Background Post-operative delirium (POD) is a common post-operative complication in elderly individuals and imposes a significant health and financial burden. Identifying predictive biomarkers may help understand the pathophysiology of POD. Our objective is to summarize the evidence of pre-operative biomarkers and imaging tests to predict POD in patients undergoing non-cardiac surgery. Methods A systematic search of English language articles in MEDLINE, EMBASE, Cochrane Database, PsychINFO, PubMed and ClinicalTrials. Gov up to January 2018 was performed. Studies that used biomarkers or imaging tests to predict POD and a validated POD assessment tool were included. Animal studies, paediatric, cardiac and intracranial surgery were excluded. Risk of bias was assessed using the Quality In Prognosis Study tool. Results Thirty-four prospective cohort studies involving 4424 patients were included. Nineteen studies described serum tests [Interleukin-6, Insulin-like Growth Factor 1, C-Reactive Protein (CRP), cholinesterases, apolipoprotein-E genotype, leptin, hypovitaminosis, hypoalbuminaemia, gamma-amino butyric acid], 10 described cerebral-spinal fluid tests (monoamine precursor, melatonin, acute phase proteins, S100B and neurofibrillary tangles), and 5 described imaging tests. Two studies had high risk of bias due to unclear outcome measurement and study participation. CRP was significantly associated with POD in 5 studies. Other biomarkers were either examined by only a single study or two or more studies with conflicting results. Conclusion CRP is the most promising biomarker associated with POD. However, we are still in the early stages in identifying biomarkers and imaging tests that may further understanding of the pathophysiology of POD. Electronic supplementary material The online version of this article (10.1186/s12871-019-0693-y) contains supplementary material, which is available to authorized users.

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In treating chronic and acute pain, opioids are widely used. Although they do provide analgesia, their usage does come with adverse events (AEs). One of the most burdensome is opioid-induced bowel dysfunction, and more specifically opioid-induced constipation (OIC). The pathogenesis of these AEs is well known as the consequence of the action of opioids on m-receptors in the enteric nervous system. In recent years, medicines counteracting this specific action at the receptors have been registered for clinical use: the peripherally acting μ-opioid receptor antagonists (PAMORAs). The knowledge of their comparative efficacy and tolerability is very important for physicians and patients in opioid therapy. This systematic review of the existing literature on PAMORAs aimed to study the relative clinical advantages and disadvantages.The most important data banks, including "PubMed," "Embase," "CT.gov," "ICTRP" and "CINAHL" were used to find the published material on PAMORAs. The selected publications were examined to systematically analyze the efficacy and safety of the four existing PAMORAs.All of the medications are superior to placebo in reducing OIC. There are few published data on alvimopan used to treat OIC, and it is only indicated for the treatment of post-abdominal surgery ileus. Methylnaltrexone is studied mainly in its subcutaneous (SC) formulation. When used in its oral formulation, it seems more rapid than naloxegol and placebo in the reduction of OIC. Naldemedine is able to produce more spontaneous bowel movements (SBMs) when compared to alvimopan and naloxegol.Tolerability was found to be similar for all of them. In particular, they affect the gastrointestinal tract (GI), with flatulence and diarrhea, especially at high dosages. For some of them, nasopharyngitis and abdominal pain were observed as treatment adverse effects (TEAs). Several cardiovascular TEAs were reported after methylnaltrexone use, but it is not clear whether they were consequences of the drug or related to the general conditions of the patients.Considering the existing data, naloxegol and naldemedine seem to be the best choices, with a higher number of spontaneous bowel movements following naldemedine administration.

There is a growing interest in multimodal prehabilitation programs prior to surgery. Several recent guidelines have recommended multimodal prehabilitation programs that include smoking cessation. While preoperative smoking cessation programs reduce perioperative complications and increase long-term abstinence, 1 the impact of smoking cessation interventions as part of multimodal prehabilitation programs has not been described. As such, we performed a systematic review to summarize the literature on prehabilitation programs that have included smoking cessation.A literature search was performed in April 2018 of Medline, Medline In-Process, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed-NOT-Medline, CINAHL, Web of Science, and Scopus. Studies that evaluated the effect of preoperative smoking cessation as part of surgical prehabilitation were included.The literature search identified seven studies for inclusion (Table). Five studies were observational studies and two were randomized-controlled trials. The study populations included patients undergoing elective thoracic, abdominal, and orthopedic surgeries. Interventions generally consisted of a combination of aerobic exercise, strength training, pulmonary rehabilitation, and lifestyle modification including smoking cessation.Five studies assessed the effect of their interventions on postoperative outcomes. Three studies found an improvement in outcomes, primarily a reduction in postoperative pulmonary complications and hospital length of stay; however, two other studies failed to show a reduction in postoperative pulmonary complications.Three studies examined the effect of the intervention on exercise capacity and health-related quality of life. The results show that the interventions can effectively improve exercise capacity; however, the results for quality of life were inconsistent.Three studies reported the number of current smokers undergoing the intervention that quit smoking preoperatively, with abstinence rates from 46-100%. The results show that the interventions resulted in a high smoking abstinence rate prior to surgery; however, longterm abstinence was not measured in any of the studies.Even though the evidence suggests some beneficial effects, the evidence for smoking cessation interventions in the context of multimodal prehabilitation programs is limited. Most of the studies were observational, and only two were randomized studies with small sample sizes. The studies were heterogeneous with regards to the surgical population, types of interventions, and outcomes. Most of the studies did not start the smoking cessation intervention early enough (at least four weeks before surgery-the minimum period shown to reduce postoperative complications). 1 Most importantly, as no study compared prehabilitation programs with and without smoking cessation, we are not able to identify the specific benefits