Minerva anestesiologica
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Minerva anestesiologica · Jan 2016
How to advance prediction of postoperative delirium? A secondary analysis comparing three methods for very early assessment of elderly patients after surgery and early prediction of delirium.
Postoperative impairment of the cerebral function can appear immediately after general anesthesia and may be predictive for a postoperative delirium. We compared three tools assessing patients on recovery room admission in order to detect early signs of postoperative brain dysfunction: the Postanesthetic Recovery Score (PARS), the Richmond Agitation-Sedation Scale (RASS) and the Nursing Delirium Screening Scale (Nu-DESC). ⋯ The RASS and Nu-DESC were independent predictors for a delirium within seven postoperative days. Very early assessment of the cerebral function may help to advance detection, prevention and treatment of postoperative delirium in elderly patients.
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Minerva anestesiologica · Jan 2016
Transfusion strategies in patients with traumatic brain injury: Which is the optimal hemoglobin target?
Robertson et al. (JAMA 2014; 312:36-47) investigated the effects of two different thresholds of hemoglobin (Hb) to guide red blood cells transfusions (RBCT; 7 g/dL vs. 10 g/dL) in patients suffering from traumatic brain injury (TBI). In a two-center, controlled, open-label trial (from May 2006 and August 2012), comatose patients with a closed TBI were randomized within 6 hours since initial resuscitation to one of the two RBCT strategies and, in a factorial design (2x2), to receive erythropoietin (EPO) or placebo. Patients were excluded if they had a Glasgow Coma Scale (GCS) score of 3 with fixed and dilated pupils, penetrating trauma, pregnancy, life-threatening systemic injuries and severe preexisting diseases. ⋯ Favorable outcome was similar between patients included in the 7 g/dL (37/87-43%) and the 10 g/dL group (31/94-33%) as if receiving EPO or placebo, even after adjustment for several covariates. Thromboembolic events were significantly more frequent in the group transfused at 10 g/dL (22/101 [22%] vs. 8/99 [8%]; P=0.009). We discussed how theses results might influence the management of such patients as well as the methodological limitations that underline the need for further investigations.