anti‑inflammatory drugs, intranasal insulin emerging promising preventive approach. Additionally, anesthesia strategies, depth monitoring, blood pressure regulation multimodal analgesia, recognized effective reducing risk POD. The present review provides overview relevant available strategies. By deepening understanding aims offer practical guidance clinicians optimizing approaches.

Language: Английский

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Comprehensive Review on Personalized Pain Assessment and Multimodal Interventions for Postoperative Recovery Optimization

Journal of Pain Research, Journal Year: 2025, Volume and Issue: Volume 18, P. 2791 - 2804

Published: June 1, 2025

Language: Английский

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