Minerva anestesiologica
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Minerva anestesiologica · Jul 2011
ReviewPostoperative delirium and postoperative cognitive dysfunction in the elderly - what are the differences?
Postoperative cognitive impairment is an increasingly common problem as more elderly patients undergo major surgery. Cognitive deficits in the postoperative period cause severe problems and are associated with a marked increase in morbidity and mortality. ⋯ Both have multifactorial pathogenesis but differ in numerous other ways, with delirium being well-defined and acute in onset and postoperative cognitive dysfunction (POCD) being subtler and with longer duration. This review aims to provide an overview of the differences in the diagnosis of the two entities and to illustrate the methodological problems that can be encountered when evaluating cognitive deficits postoperatively.
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Minerva anestesiologica · Jul 2011
Randomized Controlled TrialEfficacy of the lidocaine/flurbiprofen axetil combination for reducing pain during the injection of propofol.
Pain during the injection of propofol is a common clinical problem. Lidocaine pretreatment, preceded by venous occlusion, is the most popular method for reducing pain during the injection of propofol but cannot entirely control such pain. We aimed to evaluate the efficacy of lidocaine, flurbiprofen axetil (an injectable prodrug of flurbiprofen), and the two in combination for reducing pain during the injection of propofol. ⋯ The lidocaine/flurbiprofen axetil combination, compared with lidocaine 40 mg or flurbiprofen 50 mg, effectively reduces pain during the injection of propofol.
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Non invasive ventilation (NIV), primarily applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic respiratory failure, has also found a wide application in the postoperative period. The expanding indications to the transcatheter treatment of diseased left heart valves have led to an increase in cardiac interventional and diagnostic procedures in severely fragile cardiac patients. As an essential part of post cardiac surgery care is ventilatory support, NIV use has expanded to cardiosurgical patients. ⋯ The knowledge and the real time assessment of the possible effects of positive pressure ventilation on cardiopulmonary interactions in the clinical scenario of cardiac surgery will prompt the intensivists to tailor the respiratory support by non invasive ventilation to the individual patient. The influence on the cardiovascular system of positive pressure and volume delivered through the airways, which can be highly favorable on the impaired left heart and less favorable on the diseased right heart, should be considered when applying NIV in a cardio-surgical patient. As a consequence, the application of NIV in this setting requires an expertly skilled team, continuous hemodynamic monitoring and echocardiographic assessment.