The carbon footprint of general anaesthesia in adult patients: a multicentre observational comparison of intravenous and inhalation anaesthetic strategies in 35,242 procedures

British Journal of Anaesthesia, Год журнала: 2025, Номер unknown

Опубликована: Апрель 1, 2025

Язык: Английский

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Postoperative neurocognitive disorders: A clinical guide

Journal of Clinical Anesthesia, Год журнала: 2023, Номер 92, С. 111320 - 111320

Опубликована: Ноя. 7, 2023

Язык: Английский

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Cognitive Training for Reduction of Delirium in Patients Undergoing Cardiac Surgery

JAMA Network Open, Год журнала: 2024, Номер 7(4), С. e247361 - e247361

Опубликована: Апрель 23, 2024

IMPORTANCE Postoperative delirium is a common and impactful neuropsychiatric complication in patients undergoing coronary artery bypass grafting surgery. Cognitive training may enhance cognitive reserve, thereby reducing postoperative delirium. OBJECTIVE To determine whether preoperative reduces the incidence of grafting. DESIGN, SETTING, PARTICIPANTS This prospective, single-blind, randomized clinical trial was conducted at 3 university teaching hospitals southeastern China with enrollment between April 2022 May 2023. Eligible participants included those scheduled for elective who consented enrolled least 10 days before INTERVENTIONS Participating were randomly assigned 1:1, stratified by site, to either routine care or training, which substantial practice online tasks designed functions including memory, imagination, reasoning, reaction time, attention, processing speed. MAIN OUTCOMES AND MEASURES The primary outcome occurrence during 1 7 until hospital discharge, diagnosed using Confusion Assessment Method Intensive Care Units. Secondary outcomes dysfunction, characteristics, all-cause mortality within 30 following operation. RESULTS A total 218 208 (median [IQR] age, 66 [58-70] years; 64 female [30.8%] 144 male [69.2%]) final analysis, 102 106 care. Of all participants, 95 (45.7%) had only school education 54 (26.0%) finished high school. In group, 28 (27.5%) developed compared 46 (43.4%) Those receiving 57% less likely develop (adjusted odds ratio [aOR] 0.43; 95% CI, 0.23-0.77; P = .007). Significant differences observed severe (aOR, 0.46; 0.25-0.82; .01), median (IQR) duration (0 [0-1] vs 0 [0-2] care; .008), number delirium-positive No other secondary differed significantly. CONCLUSIONS RELEVANCE this grafting, reduced However, our analysis based on fewer than 75 events should therefore be considered exploratory basis future larger trials. Trial Registration Chinese Clinical Registry Identifier: ChiCTR2200058243

Язык: Английский

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Anaesthesia as a risk factor for long-term cognitive decline

European Journal of Anaesthesiology, Год журнала: 2025, Номер unknown

Опубликована: Фев. 18, 2025

BACKGROUND There are concerns whether (repeated) exposure to general anaesthesia is associated with long-term cognitive decline. OBJECTIVE We investigated the potential, negative relationship between total surgery under and its impact on development. DESIGN A prospective longitudinal cohort study. SETTING The Netherlands. PARTICIPANTS 1823 Adults, aged 25–84 normal functioning inclusion three serial assessments 1995 2008, comprehensive documentation demographic, lifestyle, health factors. MAIN OUTCOME MEASURES primary outcomes were test scores in domains of learning memory, executive function, selective attention, mental speed, information processing speed. Linear mixed models used analyse effects estimated time at baseline development during a 12-year follow-up period. RESULTS When adjusting for demographic systemic health-related factors, prolonged (measured minutes) negatively affected domains. These included CST (executive functioning, P < 0.05), Stroop (selective attention 0.001) LDST (information 0.005). Age education factors impacting lifetime Hypertension, diabetes, smoking various CONCLUSION Increased independently contributes Demographic variables key contributors accelerated decline over an individual's lifetime.

Язык: Английский

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Intraoperative Use of Phenylephrine versus Ephedrine and Postoperative Delirium: A Multicenter Retrospective Cohort Study

Anesthesiology, Год журнала: 2023, Номер 140(4), С. 657 - 667

Опубликована: Сен. 19, 2023

Background The treatment of intraoperative hypotension with phenylephrine may impair cerebral perfusion through vasoconstriction, which has been linked to postoperative delirium. hypothesis was that administration phenylephrine, compared ephedrine, is associated higher odds Methods A total 103,094 hospitalized adults undergoing general anesthesia for noncardiac, non-neurosurgical procedures between 2008 and 2020 at two tertiary academic healthcare networks in Massachusetts were included this multicenter hospital registry study. primary exposure the versus ephedrine during surgery, outcome delirium within 7 days. Multivariable logistic regression analyses adjusted a priori defined confounding variables including patient demographics, comorbidities, procedural factors magnitude applied. Results Between networks, 78,982 (76.6%) patients received 24,112 (23.4%) surgery; 770 (0.8%) developed median (interquartile range) dose 1.0 (0.2 3.3) mg 10.0 (10.0 20.0) ephedrine. In analyses, developing days (adjusted ratio, 1.35; 95% CI, 1.06 1.71; absolute risk difference, 0.2%; 0.1 0.3%; P = 0.015). keyword manual chart review–based approach subset 45,465 further validated these findings (delirium incidence, 3.2%; 1.88; 1.49 2.37; &lt; 0.001). Fractional polynomial analysis indicated dose-dependent effect coefficient, 0.08; 0.02 0.14; 0.013, per each μg/kg increase cumulative dose). Conclusions Based on data, clinical trials are warranted determine whether favoring over can reduce after surgery. Editor’s Perspective What We Already Know about This Topic Article Tells Us That Is New

Язык: Английский

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Influence of different anesthetic depth on postoperative delirium in elderly pre-frail patients undergoing abdominal surgery

Research Square (Research Square), Год журнала: 2025, Номер unknown

Опубликована: Фев. 11, 2025

Purpose Monitoring anesthetic depth may reduce the incidence of postoperative delirium in patients undergoing general anesthesia. This study investigated impact varying readings Cerebral State Index (CSI) on elderly pre-frail abdominal surgery. Methods A total 150 aged over 65 years scheduled for selective surgery under anesthesia were enrolled. Pre-frailty was defined as a 5-Item Modified Frailty (mFI-5) score 1–2. Patients light (LA) group maintained CSI value between 50–59, while deep (DA) 40–49. The within three days postoperatively, well visual analog scale (VAS) scores, nausea, vomiting, and 15-item quality recovery (QoR-15) scores first day recorded compared. Results approximately 14% lower compared to (P < 0.05). QoR-15 significantly higher than In contrast, VAS following Conclusion (with high score) have better outcome. Trial registration: ChiCTR2400083016, Date 15/04/2025.

Язык: Английский

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Functional MRI-based machine learning strategy for prediction of postoperative delirium in cardiac surgery patients: A secondary analysis of a prospective observational study

Journal of Clinical Anesthesia, Год журнала: 2025, Номер 102, С. 111771 - 111771

Опубликована: Фев. 13, 2025

Язык: Английский

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The Relationship Between the Average Infusion Rate of Propofol and the Incidence of Delirium During Invasive Mechanical Ventilation: A Retrospective Study Based on the MIMICIV Database

CNS Neuroscience & Therapeutics, Год журнала: 2025, Номер 31(3)

Опубликована: Фев. 28, 2025

ABSTRACT Background Delirium is a common complication observed in intensive care units (ICUs). Propofol one of the most widely used sedatives and believed to be closely connected with incidence delirium. The study was carried out explore relationship between delirium average rate propofol infusion. Methods Patients who underwent invasive mechanical ventilation (IMV) while receiving from Medical Information Mart for Intensive Care IV (MIMIC IV) database were included study. primary outcome identify potential risk factors investigate infusion secondary further analyze by subgroup analysis. Propensity score matching (PSM) employed minimize bias. Results A total 16,956 patients (delirium: 5805; control: 11,151) ultimately after PSM. median diagnostic time 18 h. An ≥ 20 μg/(kg*h) during initial h found independently significant [OR = 1.84, 95% CI (1.72, 1.98), p < 0.001], an ≤ 40 first hour showed no statistically difference 0.95, (0.88, 1.02), 0.163]. Besides, also all analyses. Conclusion identified as independent factor delirium, suggesting that accumulation might associated increased

Язык: Английский

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The effect of perioperative cognitive training on postoperative delirium in older patients undergoing total hip and knee arthroplasty: a prospective randomised trial

Age and Ageing, Год журнала: 2025, Номер 54(3)

Опубликована: Март 1, 2025

Abstract Objective This study investigated whether cognitive training (CT) ameliorates postoperative delirium (POD) in older patients undergoing total hip and knee arthroplasty. Methods clinical trial was conducted from 18 February to 10 July 2023 included individuals aged 60–79 who underwent elective arthroplasties with surgery durations ≤3 hours under general anaesthesia. Patients preoperative dysfunction dementia were excluded. The incidence of POD compared between the CT routine care (RC) groups as primary outcome. Secondary outcomes adverse events, pain within 48 hours, characteristics. Results In this study, 122 divided into two groups. overall 8.2% (10 out 122), no significant difference (9.8% for group vs. 6.6% RC group; P = .509). also showed time less, compliance rate poor (4.0%). Nonetheless, results revealed a rates among subgroups, robust correlation identified sessions lasting less than median duration 12 minutes (P .043). Conclusion or arthroplasty may not be mitigated by CT. As exclusively observed fewer sessions, it suggests that compliance-recommended contribute POD.

Язык: Английский

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Alpha-lipoic acid alleviates oxidative stress and brain damage in patients with sevoflurane anesthesia

Frontiers in Pharmacology, Год журнала: 2025, Номер 16

Опубликована: Март 20, 2025

Sevoflurane, the most commonly used inhalational anesthetic, may negatively impact brain by inducing oxidative stress. This study investigated potential protective role of alpha-lipoic acid (ALA) in mitigating sevoflurane-induced stress and damage. A total 155 patients undergoing sevoflurane anesthesia for liver resection surgery were randomly assigned to receive either ALA or a placebo. Perioperative internal jugular venous blood samples collected measure markers (8-OHdG, sORP, cORP) injury biomarkers (S100β UCH-L1). Postoperative cognitive function was also evaluated. The results demonstrated that, compared placebo group, group exhibited significant reduction 8-OHdG levels 0.007 nmol/L (95% CI, −0.011 −0.003; P = 0.03) 24 h after surgery, accompanied lower sORP higher cORP levels. Furthermore, postoperative S100β UCH-L1 significantly than (S100β, 0.02; UCH-L1, 0.03). Additionally, correlated with damage surgery. Our findings suggest that reduces damage, while improving function, indicating its neuroprotective effect. Clinical Trial Registration: https://www.chictr.org.cn/ , identifier ChiCTR2300077321.

Язык: Английский

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