Clinical therapeutics
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Clinical therapeutics · Dec 2015
Case ReportsMissed Opportunities for Intervention in a Patient With Prolonged Postoperative Delirium.
Postoperative delirium is a common and costly state of brain dysfunction that complicates postsurgical management in some patients. The purpose of this report was to describe a case of prolonged postoperative delirium and to review the appropriate identification and management of this condition. ⋯ In this high-risk patient, a proactive approach to the prevention and treatment of delirium may have avoided or mitigated the prolonged delirium and, potentially, long-term cognitive deficits.
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Clinical therapeutics · Dec 2015
ReviewPreoperative Cognitive and Frailty Screening in the Geriatric Surgical Patient: A Narrative Review.
The identification of older patients who may have deficits in cognitive or functional domains will become more pressing as increasing numbers of these patients present for preoperative evaluations. The number of older adults with deficiencies in these areas is projected to grow, and more of these patients will present for assessment in preoperative clinics with the expectation that surgeries will be performed. ⋯ Clinicians may anticipate that geriatric screening tools focused on cognitive and functional domains will play a direct role in the ongoing evolution of presurgical assessment and triage.
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Clinical therapeutics · Dec 2015
The Association of Brain MRI Characteristics and Postoperative Delirium in Cardiac Surgery Patients.
Delirium is common after cardiac surgery and is associated with adverse consequences, including cognitive decline. Identification of vulnerable older adults might allow for early implementation of delirium-prevention strategies. Brain MRI findings provide insight into structural brain changes that may identify vulnerable patients. The purpose of this study was to examine the association between brain MRI characteristics potentially associated with delirium vulnerability and the development of postoperative delirium in a nested cohort of patients undergoing cardiac surgery. ⋯ Increased brain ventricular size was independently associated with delirium after cardiac surgery. These results suggest that cerebral atrophy may contribute to increased vulnerability for postoperative delirium. Baseline brain MRIs may be useful in identifying cardiac surgery patients at high risk for postoperative delirium, who might benefit from targeted perioperative approaches to prevent delirium. ClinicalTrials.gov identifier: NCT00981474.
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Clinical therapeutics · Dec 2015
Randomized Controlled TrialPerioperative Cognitive Protection-Cognitive Exercise and Cognitive Reserve (The Neurobics Trial): A Single-blind Randomized Trial.
The Neurobics Trial is a single-blind, parallel-group, randomized, controlled trial. The main study objective is to compare effectiveness of preoperative cognitive exercise versus no intervention for lowering the incidence of postoperative delirium. Enrollment began March 2015 and is ongoing. ⋯ To our knowledge, the Neurobics Trial is the first randomized, controlled study to investigate the effectiveness of a significant preoperative cognitive exercise regimen for the prevention of delirium after noncardiac, nonneurological surgery in elderly patients.
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Clinical therapeutics · Dec 2015
Can Intraoperative Processed EEG Predict Postoperative Cognitive Dysfunction in the Elderly?
Postoperative cognitive dysfunction (POCD) is a serious and costly complication of the elderly; even mild impairment has the potential to impact overall well being. Anesthesiologists continue to search for ways to manipulate intraoperative technique to optimize postoperative cognition in the elderly. Depth of anesthesia during surgery is an area that has shown some promise for short-term outcomes, such as delirium. However, excessive depth has both positive and negative associations with longer-term POCD. We hypothesize that this uncertainty is due to the inability of median depth to capture the amount of burst suppression or electrical silence. In this study, our purpose was to identify the intraoperative processed EEG parameters that are most closely correlated with POCD. ⋯ Patients who developed POCD spent less time in EEG burst suppression and less time in deep states. Burst suppression may be protective for POCD. Further work is needed to definitively identify the role of burst suppression in the context of other patient and intraoperative variables to prevent POCD.