Psychosomatics
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Review
Psychotropic drugs and the perioperative period: a proposal for a guideline in elective surgery.
Evidence-based guidelines for the perioperative management of psychotropic drugs are lacking. The level of evidence is low and is based on case reports, open trials, and non-systematic reviews. However, the interactions and effects mentioned indicate that patients who use psychotropics and require surgery have an enhanced perioperative risk. ⋯ From the perspective of withdrawal and psychiatric recurrence or relapse, they should be seen by (their) psychiatrists. Preoperative assessment clinics offer the opportunity to assess and evaluate these risks in order to deliver patient-tailored integrated care. Authors propose a model for quality management.
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Data from 101 consecutively admitted intensive care unit (ICU) patients were examined to determine whether oxidative metabolic stress existed within the 48 hours before delirium onset. The occurrence of pneumonia and sepsis at any time during hospitalization was also recorded. Delirium was defined retrospectively with the Confusion Assessment Method (CAM). ⋯ Three measures of oxygenation (hemoglobin, hematocrit, pulse oximetry) were worse in the patients who later developed delirium. Two measures of oxidative stress (sepsis, pneumonia) occurred more frequently among those diagnosed with delirium. Hence, patients with indicators of oxidative dysfunction developed delirium more frequently, and this was not linked to illness severity.