Volatile anaesthetics and postoperative delirium in older surgical patients—A secondary analysis of prospective cohort studies

Kinjo, Sakura; Lim, Eunjung; Magsaysay, Maria Victoria; Sands, Laura P.; Leung, Jacqueline M.

doi:10.1111/aas.13227

Cited by 17 publications

(7 citation statements)

References 49 publications

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“…We also screened two patients who inhaled volatile anesthetic. Some experimental studies [40] showed that volatile anesthetics may be induce cell injury and even promote neuro-pathogenesis, so volatile anesthetics were regarded as high risk factor for POD. On the contrary, others researches [41] demonstrated that volatile anesthetics take neuroprotective effect and do not provide any convincing data to verify their impact on POD.…”

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Decreases of regional cerebral oxygen saturation reading during hip arthroplasty associated with postoperative delirium in older adults

Zhou

Wang

et al. 2021

Preprint

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Background Postoperative delirium (POD) is a sign of deterioration in the homeostasis and physical status of the patient. However, there have been no reports regarding the relationship between the decrease of regional cerebral oxygen saturation (rSctO2) reading during surgery and the POD in hip replacement in the elder. This study aims to investigate this correlation and the incidence of POD.Methods We performed a retrospective study of 4834 patients who underwent hip arthroplasties between 2015 and 2019 at our hospital. Data were collected as part of routine patient care. The patients’ cognitive performance was evaluated by using the Manual of Mental Disorders (DSM-IV-TR 4th edition) criteria. Patients found to be delirious after surgery served as the delirium group, other patients who did not develop delirium after surgery regarded as the no-delirium group. The various factors including the decline of rSctO2 reading intraoperatively were assessed using Multivariable logistic regression models. Odds ratio (OR) and 95% confidence intervals (CI) are reported.Results POD was found in 27 patients (n=351); the incidence of POD was 7.7%; all of them were in their 70’s or 80’s. Lab data and rSctO2 reading before surgery were no significantly difference between the delirium group and the no-delirium group. Patients who displayed the decline of rSctO2 reading intraoperatively were at higher risk for POD (compared with no-delirium patients: OR2.169 CI 1.663-2.829 p=0.000) and gender (compared with no-delirium patients: OR 0.163 CI 0.029-0.909 p=0.039) was at a higher risk. Twenty-four patients recovered from POD gradually. One patient had persistent and severe cognitive dysfunction after surgery, two patients died of complications either acute pulmonary embolism 4 days after surgery or acute stroke 21 days after surgery respectively.Conclusions The incidence of POD was 7.7%. This study shows that the decline of rSctO2 reading during hip replacement surgery in the elder is associated with increased probability for the POD.

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Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Decreases of regional cerebral oxygen saturation reading during hip arthroplasty associated with postoperative delirium in older adults

Zhou

Wang

et al. 2021

Preprint

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“…Postoperative delirium is a prevalent complication that is frequently observed after surgery and general anesthesia ( Sieber et al, 2018 ; Kinjo et al, 2019 ). Generally, POD shows various symptoms, such as short-term memory impairment and anxiety ( Smith et al, 2016 ; Jin et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

ATPase Inhibitory Factor 1 Is Critical for Regulating Sevoflurane-Induced Microglial Inflammatory Responses and Caspase-3 Activation

Gao

Sun

et al. 2021

Front. Cell. Neurosci.

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Postoperative delirium (POD) is one of the most important complications after surgery with general anesthesia, for which the neurotoxicity of general anesthetics is a high-risk factor. However, the mechanism remains largely unknown, which also hinders the effective treatment of POD. Here, we confirmed that a clinical concentration of the general anesthetic sevoflurane increased the expression of inflammatory factors and activated the caspase-3 by upregulating ATPase inhibitory factor 1 (ATPIF1) expression in microglia. Upregulation of ATPIF1 decreased the synthesis of ATP which is an important signaling molecule secreted by microglia. Extracellular supplementation with ATP attenuated the microglial inflammatory response and caspase-3 activation caused by sevoflurane or overexpression of ATPIF1. Additionally, the microglial inflammatory response further upregulated ATPIF1 expression, resulting in a positive feedback loop. Animal experiments further indicated that intraperitoneal injection of ATP significantly alleviated sevoflurane anesthesia-induced POD-related anxiety behavior and memory damage in mice. This study reveals that ATPIF1, an important protein regulating ATP synthesis, mediates sevoflurane-induced neurotoxicity in microglia. ATP supplementation may be a potential clinical treatment to alleviate sevoflurane-induced POD.

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“…Those who considered a cut-off to be reasonable used benzodiazepines rarely and preferably prescribe neuroleptics, opioids and alpha-agonists instead. Particularly promethazine was frequently used in the elderly, even though it has an extraordinary high anticholinergic burden (17,18), see table 6. The long-acting clorazepate was less frequently used in out-patient than in-patient anesthesia.…”

Section: Pharmacological Treatment Of Postoperative Delirium In the Pacumentioning

confidence: 99%

“…Already 10 min after PACU admission, a pathologic RASS or NuDeSc-Score, often described as emergence delirium (ED), was associated with later delirium on the ward (OR 2.4; 1.5–3.9 CI) and death after 3 months (OR 1.4; 0.7–3.4 CI) [ 5 ]. Immediately after awakening and extubation, Monk found a 3.7% incidence of ED, declining to 1.3% when re-evaluated in the PACU [ 6 ]. Another study found a 4% incidence of ED at the time of discharge from the PACU [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of strategies to prevent and treat postoperative delirium in the post-anesthesia caring unit

Saller

Hofmann-Kiefer

Saller

et al. 2020

J Clin Monit Comput

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Background Postoperative delirium is associated with worse outcome. The aim of this study is to understand present strategies for delirium screening and therapy in German Post Anesthesia Caring Units (PACU) in hospitals and ambulatory anesthesia facilities. Methods We designed German-wide web-based survey of 922 leading anesthesiologists in hospitals and 726 in ambulatory surgery. Results The response rate was 30% for hospital anesthesiologists. 10% (95%-confidence interval: 8-12) of the anesthesiologists applied a standardised screening for delirium. Even though not on a regular basis, in 44% (41-47) of the hospitals, a recommended and validated screening was used, the Nursing Delirium Screening Scale (NuDesc) or the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). If delirium is likely to occur, 46% (43-50) of the patients were examined using a delirium tool and 20% (17-23) screened in intensive care units. For the treatment of delirium, alpha-2-agonists (83%, 80-85) were used most frequently for vegetative symptoms, benzodiazepines in anxiety in 71% (68-74), typical neuroleptics in 77% (71-82%) of patients with psychotic symptoms and in 20% (15-25) of patients with hypoactive delirium. 45% (39-51) of the respondents suggested no therapy for this entity. One third of the respondents indicated an age limit for pre-anesthetic medication with a mean age (SD) of 74.2 (±6.4) years and avoid benzodiazepines. Conclusions Monitoring of delirium was not established as a standard procedure in German PACUs. However, symptom-oriented therapy for postoperative delirium corresponded with the current guidelines.

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Volatile anaesthetics and postoperative delirium in older surgical patients—A secondary analysis of prospective cohort studies

Abstract: Each VA may have different effects on postoperative cognition. Further studies using a prospective randomized approach will be necessary to discern whether anaesthetic type or management affects the occurrence of postoperative delirium.

Cited by 17 publications

References 49 publications

WITHDRAWN: Decreases of regional cerebral oxygen saturation reading during hip arthroplasty associated with postoperative delirium in older adults

WITHDRAWN: Decreases of regional cerebral oxygen saturation reading during hip arthroplasty associated with postoperative delirium in older adults

ATPase Inhibitory Factor 1 Is Critical for Regulating Sevoflurane-Induced Microglial Inflammatory Responses and Caspase-3 Activation

Implementation of strategies to prevent and treat postoperative delirium in the post-anesthesia caring unit

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