European journal of anaesthesiology
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Postoperative delirium in hip fracture patients is common and is associated with substantial morbidity and consumption of resources. ⋯ We identified modifiable factors associated with postoperative delirium incidence among patients undergoing hip fracture repair surgery.
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Pre-operative risk assessment is important to quantify the patient's risks of morbidity and mortality, but its quality differs. We created a process-oriented score (PRO-score) for risk evaluation of adults as a three-stage warning score checklist with concrete guidance. It contains the contents of current guidelines and the assessment of vital signs. ⋯ The PRO-score detected warning signs in 'healthy' ASA-PS 1 or 2 and in ASA-PS 3 or 4 patients. Furthermore, it influenced the management of these patients, and thus improved the process quality of risk assessment. The physical examination should include the assessment of vital signs.
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The altered neurodevelopment of children operated on during the neonatal period might be due to peri-operative changes in the homeostasis of brain perfusion. Monitoring of vital signs is a standard of care, but it does not usually include monitoring of the brain. ⋯ Neuromonitoring with the techniques currently used will neither help our understanding of the altered neonatal pathophysiology, nor enable early detection of deviation from the norm. The modalities lack specificity and are not related to clinical (long-term) outcome or prognosis. Accordingly, we were unable to draw up a monitoring guideline.
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There is limited and conflicting data on whether sleep-disordered breathing (SDB) is associated with postoperative major cardiovascular and cerebrovascular events (MACCE), and mortality. ⋯ SDB was associated with increased risks of MACCE, and respiratory and vascular complications, but had a lower incidence of in-hospital mortality and shorter length of hospital stay.