Rhode Island medical journal (2013)
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Endoscopic discectomy is an ultra- minimally invasive outpatient surgical option for the treatment of lumbar herniated discs. The purpose of this study was to assess the benefit of tranforaminal versus interlaminar endoscopic discectomy in patients with single level Lumbar 5-Sacral 1(L5-S1) disc herniations and lumbar radiculopathy. ⋯ The 1-year follow-up data presented here for transforaminal and intralaminar approaches to L5-S1 disc herniations appears to indicate that either approach can be used as determined to best suit the pathology without sacrificing the probability of postoperative pain improvement.
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Delirium management begins with non-pharmacologic interventions and treatment of the underlying causes. There are no FDA-approved medications for delirium-related psychosis and agitation, although numerous agents have been studied. ⋯ Studies and expert guidelines support the use of antipsychotics for delirium-related psychosis and agitation, and demonstrate comparable efficacy and safety between first- and second- generation agents. Mounting evidence also suggests that antipsychotics and dexmedetomidine are effective in preventing delirium in surgical and mechanically- ventilated patients, respectively.
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Delirium is a highly prevalent and complex neuro- psychiatric disorder marked by attentional dysfunction, disturbances in multiple cognitive domains, and changes in motor behavior, perception, sleep, and thought process. Delirium results from diverse toxic, metabolic, infectious, and structural etiologies and is associated with a number of adverse outcomes. Delirium pathophysiology involves perturbation of multiple neurotransmitter systems. ⋯ Diagnostic assessment of delirium includes thorough physical examination, careful cognitive testing, appropriate metabolic and infectious studies, review of medications, and structural brain imaging and electroencephalography as indicated. Pharmacologic and non-pharmacologic interventions have been documented to reduce the incidence and severity of delirium. Anti- psychotics are the treatment of choice for delirium-related agitation and psychosis.