Revisiones_bibliográficas TyO_Web: Delirio postoperatorio en geriatría / Postoperative delirium in geriatrics

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miércoles, 29 de marzo de 2017

Delirio postoperatorio en geriatría / Postoperative delirium in geriatrics

Marzo 29, 2017. No. 2643

Delirio postoperatorio en geriatría

Postoperative Delirium in the Geriatric Patient.

Schenning KJ1, Deiner SG2.

Anesthesiol Clin. 2015 Sep;33(3):505-16. doi: 10.1016/j.anclin.2015.05.007. Epub 2015 Jul 7.

Abstract

Postoperative delirium, a common complication in older surgical patients, is independently associated with increased morbidity and mortality. Patients older than 65 years receive greater than one-third of the more than 40 million anesthetics delivered yearly in the United States. This number is expected to increase with the aging of the population. Thus, it is increasingly important that perioperative clinicians who care for geriatric patients have an understanding of the complex syndrome of postoperative delirium.

KEYWORDS: Geriatric; Management; Postoperative delirium; Risk factors; Screening

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Demencia y delirio, resultados en pacientes con fracturas de cadera de edad avanzada.

Dementia and delirium, the outcomes in elderly hip fracture patients.

Mosk CA1, Mus M1, Vroemen JP1, van der Ploeg T2, Vos DI1, Elmans LH3, van der Laan L1.

Clin Interv Aging. 2017 Mar 10;12:421-430. doi: 10.2147/CIA.S115945. eCollection 2017.

Abstract

BACKGROUND: Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium. METHODS: This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA) was used to assess data between January 2014 and September 2015. All patients presented were aged ≥70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes. RESULTS: Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9). Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001), increased association with complications (P<0.001), institutionalization (P<0.001), and 6-month mortality (P<0.001). Patients with dementia (N=168) had a higher delirium rate (57.7%, P<0.001) but a shorter hospital stay (P<0.001). There was no significant difference in the 6-month mortality between delirious patients with (34.0%) and without dementia (26.3%). CONCLUSION: Elderly patients with a hip fracture are vulnerable for delirium, especially when the patient has dementia. Patients who underwent an episode of delirium were at increased risk for adverse outcomes.

KEYWORDS: adverse outcomes; complications; delirium; dementia; elderly; hip fracture

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Intralipid en el tratamiento del delirio postoperatorio

Intralipid Treatment for Post Operative Delirium

Eldor J

Anesth Crit Care Open Access 2017, 7(5): 00273

Abstract

Postoperative delirium (POD) is a common and serious adverse event in the elderly patient and is associated with significant morbidity and mortality. A new treatment for POD by intravenous Intralipid injection in the recovery room is first suggested in the medical literature. Keywords:

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