Anesthesia and analgesia
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Anesthesia and analgesia · May 2011
ReviewReview articles: the effects of perioperative and intensive care unit sedation on brain organ dysfunction.
Analgesia and sedation are routinely administered to patients in procedural suites, operating rooms, and intensive care units to permit invasive procedures, prevent pain and anxiety, reduce stress and oxygen consumption, allow mechanical ventilation, and for numerous other patient comfort and safety reasons. Increasing research and evidence, however, has implicated commonly prescribed sedative medications as risk factors for untoward events and worse patient outcomes, including brain organ dysfunction manifested as delirium and coma. ⋯ Fortunately, our methods of sedation and choice of medications can likely mitigate this cognitive risk. In this review, we detail the effects of perioperative and intensive care unit sedation on the development of delirium and cognitive impairment and provide an evidence-based approach towards analgesia and sedation paradigms to improve patient outcomes.
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Anesthesia and analgesia · May 2011
ReviewReview article: high stakes and high risk: a focused qualitative review of hazards during cardiac surgery.
Cardiac surgery is a high-risk procedure performed by a multidisciplinary team using complex tools and technologies. Efforts to improve cardiac surgery safety have been ongoing for more than a decade, yet the literature provides little guidance regarding best practices for identifying errors and improving patient safety. This focused review of the literature was undertaken as part of the FOCUS initiative (Flawless Operative Cardiovascular Unified Systems), a multifaceted effort supported by the Society of Cardiovascular Anesthesiologists Foundation to identify hazards and develop evidence-based protocols to improve cardiac surgery safety. ⋯ This review fills an important gap in the literature on cardiac surgery safety, that of systematically identifying and categorizing known hazards according to their primary systemic contributor (or contributors). We conclude with recommendations for improving patient outcomes by building a culture of safety, promoting transparency, standardizing training, increasing teamwork, and monitoring performance. Finally, there is an urgent need for studies that evaluate interventions to mitigate the inherent risks of cardiac surgery.
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Anesthesia and analgesia · May 2011
Brief report: preoperative frailty in older surgical patients is associated with early postoperative delirium.
We investigated whether preoperative frailty among older noncardiac surgical patients provides information about the development of postoperative delirium that is in addition to traditional geriatric risk factors. One-third of patients had a frailty score ≥3, which is considered "frail" in others' research. ⋯ Multivariable logistic regression showed that age, activities of daily living dependence, instrumental activities of daily living dependence, and cognitive functioning did not contribute significantly to the prediction of postoperative delirium. Only preoperative symptoms of depression (odds ratio=1.42; 95% confidence interval=1.06-1.91; P=0.018) and the frailty score (odds ratio=1.84; 95% confidence interval=1.07-3.1; P=0.028) were independently associated with the development of postoperative delirium.
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Anesthesia and analgesia · May 2011
Cognitive and functional predictors and sequelae of postoperative delirium in elderly patients undergoing elective joint arthroplasty.
Postoperative delirium (POD) is common in the elderly and associated with adverse outcomes. The cognitive and functional sequelae of POD in elective surgical patients are not known. We sought to determine whether (1) lower scores on sensitive neurocognitive tests are an independent risk factor for POD in elderly surgical patients, and (2) POD predicts cognitive and functional decline 3 months postoperatively. ⋯ Subtly reduced preoperative neurocognitive and functional status predict POD. However, in the small group that developed POD, there was no evidence of cognitive and functional decline 3 months after surgery. POD is associated with decreased preoperative cognitive reserve but, in elderly elective surgical patients, may be without adverse cognitive or functional sequelae 3 months postoperatively.
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Anesthesia and analgesia · May 2011
Volatile anesthetics may not induce significant toxicity to human neuron-like cells.
In vitro experiments and in vivo animal studies suggest detrimental effects of volatile anesthetics including isoflurane on brain cells. It is not clear whether volatile anesthetics can cause human brain cell injury. ⋯ Our results suggest that volatile anesthetics at clinically relevant concentrations do not cause human neuron-like cell injury. Isoflurane also may not alter the quantity of dendritic spines and synapses in these human cells.