Science China Life Sciences, Год журнала: 2025, Номер unknown
Опубликована: Янв. 22, 2025
Язык: Английский
CNS Neuroscience & Therapeutics, Год журнала: 2022, Номер 28(8), С. 1147 - 1167
Опубликована: Июнь 1, 2022
Abstract Perioperative neurocognitive disorders (NCDs) refer to abnormalities detected during the perioperative periods, including preexisting cognitive impairment, preoperative delirium, delirium occurring up 7 days after surgery, delayed recovery, and postoperative NCD. The Diagnostic Statistical Manual of Mental Disorders‐5th edition (DSM‐5) is golden standard for diagnosing NCDs. Given impracticality using DSM‐5 by non‐psychiatric practitioners, many diagnostic tools have been developed validated different clinical scenarios. etiology NCDs multifactorial includes predisposing precipitating factors. Identifying these risk factors conducive stratification reduction. Prevention should include avoiding possible contributors implementing nonpharmacologic pharmacological interventions. former generally benzodiazepines, anticholinergics, prolonged liquid fasting, deep anesthesia, cerebral oxygen desaturation, intraoperative hypothermia. Nonpharmacologic measures prehabilitation, comprehensive geriatric assessment, fast‐track combined use regional block, sleep promotion. Pharmacological dexmedetomidine, nonsteroidal anti‐inflammatory drugs, acetaminophen are found beneficial effects. Nonpharmacological treatments first‐line established still limited severely agitated or distressed patients.
Язык: Английский
Процитировано
91
British Journal of Anaesthesia, Год журнала: 2023, Номер 131(2), С. 253 - 265
Опубликована: Июнь 4, 2023
Delirium is a common and disturbing postoperative complication that might be ameliorated by propofol-based anaesthesia. We therefore tested the primary hypothesis there less delirium after than sevoflurane-based anaesthesia within 7 days of major cancer surgery.This multicentre randomised trial was conducted in 14 tertiary care hospitals China. Patients aged 65-90 yr undergoing surgery were to either or The endpoint incidence days.A total 1228 subjects enrolled randomised, with 1195 included modified intention-to-treat analysis (mean age 71 yr; 422 [35%] women); one subject died before assessment. occurred 8.4% (50/597) given vs 12.4% (74/597) (relative risk 0.68 [95% confidence interval {CI}: 0.48-0.95]; P=0.023; adjusted relative 0.59 CI: 0.39-0.90]; P=0.014). reduction mainly on first day surgery, prevalence 5.4% (32/597) propofol 10.7% (64/597) sevoflurane 0.50 0.33-0.75]; P=0.001). Secondary endpoints, including ICU admission, duration hospitalisation, complications 30 days, cognitive function at 3 yr, safety outcomes, did not differ significantly between groups.Delirium third older patients having surgery. Clinicians reasonably select high delirium.Chinese Clinical Trial Registry (ChiCTR-IPR-15006209) ClinicalTrials.gov (NCT02662257).
Язык: Английский
Процитировано
43
Journal of Clinical Anesthesia, Год журнала: 2023, Номер 92, С. 111320 - 111320
Опубликована: Ноя. 7, 2023
Язык: Английский
Процитировано
37
World Neurosurgery, Год журнала: 2025, Номер 194, С. 123570 - 123570
Опубликована: Янв. 23, 2025
Perioperative neurocognitive disorders (PND) are common perioperative complications associated with various poor outcomes. Regional cerebral oxygen saturation (rSO2) monitoring is a non-invasive technique based on near-infrared spectroscopy detection. Due to the considerable controversy among currently published studies application of intraoperative rSO2 in adult patients undergoing elective non-cardiac surgery, this study aims conduct systematic review and meta-analysis provide more comprehensive robust evidence support clinical decision-making. This conducted literature search databases including PubMed, Embase, CENTRAL, Web Science, from their inception May 1, 2024. The eligible randomized controlled trials included surgery under general anesthesia who received optimized management guided by those control group routine standard or blinded monitoring. primary outcomes were incidence PND, postoperative delirium (POD) cognitive dysfunction (POCD), Mini-Mental State Examination (MMSE) scores. Secondary desaturation length hospital stay (LOS). pooled results showed that compared group, significantly reduced POCD within 7 days postoperatively may reduce at 3 months longer periods postoperatively. However, it not POD postoperatively, improve MMSE scores, desaturation, shorten LOS. Given substantial heterogeneity for scores LOS, limited number reporting POD, POCD, after related should be interpreted caution. Despite presence inclusion some outcomes, still recommended anesthesiologists routinely perform optimize maximize perfusion, thereby improving patients' Further large-scale high-quality needed confirm conclusions study.
Язык: Английский
Процитировано
1
Journal of Patient Safety, Год журнала: 2025, Номер unknown
Опубликована: Янв. 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
Язык: Английский
Процитировано
1
CNS Neuroscience & Therapeutics, Год журнала: 2022, Номер 29(1), С. 158 - 167
Опубликована: Окт. 11, 2022
Abstract Aims To compare the performance of logistic regression and machine learning methods in predicting postoperative delirium (POD) elderly patients. Method This was a retrospective study perioperative medical data from patients undergoing non‐cardiac non‐neurology surgery over 65 years old January 2014 to August 2019. Forty‐six variables were used predict POD. A traditional five models (Random Forest, GBM, AdaBoost, XGBoost, stacking ensemble model) compared by area under receiver operating characteristic curve (AUC‐ROC), sensitivity, specificity, precision. Results In total, 29,756 enrolled, incidence POD 3.22% after variable screening. AUCs 0.783 (0.765–0.8) for method, 0.78 random forest, 0.76 0.74 0.73 0.77 model. The respective sensitivities 6 aforementioned 74.2%, 72.2%, 76.8%, 63.6%, 71.6%, 67.4%. specificities 70.7%, 99.8%, 96.5%, 98.8%, 96.1%. precision values 7.8%, 52.3%, 55.6%, 57%, 54.5%, 56.4%. Conclusions optimal application model could provide quick convenient risk identification help improve management surgical because its better fewer variables, easier interpretability than
Язык: Английский
Процитировано
33
CNS Neuroscience & Therapeutics, Год журнала: 2023, Номер 30(2)
Опубликована: Июль 5, 2023
Abstract Aims The aims of the study were to determine relationship between preoperative geriatric nutritional risk index (GNRI) and occurrence postoperative delirium (POD) in elderly patients after cardiac surgery evaluate additive value GNRI for predicting POD. Methods data extracted from Multiparameter Intelligent Monitoring Intensive Care (MIMIC‐IV) database. Patients who underwent aged 65 or older included. POD was investigated using logistic regression. We determined added predictive by measuring changes area under receiver operating characteristic curve (AUC) calculating net reclassification improvement (NRI) integrated discrimination (IDI). Results A total 4286 included study, 659 (16.1%) developed with had significantly lower scores than without (median 111.1 vs. 113.4, p < 0.001). Malnourished (GNRI ≤ 98) a higher (odds ratio, 1.83, 90% CI, 1.42–2.34, 0.001) those malnutrition > 98). This correlation remains adjusting confounding variables. addition multivariable models slightly but not increases AUCs (all 0.05). Incorporating NRIs some IDIs all Conclusions Our results showed negative association undergoing surgery. prediction may improve their accuracy. However, these findings based on single‐center cohort will need be validated future studies involving multiple centers.
Язык: Английский
Процитировано
20
Frontiers in Neurology, Год журнала: 2024, Номер 14
Опубликована: Янв. 8, 2024
Postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) are common post-surgical complications that often lead to prolonged hospitalization, reduced quality of life, increased healthcare costs, patient mortality. We conducted a meta-analysis evaluate the effects preoperative function training on function.
Язык: Английский
Процитировано
8
Brain Research Bulletin, Год журнала: 2024, Номер 211, С. 110945 - 110945
Опубликована: Апрель 10, 2024
Sleep fragmentation (SF) is a common sleep problem experienced during the perioperative period by older adults, and associated with postoperative cognitive dysfunction (POCD). Increasing evidence indicates that delta-wave activity non-rapid eye movement (NREM) involved in sleep-dependent memory consolidation hippocampal theta oscillations are related to spatial exploratory memory. Recovery (RS), self-regulated state of homeostasis, enhances power performance sleep-deprived mice. However, it remains unclear whether RS therapy has positive effect on changes following SF mouse models. Therefore, this study aimed explore preoperative can alleviate deficits aged mice SF. A model 24-h combined laparotomy-induced POCD was established 18-month-old Aged were treated 6-h surgery, respectively. The hippocampus-dependent function investigated using behavioral tests, electroencephalography (EEG), local field potential (LFP), magnetic resonance imaging, neuromorphology. Mice underwent surgery exhibited severe impairment; impaired could be alleviated treatment. In addition, increased NREM sleep; enhanced EEG LFP oscillation CA1; improved perfusion, microstructural integrity, neuronal damage. Taken together, these results provide may ameliorate severity aggravated enhancing delta slow-wave oscillation, ameliorating reduction regional cerebral blood flow white matter microstructure integrity hippocampus.
Язык: Английский
Процитировано
6
Journal of Clinical Anesthesia, Год журнала: 2024, Номер 98, С. 111573 - 111573
Опубликована: Авг. 2, 2024
Язык: Английский
Процитировано
6