Postoperative delirium after anestesia with propofol, sevoflurane or desflurane: The Pinocchio trial. Interim analysis of safety and preliminary results

Doronzio, Andrea; Lanni, Fransiska; Ayrian, Eugenia; Zhang, Y. P.; Bilotta, F.; Rosa, Giovanni

doi:10.1097/00003643-201306001-00337

Cited by 4 publications

(3 citation statements)

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“…In our study, whether or not propofol was used as an induction drug was insignificant, which is inconsistent with a finding from a study that reported a higher occurrence rate of delirium in patients in whom propofol was used compared to those in whom inhalation anaesthesia was used (Doronzio, Ayrian, Zhang, Bilotta, & Rosa, ). We speculate that this was because the dose of propofol was relatively small in our study compared to that in the other study, as propofol was used as an induction drug rather than propofol anaesthesia in our patients.…”

Section: Discussioncontrasting

confidence: 99%

Operative and anaesthetic factors influencing on delirium in the intensive care unit: An Analysis of electronic health records

Jin

et al. 2019

Journal of Clinical Nursing

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The occurrence rate of postoperative delirium, which affects the patient outcomes negatively, is expected to increase as the number of operations associated with delirium increases yearly in Korea.However, a cognitive disorder following anaesthesia often hinders the early detection of symptom of delirium. Therefore, the identification of the risk factors that influence the postoperative delirium is important to provide early preventive intervention for the patients with those risk factors. | BACKG ROU N DThe reported occurrence rate of postoperative delirium is 36.8% Abstract Aims and objectives: To analyse the operation, anaesthesia and recovery-related factors affecting the occurrence of delirium in the intensive care unit. Background:The occurrence rate of postoperative delirium is high in surgical patients. Postoperative delirium most frequently occurs usually within 3 days after an operation.Design: This study used a secondary data analysis based on a case-control study. Methods:This study analysed data extracted from the electronic health records at a university hospital from October 2009-July 2015. One hundred and eighty patients with delirium admitted to the intensive care unit through the recovery room after surgery, and 720 nondelirium controls were included. A total of 17 variables were selected, and hierarchical logistic regression was performed to identify operative and anaesthetic factors influencing on delirium. STROBE statement was applied for reporting this study. Results:The operation, anaesthesia and recovery-related factors increasing the risk of delirium included Class II or higher in the classification system of American Society of Anesthesiologists physical status, continuous remifentanil infusion and lower than sevenpoint postanaesthesia recovery score at the time of admission to the recovery room. Conclusion:The operative and anaesthetic factors influencing the occurrence of delirium should be assessed when a patient is admitted to the ICU following an operation even if a patient is conscious.Relevance to clinical practice: Identifying operative and anaesthetic risk factors for delirium can improve the prevention intervention and the patient outcome in the intensive care unit. K E Y W O R D Sdelirium, electronic health records, intensive care unit, risk factor Journal of Critical Care, 30(3), 606-612. https://doi.

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Section: Discussioncontrasting

confidence: 99%

Operative and anaesthetic factors influencing on delirium in the intensive care unit: An Analysis of electronic health records

Jin

et al. 2019

Journal of Clinical Nursing

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“…To show effects in diabetic patients, cells were glycated with MGO before inoculating with bacteria. The single treatment with propofol indicates a damaging effect and a support of the breakdown of BBB as some studies also proposed [ 29 , 30 ]. As the effects of propofol are distinct in our experiments, we cannot confirm neuroprotective effects of propofol as some studies comparing to sevoflurane anesthesia propose [ 32 ].…”

Section: Discussionmentioning

confidence: 90%

“…It has also not been systematically evaluated, how compounds affecting the brain, especially anesthetics, can influence the permeability of the BBB. There are studies showing that propofol as a common anesthetic induce cellular stress and support the breakdown of BBB [ 29 , 30 ]. In addition, some studies proof the neuroprotective effect of propofol by tighten the BBB and lower incidence of post-operative delirium compared with other anesthetics such as sevoflurane [ 31 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

Glycation Increases the Risk of Microbial Traversal through an Endothelial Model of the Human Blood-Brain Barrier after Use of Anesthetics

Weber

Olzscha

Längrich

et al. 2020

JCM

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The function of the human blood–brain barrier (BBB), consisting mainly of the basement membrane and microvascular endothelial cells, is to protect the brain and regulate its metabolism. Dysfunction of the BBB can lead to increased permeability, which can be linked with several pathologies, including meningitis, sepsis, and postoperative delirium. Advanced glycation end products (AGE) are non-enzymatic, posttranslational modifications of proteins, which can affect their function. Increased AGE levels are strongly associated with ageing and degenerative diseases including diabetes. Several studies demonstrated that the formation of AGE interfere with the function of the BBB and may change its permeability for soluble compounds. However, it is still unclear whether AGE can facilitate microbial traversal through the BBB and how small compounds including anesthetics modulate this process. Therefore, we developed a cellular model, which allows for the convenient testing of different factors and compounds with a direct correlation to bacterial traversal through the BBB. Our results demonstrate that both glycation and anesthetics interfere with the function of the BBB and promote microbial traversal. Importantly, we also show that the essential nutrient and antioxidant ascorbic acid, commonly known as vitamin C, can reduce the microbial traversal through the BBB and partly reverse the effects of AGE.

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The effect of desflurane versus propofol anesthesia on postoperative delirium in elderly obese patients undergoing total knee replacement: A randomized, controlled, double-blinded clinical trial

Tanaka

Goodman

Sommer

et al. 2017

Journal of Clinical Anesthesia

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Postoperative delirium after anestesia with propofol, sevoflurane or desflurane: The Pinocchio trial. Interim analysis of safety and preliminary results

Cited by 4 publications

References 0 publications

Operative and anaesthetic factors influencing on delirium in the intensive care unit: An Analysis of electronic health records

Operative and anaesthetic factors influencing on delirium in the intensive care unit: An Analysis of electronic health records

Glycation Increases the Risk of Microbial Traversal through an Endothelial Model of the Human Blood-Brain Barrier after Use of Anesthetics

The effect of desflurane versus propofol anesthesia on postoperative delirium in elderly obese patients undergoing total knee replacement: A randomized, controlled, double-blinded clinical trial

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