Evidence-based clinical update: General anesthesia and the risk of delirium and postoperative cognitive dysfunction

Bryson, Gregory L.; Wyand, Anna

doi:10.1007/bf03021625

Cited by 183 publications

(105 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In patients with delirium, as others have reported, this study did not find any significant difference between the type of anesthesia (locorregional versus general) neither with duration of anesthesia 26,30,31 .…”

Section: Discussionsupporting

confidence: 53%

Delirium pós-operatório em pacientes críticos: fatores de risco e resultados

Veiga¹,

Luís²,

Parente³

et al. 2012

Rev. Bras. Anestesiol.

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 53%

Delirium pós-operatório em pacientes críticos: fatores de risco e resultados

Veiga¹,

Luís²,

Parente³

et al. 2012

Rev. Bras. Anestesiol.

View full text Add to dashboard Cite

“…Cette question a été abordée dans une mise à jour clinique basée sur des données probantes. 40 Un total de huit essais randomisés contrôlés ont été trouvés: après randomisation, les patients ont reçu une anesthésie régionale ou une anesthésie générale et la survenue d'un delirium a servi de critère d'évaluation. Dans toutes les études sauf une, il n'y a pas eu de différence dans l'incidence de delirium postopératoire.…”

Section: Type D'anesthe´siqueunclassified

“…This question was addressed in an evidence-based clinical update. 40 A total of eight RCTs were found in which patients were randomized to regional anesthesia or general anesthesia, and delirium was used as an outcome measure. In all trials but one, there was no difference found in the rate of postoperative delirium.…”

mentioning

confidence: 99%

Postoperative delirium: risk factors and management: Continuing Professional Development

Chaput

Bryson

2012

Can J Anesth/J Can Anesth

Self Cite

View full text Add to dashboard Cite

Purpose Postoperative delirium often remains undiagnosed and therefore untreated. The purpose of this continuing professional development module is to identify patients at high risk of developing delirium following noncardiac surgery and to provide tools to aid in the diagnosis of delirium at the bedside. Optimal prevention and treatment strategies are recommended. Principal findings Delirium is characterized by an acute onset and a fluctuating course, inattention, disorganized thinking and an altered level of consciousness, and occurs in up to 40% of patients in the perioperative period. The pathophysiology of delirium is multifactorial, but it is believed to be related to inflammation, altered neurotransmission, and stress in the patient who has had surgery. Acetylcholine and dopamine appear to play a significant role. There is an increased risk of a poor outcome in patients who develop delirium, including a longer hospital stay and death. Surgical and patient factors play a significant role in predicting who will subsequently develop delirium. Prevention is much more effective than treatment in the management of delirium. The most effective prevention strategies include proactive geriatric assessment and care of the patient on a geriatrics surgical ward as well as prophylactic low-dose antipsychotic agents. From an anesthetic perspective, evidence in some surgical populations would support the use of regional techniques and minimal sedation. If delirium develops, treatment with lowdose oral antipsychotics appears to be most effective.Conclusions Delirium is a serious condition that must be recognized early and treated promptly to minimize deleterious outcomes. In order to institute prevention strategies and treat the condition effectively when it occurs, the anesthesiologist must be vigilant in identifying patients at risk and in screening for this condition. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to:1. Define delirium in the context of other cognitive changes following non-cardiac surgery. 2. Understand the incidence and adverse outcomes associated with delirium. 3. List predisposing and precipitating factors of postoperative delirium and identify the patient at risk. 4. Explain the underlying pathophysiologic mechanisms believed to be implicated in causing delirium. 5. Formulate an anesthetic plan that minimizes the risk of developing postoperative delirium. 6. Devise a management plan to treat postoperative delirium most effectively while minimizing the adverse effects of treatment.Like other Western nations, Canada's population is aging rapidly. Over the past 50 years, the proportion of Canadians over the age of 65 has risen from 7.7% to 13.7%. A Statistics Canada estimates that the proportion of seniors will double 123Can J Anesth/J Can Anesth (2012) 59:304-320 DOI 10.1007 yet again by 2036 and will represent 23-25% of Canada's population. B This rapid demographic shift will impact anesthesiologists and hospitals ...

show abstract

“…126,127 Ancelin found that ''Adding sedation to peridural anaesthesia led to a decline in verbal secondary memory,'' 128 and Sieber et al found that lighter sedation during spine surgery led to less delirium. 129 Again, there are empirical and neuropathological reasons to suspect a link between delirium, deep sedation, poor neurological outcome, and POCD 101 -109 .…”

Section: Regional Versus General Anesthesiamentioning

confidence: 99%

Developmental Disability in the Young and Postoperative Cognitive Dysfunction in the Elderly After Anesthesia and Surgery: Do Data Justify Changing Clinical Practice?

Cottrell

Hartung

2012

Mount Sinai J Medicine

View full text Add to dashboard Cite

The assumption that anesthesia has no serious, long‐term, adverse central nervous system consequences may be true for most patients between 6 months and 60 years of age. However, for patients younger than 6 months or older than 60 years, that status quo assumption is under challenge from a growing body of evidence. Fetuses and newborns appear to be at risk because systems that would enable them to fully recover from the effects of more than 2 hours of anesthesia are still in development. In distinction, the elderly appear to be at risk because systems that once enabled them to fully recover have ever‐diminishing capacity. Even for those between the age of 6 months and 60 years, full recovery may require replacing apoptosed neurons and pruning overabundant dendritic spines … perhaps leaving patients not quite the same person that they were before they were anesthetized. Mt Sinai J Med 79:75–94, 2012. © 2012 Mount Sinai School of Medicine

show abstract

Evidence-based clinical update: General anesthesia and the risk of delirium and postoperative cognitive dysfunction

Cited by 183 publications

References 44 publications

Delirium pós-operatório em pacientes críticos: fatores de risco e resultados

Delirium pós-operatório em pacientes críticos: fatores de risco e resultados

Postoperative delirium: risk factors and management: Continuing Professional Development

Developmental Disability in the Young and Postoperative Cognitive Dysfunction in the Elderly After Anesthesia and Surgery: Do Data Justify Changing Clinical Practice?

Contact Info

Product

Resources

About