Psychosomatics
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Randomized Controlled Trial Comparative Study
Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery.
Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances. ⋯ The findings of this open-label, randomized clinical investigation suggest that postoperative sedation with dexmedetomidine was associated with significantly lower rates of postoperative delirium and lower care costs.
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Delirium is an acute confusional state that is common, preventable, and life-threatening. ⋯ The data suggest that instruments measuring delirium severity and psychomotor features provide important prognostic information and should be integrated into the assessment of delirium.
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Falls and delirium in general-hospital inpatients are related to increases in morbidity, mortality, and healthcare costs. Patients fall despite safeguards and programs to reduce falling. ⋯ Improving the recognition of undiagnosed delirium may lead to sustainable and successful fall prevention programs. Detection of impairments in mental status can assist staff to create individualized patient care plans. Knowledge about which patients are at risk for injury from delirium and falls can lead to improvements in patient safety, functioning, and quality of life.
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Earlier reviews have covered pharmacokinetic drug interactions of natural and semi-synthetic opioid analgesics. This review will focus on the pharmacokinetic drug-drug interactions of methadone, propoxyphene, levomethadyl, meperidine, other phenylpiperidines (such as fentanyl), pentazocine, diphenoxylate, loperimide, and tramadol. ⋯ Therefore, these drugs are likely to produce drug-drug interactions when the CYP3A4 system is inhibited or induced. Knowledge of these drug-drug interactions is important because such interactions may decrease drug efficacy or result in adverse effects.
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Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse event associated with the use of antipsychotics. ⋯ Clinicians utilizing antipsychotics in managing delirium or agitation are advised to be vigilant for NMS. Further study is required to determine whether certain patient characteristics or medications present greater risk for this serious adverse event.