Lancet
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Drugs with anticholinegic effects are often used in surgical procedures and may impair higher cognitive functions and produce delirious states. This prospective study examined the relation between serum levels of anticholinergic drugs, measured by a radioreceptor assay, and the development of delirium in patients undergoing cardiac surgery. Most patients who had postoperative delirium had high serum levels of anticholinergic drugs, whereas those who remained cognitively intact had low levels; and impairment in cortical function correlated with serum levels of anticholinergic drugs (p less than 0.001). Raised serum levels of drugs with anticholinergic effects may contribute to the development of delirium, and to the increase in risk of morbidity following cardiac surgery.
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In teaching hospitals the responsibility for cardiopulmonary resuscitation usually rests with the house-staff, yet most house-officers receive no formal training in life support. The life-support skills of 45 medical and surgical house-officers in a university teaching hospital were tested by means of simulated cardiac arrests. House-officers were graded on the basis of a performance checklist derived from the standards of the American Heart Association. ⋯ House-officers who had received prior life-support training performed better in BLS (p less than 0.001) but not in ACLS. It was concluded that (a) most medical and surgical house-officers are not reasonably proficient in BLS and ACLS, and (b) cardiac arrest simulation is a motivating exercise which permits analysis of each house-officer's life-support skills. House-officers should have more training and practice in life support, or they should not have primary responsibility for cardiopulmonary resuscitations.