Lower Incidence Of Postoperative Delirium Research Articles

Effect of Optimizing Regional Cerebral Oxygen Saturation during Infant Cardiac Surgery on the Incidence of Postoperative Delirium: A Retrospective Study.

To investigate the effect of optimizing regional cerebral oxygen saturation (rScO2) on the incidence of postoperative delirium and surgical outcome in infants with congenital heart disease. Sixty-one infants experienced desaturation in rScO2 of 10% from baseline for more than 30 seconds during surgery between January 2020 and January 2022. Among them, 32 cases (Group A) received the corresponding treatment in the process of desaturation and 29 cases (Group B) were observed without receiving any treatment. General information, cerebral oxygen saturation, the incidence of postoperative delirium, and other relevant clinical data were collected. The duration and severity of intraoperative rScO2 desaturation in Group A were significantly lower than those in Group B. The incidence of postoperative delirium in Group A was significantly lower than that in Group B. There was no significant difference in the positive screening score for delirium between the two groups. Binary logistic regression analysis showed that the aortic cross-clamp time, mechanical ventilation duration, and severity of intraoperative rScO2 desaturation were significantly correlated with the occurrence of postoperative delirium. Aggressive rScO2 desaturation treatment is associated with a lower incidence of postoperative delirium and improved surgical outcomes.

Effect of Different Administration Routes of Dexmedetomidine on Postoperative Delirium in Elderly Patients Undergoing Elective Spinal Surgery: A Prospective Randomized Double-Blinded Controlled Trial.

Intravenous dexmedetomidine has been reported to decrease the occurrence of postoperative delirium (POD) in elderly patients. Nevertheless, some previous studies have indicated that intratracheal dexmedetomidine and intranasal dexmedetomidine are also effective and convenient. The current study aimed to compare the effect of different administration routes of dexmedetomidine on POD in elderly patients. We randomly allocated 150 patients (aged 60 years or more) scheduled for spinal surgery to receive intravenous dexmedetomidine (0.6 μg/kg), intranasal dexmedetomidine (1 μg/kg) before anesthesia induction, or intratracheal dexmedetomidine (0.6 µg/kg) after anesthesia induction. The primary outcome was the frequency of delirium during the first 3 postoperative days. The secondary outcomes were the incidence of postoperative sore throat (POST) and sleep quality. Adverse events were recorded, and routine treatment was performed. Compared with the intranasal group, the intravenous group had a significantly lower occurrence of POD within 3 days (3 of 49 [6.1%] vs 14 of 50 [28.0%]; odds ratio [OR], 0.17; 95% confidence intervals [CIs], 0.05-0.63; P < .017). Meanwhile, patients in the intratracheal group had a lower incidence of POD than those in the intranasal group (5 of 49 [10.2%] vs 14 of 50 [28.0%]; OR, 0.29; 95% CI, 0.10-0.89; P < .017). Whereas, there was no difference between the intratracheal and intravenous groups (5 of 49 [10.2%] vs 3 of 49 [6.1%]; OR, 1.74; 95% CI, 0.40-7.73; P > .017). The rate of POST was lower in the intratracheal group than that in the other 2 groups at 2 hours after surgery (7 of 49 [14.3%] vs 12 of 49 [24.5%] vs 18 of 50 [36.0%], P < .017, respectively). Intravenous dexmedetomidine had the lowest Pittsburgh Sleep Quality Index score on the second morning after surgery (median [interquartile range {IQR}]: 4 [3-5] vs 6 [4-7] vs 6 [4-7], P < .017, respectively). Compared with the intranasal group, the intravenous group had a higher rate of bradycardia and a lower incidence of postoperative nausea and vomiting (P < .017). The intranasal group was associated with the highest incidence of hypertension (P < .017). For patients aged ≥60 years undergoing spinal surgery, compared with the intranasal route of dexmedetomidine, intravenous and intratracheal dexmedetomidine reduced the incidence of early POD. Meanwhile, intravenous dexmedetomidine was associated with better sleep quality after surgery, and intratracheal dexmedetomidine resulted in a lower incidence of POST. Adverse events were mild in all 3 administration routes of dexmedetomidine.

Transcutaneous Electrical Acupoint Stimulation for Preventing Postoperative Delirium: A Meta-Analysis.

This meta-analysis of randomized controlled trials (RCTs) aims to evaluate the efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) for postoperative delirium (POD) in surgical patients. Based on database searches of the Wanfang, China National Knowledge Infrastructure (CNKI), VIP, Chinese Biology Medicine (CBM), PubMed, Cochrane Library, and Web of Science, relevant RCTs published before December 30, 2022, were extracted. Outcome indicators included the incidence of POD, changes in Confusion Assessment Method (CAM) scores, Visual Analogue Scale (VAS) scores, and the intraoperative consumption of anesthetics. Data were pooled and analyzed by Review Manager 5.3, and publication bias detection was conducted using Stata 17.0. A meta-analysis containing 715 experimental and 717 control participants from 12 RCTs was performed. The overall results showed that TEAS had obvious superiority with a lower incidence of POD on any day during the postoperative 1 week. In subgroup analyses, the CAM scores on the third postoperative day were significantly lower in the TEAS group than in the control group (MD = -0.52, 95% CI: -1.02 to -0.03, P = 0.04), the VAS scores on the first postoperative day were significantly lower in the TEAS group than in the control group (MD = -0.19, 95% CI: -0.36 to -0.02, P = 0.03), the consumption of propofol and remifentanil were both significantly lower in the TEAS group compared with the control group (MD = -23.1, 95% CI: -37.27 to -8.94, P = 0.001; MD = -105.69, 95% CI: -174.20 to -37.19, P = 0.002). No serious adverse events of TEAS were reported in any of the referenced studies. TEAS has an obvious curative effect in preventing POD and pain in the earlier stage of surgical patients. It could be a promising assisted anesthesia technique in the future.

Dexmedetomidine adjunct to ropivacaine for ultrasound-guided transversus abdominis plane block for open inguinal hernia repair in the older adults: A randomised clinical trial.

The aim of this study was to evaluate the effect of adding dexmedetomidine to ropivacaine on pain relief and quality of recovery in older patients undergoing open inguinal hernia repair surgeries. This was a prospective and randomised clinical trial of 102 patients aged over 65 years who received an ultrasound-guided transversus open mesh herniorrhaphy abdominis plane (TAP) block with either 0.375% ropivacaine 20 ml (Group R, n = 47) or 0.375% ropivacaine combined with 1 μg/kg dexmedetomidine 20 ml (Group RD, n = 45) in the pre-anaesthesia care unit before elective open inguinal hernia surgeries. The primary outcome measure was Visual Analogue Scale (VAS) pain scores at rest and on movement at 2, 4, 8, 12 and 24 h and at 1 and 3 months' postoperatively. The secondary outcome measures were the incidence of post-operative delirium (POD), nausea and vomiting and the occurrence of side effects or complications on post-operative day 1. Group RD had lower VAS scores at rest and on movement at 8 and 12 h postoperatively and a lower incidence of POD on the post-operative day 1 than Group R. Transient bradycardia was more frequent in Group RD than in Group R, and side effects or post-operative complications were reported in either group. The addition of dexmedetomidine to ropivacaine in a TAP block enhances postoperative analgesia during hospitalisation and improves the quality of recovery without affecting chronic pain in older patients undergoing open inguinal hernia repair surgery.

Pretransplant physical frailty, postoperative delirium, and short-term outcomes among older lung transplant recipients.

Delirium is a common, complex medical challenge that faces surgical patients in the postoperative period. Patients undergoing lung transplantation are at especially high risk given their predisposition to physical frailty and prolonged hospitalization. We sought to investigate the relationship between physical frailty, delirium, and short-term lung transplantation outcomes. A retrospective study of adult patients who underwent lung transplantation was conducted. Pretransplant frailty markers, including the six-minute walk distance (6MWD) and short physical performance battery (SPPB), and postoperative outcomes, including the incidence of primary graft dysfunction (PGD) and the number of hospital free days alive in the 90-day interval following lung transplantation, were evaluated for association with delirium. A total of 100 patients were included, 38% of whom experienced delirium. Greater pretransplant SPPB scores (indicating lower physical frailty) associated with a lower incidence of postoperative delirium. Postoperative delirium also associated with the number of hospital free days alive, independent of PGD. Pretransplant frailty is associated with greater incidence of postoperative delirium, which associated with fewer days alive outside of the hospital. Targeting frailty and postoperative delirium may be modifiable risk factors to improve short-term clinical outcomes.

Effect of Programmed Comprehensive Nursing for Postoperative Delirium in Intensive Care Unit Patients.

Background This study is to evaluate the effect of programmed comprehensive nursing for postoperative delirium in intensive care unit (ICU) patients. Methods A total of 90 cases of ICU surgery patients admitted to our hospital from July 2019 to July 2020 were recruited and assigned via the random number table method (1 : 1) to receive either conventional nursing (control group) or programmed comprehensive nursing (experimental group). The delirium assessment method was used to record the incidence of delirium events at different time points after the intervention. Outcome measures included delirium events, the Visual Analogue Scale (VAS) scores, the Pittsburgh sleep quality index (PSQI) scores, the activities of daily living (ADL) scale scores, nursing satisfaction, and total nursing efficiency. Results Programmed comprehensive nursing was associated with significantly better nursing satisfaction, ADL scores, VAS scores, PSQI scores, and nursing efficiency than conventional nursing (all P < 0.05). Programmed comprehensive nursing resulted in a significantly lower incidence of postoperative delirium than conventional nursing (P < 0.05). Conclusion The application of programmed comprehensive nursing for postoperative delirium in ICU patients shows a promising efficiency, effectively alleviates the clinical symptoms of patients, and optimizes various clinical indicators of patients; hence, it is worthy of further application and promotion.

Effect of general anesthesia with thoracic paravertebral block on postoperative delirium in elderly patients undergoing thoracoscopic lobectomy: a randomized-controlled trial

BackgroundPostoperative delirium (POD) is characterized by acute brain dysfunction, especially in elderly patients. Postoperative pain is an important factor in the development of delirium, and effective pain management can reduce the risk of POD. Thoracic paravertebral block (TPVB) can effectively relieve postoperative pain and inhibit the perioperative stress and inflammatory response. We investigated whether the combination of TPVB with general anesthesia reduced the occurrence of POD following thoracoscopic lobectomy.MethodsA total of 338 elderly patients, aged 65–80 years, who underwent elective surgery for video-assisted thoracoscopic lobectomy (VATS) were randomly assigned to either a patient-controlled intravenous analgesia group (PIA) or a patient-controlled paravertebral-block analgesia group (PBA). POD was evaluated using the 3-min diagnostic confusion assessment method (3D-CAM). The postoperative quality of recovery (QoR) was assessed with Chinese version of QoR-40 scale. Pain intensity was measured using the visual analog scale (VAS) score. Tumor necrosis factor-α (TNF-α) and neurofilament light (NFL) levels were determined using enzyme-linked immunosorbent assay (ELISA) kits.ResultsDelirium occurred in 47 (28%) of 168 cases in the PIA group and 28 (16.5%) of 170 cases in the PBA group (RR 1.7, p = 0.03). PBA was also associated with a higher rate of overall recovery quality at day 7 after surgery (27.1% vs. 17.3%, P = 0.013) compared with PIA. The incremental change in surgery-induced TNF-α and NFL was greater in the PIA group than PBA group (p < 0.05).ConclusionThoracic paravertebral block analgesia is associated with lower incidence of postoperative delirium, probably due to its anti-neuroinflammatory effects. Furthermore, as a component of multimodal analgesia, TPVB provides not only superior analgesic but also opioid-sparing effects.Trial registrationThe study was registered on the Chinese Clinical Trial Registry Center (www.chictr.org.cn; registration number: ChiCTR 2,000,033,238) on 25/05/2018.

Prevention of postoperative delirium after cardiovascular surgery: A team-based approach

ObjectiveWe investigated the efficacy of the Delirium Team Approach program for delirium prevention after cardiovascular surgery. MethodsWe retrospectively investigated 256 patients who underwent cardiac or thoracic vascular surgery between May 2017 and May 2020. We compared the outcomes before and after implementation of the Delirium Team Approach program in December 2018. The program included the following components: (a) educational sessions for the medical team regarding delirium and its management, (b) review of preprinted physician orders for insomnia and agitation, and (c) routine screening for delirium. We investigated the early outcomes and effects of the Delirium Team Approach program on postoperative delirium. ResultsThe incidence of postoperative delirium significantly decreased from 53.3% to 37.0% after implementation of the Delirium Team Approach program (P = .008). Although no intergroup differences were observed in the rates of stroke and reexploration for bleeding, the length of intensive care unit stay and the overall length of postoperative hospital stay were shorter in the postintervention group. Hospital costs, excluding surgery, and the cost during intensive care unit stay were lower in the postintervention group. Multivariable analysis showed that the Delirium Team Approach program was associated with a reduction in postoperative delirium (odds ratio, 0.38; 95% confidence interval, 0.21-0.67; P = .001). Other predictors of delirium included age, dementia, chronic kidney disease, and intubation time. After risk adjustment using propensity score matching, the rate of postoperative delirium was lower in the postintervention group. ConclusionsImplementation of the Delirium Team Approach program was associated with a lower incidence of postoperative delirium in patients who underwent cardiovascular surgery.

The effect of peri-operative dexmedetomidine on the incidence of postoperative delirium in cardiac and non-cardiac surgical patients: a randomised, double-blind placebo-controlled trial.

Delirium occurs commonly following major non-cardiac and cardiac surgery and is associated with: postoperative mortality; postoperative neurocognitive dysfunction; increased length of hospital stay; and major postoperative complications and morbidity. The aim of this study was to investigate the effect of peri-operative administration of dexmedetomidine on the incidence of postoperative delirium in non-cardiac and cardiac surgical patients. In this randomised, double-blind placebo-controlled trial we included 63 patients aged≥60years undergoing major open abdominal surgery or coronary artery bypass graft surgery with cardiopulmonary bypass. The primary outcome was the incidence of postoperative delirium, as screened for with the Confusion Assessment Method. Delirium assessment was performed twice daily until postoperative day 5, at the time of discharge from hospital or until postoperative day 14. We found that dexmedetomidine was associated with a reduced incidence of postoperative delirium within the first 5 postoperative days, 43.8% vs. 17.9%, p=0.038. Severity of delirium, screened with the Intensive Care Delirium Screening Checklist, was comparable in both groups, with a mean maximum score of 1.54 vs. 1.68, p=0.767. No patients in the dexmedetomidine group died while five (15.6%) patients in the placebo group died, p=0.029. For patients aged≥60years undergoing major cardiac or non-cardiac surgery, we conclude that the peri-operative administration of dexmedetomidine is associated with a lower incidence of postoperative delirium.

The Effects of Propofol or Dexmedetomidine Sedation on Postoperative Recovery in Elderly Patients Receiving Lower Limb Surgery under Spinal Anesthesia: A Retrospective Propensity Score-Matched Analysis.

Propofol and dexmedetomidine are the two most popular intravenous sedatives during anesthesia. However, data comparing the effects of these two sedatives during spinal anesthesia on postoperative recovery are still insufficient. We retrospectively analyzed the medical records of patients aged ≥65 years who underwent orthopedic surgery under spinal anesthesia between March 2012 and February 2017. The patients were allocated into two groups according to the intraoperative sedatives: the propofol group and dexmedetomidine group. We analyzed the incidence of postoperative delirium, analgesic requirement, and rescue anti-emetic treatment. A total of 1045 patients were included in the analysis. After propensity score matching with the propofol group, the dexmedetomidine group showed a lower incidence of postoperative delirium (odds ratio, 0.19; 95% CI, 0.07–0.56; p = 0.011). Postoperative analgesic and anti-emetic requirement were not significantly different between the two groups (p = 0.156 and 0.245, respectively). Multivariate logistic regression analysis revealed that intraoperative sedation, age, preoperative albumin level, and hip surgery were significantly associated with the incidence of postoperative delirium. This study showed that intraoperative dexmedetomidine sedation under spinal anesthesia during lower limb surgery is associated with a lower incidence of postoperative delirium compared with propofol sedation.

Mannitol Is Associated with Less Postoperative Delirium after Aortic Valve Surgery in Patients Treated with Bretschneider Cardioplegia.

Background Heart surgery with extracorporeal circulation (ECC) often leads to postoperative delirium (POD). This is associated with increased morbidity resulting in longer hospital stay and associated costs. The purpose of our study was to analyze the effect of intraoperative mannitol application on POD in patients undergoing elective aortic valve replacement (AVR). Materials and Method s In our retrospective single-center study, 259 patients underwent elective AVR, using Bretschneider cardioplegic solution for cardiac arrest, between 2014 and 2017. Patients were divided in mannitol ( n = 188) and nonmannitol ( n = 71) groups. POD was assessed using the confusion assessment method for the intensive care unit (ICU). Statistical significance was assumed at p < 0.05. Results Baseline patient characteristics did not differ between the groups. Incidence of POD was significantly higher in the nonmannitol group (33.8 vs. 13.8%; p = 0.001). These patients required longer ventilation time (24.1 vs. 17.1 hours; p = 0.021), higher reintubation rate (11.3 vs. 2.7%; p = 0.009), ICU readmission (12.7 vs. 4.8%; p = 0.026), prolonged ICU (112 vs. 70 hours; p = 0.040), and hospital stay (17.8 vs. 12.6 days; p < 0.001), leading to higher expenses (19,349 € vs. 16,606 €, p < 0.001). A 30-day mortality was not affected, but nonmannitol group showed higher Simplified Acute Physiology Score II score (32.2 vs. 28.7; p < 0.001). Mannitol substitution was independently associated with lower incidence of POD (odds ratio: 0.40; 95% confidence interval: 0.18–0.89; p = 0.02). Conclusion Treatment with mannitol during ECC was associated with decreased incidence of POD. This was accompanied by shorter ventilation time, ICU and hospital stay, and lower treatment expenses.

THE EFFICACY OF DEXMEDETOMIDINE, PROPOFOL AND KETAMINE IN ELDERLY PATIENT UNDERGOING SPINAL ANESTHESIA FOR PREVENTION OF POST-OPERATIVE DELIRIUM

Background: Post-operative delirium in elderly patient needed to operative procedures is a risk factor to deteriorate outcomes of this patient. The prevalence of post-operative delirium ranges from 10% to 37% in elderly patient undergoing anesthesia especially in those receiving general anesthesia and is related to poor function recovery, increasing length of stay in hospital, increasing the frequency of early post-operative cognitive dysfunction (POCD) and morbidity. Objective: to compare the efficacy of dexmedetomidine, propofol, and ketamine in elderly patients undergoing spinal anesthesia for prevention of post-operative delirium. Patients and Methods: A prospective, randomized controlled study was conducted on 60 patients of both genders, aged 60 -75 years, with ASA physical status I, II and III, scheduled for elective surgery in the lower abdomen and lower limb undergoing spinal anesthesia from March 2019 to March 2020 at Al-Azhar University Hospital (Damietta). They were randomized into three equal groups: Group I received premedication dexmedetomidine (1 μg/kg), given slowly intravenously over 10 minutes, Group II received intravenous propofol (0.5 mg/kg), and Group III received intravenous ketamine (0.5 mg./kg). The primary endpoint was the incidence of post-operative delirium (POD), which was assessed using confusion assessment method (CAM) from the first postoperative day to the third postoperative day. Results: Dexmedetomidine group has a lower incidence of postoperative delirium than propofol group without statistical significant difference, while ketamine group has high incidence of postoperative delirium with statistical significant difference than other two groups numbering from statistics. Conclusion: Dexmedetomidine group was associated with a lower incidence of POD than propofol group, while ketamine group was associated with a high incidence of POD than other two groups and thus resulting in better short recovery, short hospital stay, and thus decreasing health care cost and morbidity.

THE EFFICACY OF DEXMEDETOMIDINE, PROPOFOL AND KETAMINE IN ELDERLY PATIENT UNDERGOING SPINAL ANESTHESIA FOR PREVENTION OF POST-OPERATIVE DELIRIUM

Background: Post-operative delirium in elderly patient needed to operative procedures is a risk factor to deteriorate outcomes of this patient. The prevalence of post-operative delirium ranges from 10% to 37% in elderly patient undergoing anesthesia especially in those receiving general anesthesia and is related to poor function recovery, increasing length of stay in hospital, increasing the frequency of early post-operative cognitive dysfunction (POCD) and morbidity. Objective: to compare the efficacy of dexmedetomidine, propofol, and ketamine in elderly patients undergoing spinal anesthesia for prevention of post-operative delirium. Patients and Methods: A prospective, randomized controlled study was conducted on 60 patients of both genders, aged 60 -75 years, with ASA physical status I, II and III, scheduled for elective surgery in the lower abdomen and lower limb undergoing spinal anesthesia from March 2019 to March 2020 at Al-Azhar University Hospital (Damietta). They were randomized into three equal groups: Group I received premedication dexmedetomidine (1 μg/kg), given slowly intravenously over 10 minutes, Group II received intravenous propofol (0.5 mg/kg), and Group III received intravenous ketamine (0.5 mg./kg). The primary endpoint was the incidence of post-operative delirium (POD), which was assessed using confusion assessment method (CAM) from the first postoperative day to the third postoperative day. Results: Dexmedetomidine group has a lower incidence of postoperative delirium than propofol group without statistical significant difference, while ketamine group has high incidence of postoperative delirium with statistical significant difference than other two groups numbering from statistics. Conclusion: Dexmedetomidine group was associated with a lower incidence of POD than propofol group, while ketamine group was associated with a high incidence of POD than other two groups and thus resulting in better short recovery, short hospital stay, and thus decreasing health care cost and morbidity.

The effects of multimedia education on postoperative delirium in patients undergoing coronary artery bypass graft: A randomized clinical trial.

Patients undergoing cardiac surgeries are at high risk of developing delirium. The present study aimed to determine the effects of multimedia education on postoperative delirium in patients undergoing a coronary artery bypass graft. This study was a randomized clinical trial. In this study, 110 patients undergoing a coronary artery bypass graft were assigned to two groups, control and intervention. Patients in the intervention group received multimedia education, and those in the control group received routine training. The inclusion criteria were experiencing the coronary artery bypass graft for the first time and non-development of post-operative cardiogenic shock or myocardial rupture. After measuring the level of consciousness, patients were examined in terms of delirium using the confusion assessment method for the ICU scale twice a day from admission to discharge from the ICU. The data were statistically analysed using χ2 test and Fisher's exact test. Patients of both groups were matched in terms of demographics. The highest incidence of delirium was observed on the first day after surgery in the intervention group (14.5%) and in the morning of the second day after surgery (29.1%) in the control group. Moreover, there was a significant difference between the two groups in the incidence of delirium in the morning of the second, third, and fourth days after surgery as it was higher in the control group over these days. Considering the lower incidence of post-operative delirium in patients who experienced multimedia education rather than control group, the use of this non-pharmaceutical method is recommended to prevent delirium in such patients. Delirium is also an acute organic brain syndrome that often leads to complicated conditions after cardiac surgeries. Fortunately, delirium is a preventable issue. The implementation of multimedia education as a non-pharmacological approach had positive effects on patients' delirium.

Pharmacological Prevention of Postoperative Delirium: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background The high prevalence of delirium among postoperative patients has increased morbidity and mortality. The kind of drug that can effectively reduce the incidence of delirium has become the focus of discussion in recent years. However, a consensus in this respect has yet to be reached. Methods Randomized controlled trials (RCTs) were retrieved from the PubMed, Cochrane Library, ClinicalTrials.gov, and Embase databases from their inception through October 12, 2018. We included RCTs of pharmacological prevention for postoperative delirium in adults (at least 18 years), and the Cochrane risk of bias tool was used to evaluate the methodological quality of trials. The primary outcomes were the risk ratios (RRs) of incidence of postoperative delirium, and the secondary outcomes were the RRs of mortality and adverse events in the intervention and control groups. Results Thirty-eight trials, which comprised 20302 patients and 18 different drugs, were included in the analysis. Of the 38 studies, 17 were rated as low risk with respect to methodological quality. Dexmedetomidine administration (RR 0.58, 95%CI 0.44-0.76, P<0.01) was associated with a significantly lower incidence of postoperative delirium than the control conditions. However, the findings from the studies with a low risk of bias did not show a significant difference in this beneficial effect (RR 0.64, 95%CI 0.39-1.04, P=0.07). The antipsychotic drugs olanzapine (RR 0.44, 95%CI 0.30- 0.65, P<0.01) and risperidone (RR 0.42, 95%CI 0.19-0.92, P=0.03) had promising effects, but there was a lack of sufficient evidence to obtain a definitive conclusion. The beneficial effect of other drugs, including haloperidol, methylprednisolone, dexamethasone, gabapentin, ketamine, cyproheptadine, donepezil, hypertonic saline, melatonin, nimodipine, ondansetron, pregabalin, rivastigmine, TJ-54, and tryptophan, was not proven on the basis of present evidence. Conclusion Among the pharmacological prophylactic measures for postoperative delirium, dexmedetomidine, olanzapine, and risperidone showed higher efficacy than other drugs. However, more high-quality evidence is needed to confirm these results.

OC57 PATIENT-PROSTHESIS MISMATCH ION ELDERLY WOMEN: THE BENEFICIAL IMPACT OF SUTURELESS VALVES VERSUS STENTED BIOPROSTHESIS

Background: Elderly women undergoing aortic valve surgery are at high risk to develop patient-prosthesis mismatch (PPM) due to their small body size and cardiac structures; sutureless valves can overcome this problem. Aim: this retrospective study aims to compare sutureless valves with stented bioprosthesis in terms of (PPM) occurrence. Methods: From July 2001 to September 2017, 442 female patients received 280 sutured bioprosthesis and 162 sutureless bioprosthesis in the same center. Projected effective orifice arean was used to calculate the indexed effective orifice area (iEOA). A 1:1 propensity matching model based on patients’ BSA yield 162 comparable pairs. Results: sutureless valve exhibited lower CPB time and cross-clamp time (sutured vs. suturelss: 106.7 ± 42.0 min vs 92.6 ± 29.1 min; 71.9 ± 28.8 min vs 58.4 ± 19.9 min; p &lt; 0.001), less transfusion rate (sutured vs. sutureless: 26% vs 14%; p = 0.014), lower delirium (sutured vs. sutureless: 11% vs 9%) and higher EOA and iEOA (sutured vs. suturelss: 1.716 ± 0.313 cm2 vs 2.527 ± 0.324 cm2; 1.016 ± 0.20 cm2/m2 vs. 1.495 ± 0.221 cm2/m2; p &gt; 0.001). At follow-up, sutureless valves had lower mean gradient (sutured vs suturelss: 15.96 ± 8.33 mmHg vs 12.38 ± 5.10mmHg; p = 0.049). Conclusions: in our series, sutureless valves allowed expedite surgery, lower incidence of post-operative delirium and less hours of mechanical ventilation; hospital stay and mortality did not differed. Sutureless valves are associated with no PPM and lower mean gradients at follow-up. When anatomically indicated, sutureless valves should be the prosthesis of choice in elderly women.

Intraoperative Sedation With Dexmedetomidine is Superior to Propofol for Elderly Patients Undergoing Hip Arthroplasty

Peripheral nerve block is a preferable method for elderly patients receiving hip arthroplasty. Sedation with dexmedetomidine may reduce postoperative delirium (POD). The aim of this study was to investigate whether intraoperative sedation with dexmedetomidine, as a supplementary to peripheral nerve block for elderly patients receiving total hip arthroplasty, can decrease the prevalence of POD. A prospective, randomized controlled study was conducted with patients 65 years of age or older who underwent total hip arthroplasty between June 2016 and June 2017. The patients were randomly assigned to receive a lumbosacral plexus plus T12 paravertebral block supplemented with propofol or dexmedetomidine for sedation. Incidence of POD was the primary endpoint and was determined with the confusion assessment method, and incidence of postoperative cognitive dysfunction (POCD) was assessed with the mini-mental state examination. The time of ambulation, discharge time, and complications over a 30-day postsurgery period were also recorded. A total of 296 patients were randomly assigned to 2 groups. The patients sedated with dexmedetomidine had lower incidences of POD and POCD and were out of bed and discharged sooner than the patients sedated with propofol. There was no difference in complications between the 2 groups. As a supplementary to peripheral nerve block, intraoperative sedation with dexmedetomidine could be associated with a lower incidence of POD, which may have benefits on reducing the incidence of early POCD and offering a better short-term recovery for elderly patients receiving hip arthroplasty.

A nursing protocol targeting risk factors for reducing postoperative delirium in patients following coronary artery bypass grafting: Results of a prospective before-after study

ObjectiveThe results of postoperative delirium (POD) warrant testing for prevention. The purpose of this study was to determine whether a nursing intervention targeting risk factors could decrease the incidence of POD among patients who had coronary artery bypass grafting (CABG) in China. MethodsA prospective before-after study was conducted between April 2014 and April 2015. A nursing delirium intervention protocol targeting risk factors for delirium was performed for 141 patients undergoing CABG in a cardiothoracic ICU from November 2014 to April 2015. Intervention consisted of screening for delirium risk factors, followed by targeted risk factor modification, including pain control, early catheter removal, patient orientation using the 5W1H procedure, increased family visits, minimizing care-related interruptions, comfortable nursing and monitoring for sleeping difficulties. Outcomes of the Intervention Group were compared with those of the Control Group for 137 CABG patients from April 2014 to October 2014. Delirium was assessed using the confusion assessment method for the intensive care unit (CAM-ICU). The sample size was justified by PASS2000, based on previous data of delirium incidence in our institution (30%). Main resultsDelirium incidence during the first seven postoperative days was significantly lower in the Intervention Group at 13.48% (19/141) vs. 29.93% (41/137) for the Control Group (χ2 = 11.112, P = 0.001). In addition, POD in the Intervention Group occurred between the 3rd and 6th postoperative days, while POD in the Control Group mainly occurred on the first three days postoperatively. Delirium in the Intervention Group occurred later than delirium in the Control Group (χ2 = 12.743, P < 0.001). Length of ICU stay was reduced significantly (Z = −6.026, P < 0.001). ConclusionThe application of a nursing protocol targeting risk factors in this study seems to be associated with a lower incidence of POD in patients after CABG. This finding suggests that managing the predictors properly is one of the effective strategies to prevent delirium.

Perioperative Psycho-Educational Intervention Can Reduce Postoperative Delirium in Patients after Cardiac Surgery: A Pilot Study

Postoperative delirium after cardiac surgery is associated with many consequences such as poorer functional recovery, more frequent postoperative complications, higher mortality, increased length of hospital stay, and higher hospital costs. The aim of this study was to evaluate the efficacy of perioperative psycho-educational intervention in preventing postoperative delirium in post cardiac surgery patients. We conducted a comparative retrospective study between 49 patients who had received perioperative psycho-educational intervention and 46 patients who had received standard care. The primary outcome was the incidence of postoperative delirium. Secondary outcomes included length of ICU stay, and severity and duration of postoperative delirium among the patients who had developed delirium. The incidence of postoperative delirium was significantly lower in the intervention group than that in the control group (12.24% vs. 34.78%, P = 0.009). Among the patients who had developed postoperative delirium, there was no statistical difference between the two groups regarding secondary outcomes. Our results show that the patients who received perioperative psycho-educational intervention were associated with a lower incidence of postoperative delirium after cardiac surgery than those who received standard care. Clinicians would be able to implement this psycho-educational intervention as part of routine practice to reduce delirium.

Remifentanil Reduces the Incidence of Post-Operative Delirium

A secondary exploratory analysis of data from an observational study was used to study the influence of the opioid used for intraoperative anaesthesia on the incidence of post-operative delirium. Patients who had been admitted to the recovery room following elective general anaesthesia were divided into those who had received fentanyl or remifentanil. For unbiased patient analysis, matched pairs were built with respect to gender, age, physical status, anaesthetic type and surgery duration. In 752 patients, the overall incidence of delirium was 9.9% in the recovery room and 3.8% on the first post-operative day. Compared with the remifentanil group, the fentanyl group had a significantly higher incidence of delirium in the recovery room (12.2% versus 7.7%) and on the first post-operative day (5.8% versus 1.9%). Delirium in the recovery room and on the first post-operative day were both associated with a significantly prolonged post-operative hospital stay. The choice of intraoperative opioid influences the incidence of post-operative delirium. Remifentanil was associated with a lower incidence of post-operative delirium in the early post-operative period.