European journal of anaesthesiology
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As people live longer, the burden of cognitive impairment to elderly patients, their families and society becomes increasingly common and important. The loss of independence, a reduction in the quality of life and increased mortality are possible correlates to the mental disintegration. Cognitive dysfunction following major surgery on the elderly is a significant problem which adds to other cognitive impairments caused by neurodegeneration, cerebrovascular impairments and other causes. ⋯ There is no standard definition; the diagnosis is made only by the results of neuropsychological tests which are not standardised for this purpose; test results are analysed by different statistical methods (some of them inappropriate); controls are often absent or poorly matched; and pre-existing mild cognitive impairment, which affects 10 to 20% of people older than 65 years and is similar to the subtle cognitive impairment following surgery, is not sought for and recognised. Reviews of the subject have varied from descriptions such as 'a well recognised and significant problem' to 'a hypothetical phenomenon for which there is no International Statistical Classification of Disease (ICD-9) code, and no Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) code'. This article examines both sides of the spectrum in a detailed review which explains the necessary psychological 'jargon', discusses the methods used and points to areas of future research.
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The immediate postoperative period is important, as the patient recovers from the acute derangements resulting from the surgical insult and anaesthesia. Incomplete or incorrect communication between the anaesthesiologist and the postanaesthesia care unit nurse during the transfer process may lead to dangerous clinical mistakes. The literature examining handovers from operating room to the postanaesthesia care unit is scarce. ⋯ This study demonstrates that the handover process is inconsistent and in some cases information defined as important by the physicians and the nurses is not transferred. Further studies need to investigate whether a handover protocol leads to a minimisation of omissions in information transfer.
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Editorial Historical Article
History of anaesthesia: why did professional anaesthetists appear in Britain first?