Medicinski pregled,
Год журнала:
2022,
Номер
75(3-4), С. 133 - 137
Опубликована: Янв. 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.
JTCVS Open,
Год журнала:
2022,
Номер
12, С. 118 - 136
Опубликована: Сен. 27, 2022
There
is
a
paucity
of
data
on
the
inflammatory
response
that
takes
place
in
pericardial
space
after
cardiac
surgery.
This
study
provides
comprehensive
assessment
local
postoperative
response.Forty-three
patients
underwent
cardiotomy,
where
native
fluid
was
aspirated
and
compared
with
effluent
collected
at
4,
24,
48
hours'
postcardiopulmonary
bypass.
Flow
cytometry
used
to
define
levels
proportions
specific
immune
cells.
Samples
were
also
probed
for
concentrations
cytokines,
matrix
metalloproteinases
(MMPs),
tissue
inhibitors
(TIMPs).Preoperatively,
mainly
contains
macrophages
T
However,
postsurgical
populated
predominately
by
neutrophils,
which
constituted
almost
80%
cells
present,
peaked
24
hours.
When
surgical
approaches
compared,
minimally
invasive
surgery
associated
fewer
neutrophils
4
postsurgery.
Analysis
intrapericardial
mediators
showed
interleukin-6,
MMP-9,
TIMP-1
be
highest
Over
time,
MMP-9
decreased
significantly,
whereas
increased,
resulting
significant
reduction
ratio
MMP:TIMP
surgery,
suggesting
active
processes
may
influence
extracellular
remodeling.These
results
show
elicits
profound
alterations
cell
profile
space.
Defining
cellular
molecular
drive
pericardial-specific
allow
targeted
therapies
reduce
immune-mediated
complications.
Frontiers in Cardiovascular Medicine,
Год журнала:
2022,
Номер
9
Опубликована: Май 18, 2022
Background
The
effectiveness
of
melatonin
and
its
analogs
in
preventing
postoperative
delirium
(POD)
following
cardiac
surgery
is
controversial.
purpose
this
systematic
review
meta-analysis
was
to
confirm
the
benefits
on
prevention
adults
who
underwent
surgery.
Methods
We
systematically
searched
PubMed,
Cochrane
Library,
Web
Science,
Embase,
EBSCOhost
databases,
last
search
performed
October
2021
repeated
before
publication.
controlled
studies
were
included
if
investigated
impact
POD
primary
outcome
incidence
delirium.
Stata
statistical
software
17.0
used
perform
study.
Results
This
eight
randomized
trials
(RCTs)
two
cohort
with
a
total
1,714
patients.
results
showed
that
ramelteon
administration
associated
significantly
lower
(odds
ratio
[OR],
0.46;
95%
confidence
interval
[CI],
0.29–0.74;
P
=
0.001).
subgroup
analyses
confirmed
3
mg
(OR,
0.37;
CI,
0.18–0.76;
0.007)
5
0.34;
0.21–0.56;
<
0.001)
reduced
POD.
Conclusion
Melatonin
at
dosages
considerably
decreased
risk
surgery,
according
our
results.
Cautious
interpretation
important
owing
modest
number
heterogeneity
among
them.
Systematic
Review
Registration
PROSPERO
registration
number:
CRD42021246984.
Journal of Cardiothoracic Surgery,
Год журнала:
2024,
Номер
19(1)
Опубликована: Дек. 20, 2024
Post-operative
delirium
(POD)
is
a
relatively
common
occurrence
following
surgical
procedures,
particularly
cardiac
surgeries.
Given
that
the
majority
of
pharmacologic
treatments
for
have
demonstrated
inadequate
efficacy,
it
great
importance
to
identify
risk
factors
prevent
or
reduce
its
complications.
Consequently,
in
this
systematic
review
and
meta-analysis,
we
identified
POD
after
surgery.
A
comprehensive
search
literature
was
conducted
using
databases
Scopus,
PubMed,
Web
Science
from
inception
April
22,
2024.
The
objective
prospective
cohorts
had
assessed
associated
with
patients
undergoing
surgery
multivariate
regression.
Of
3,166
studies
were
initially
screened,
23
included
review.
Nine
evaluated
including
age
(OR
1.06,
95%
CI
(1.04,
1.08),
p
<
0.001),
pre-operative
depression
3.71,
(2.45,
5.62),
post-operative
atrial
fibrillation
(AF)
2.39,
(1.79,
3.21),
hypertension
(HTN)
1.64,
(0.75,
3.56),
=
0.212),
≥
65
3.32,
(2.40,
4.60),
AF
4.43,
(2.56,
7.69),
diabetes
mellitus
2.16,
(1.39,
3.35),
combined
coronary
artery
bypass
graft
(CABG)
+
valve
2.73,
(1.66,
4.49),
cardiopulmonary
(CPB)
time
1.02,
(1.01,
1.04),
0.001).
total
nine
evaluated,
which
eight
found
statistically
significant
effect
on
developing
POD.
These
can
be
employed
more
effectively
at-risk
Furthermore,
approach
facilitate
earlier
diagnosis
effective
patient
care.
