Association of Pain With Atrial Fibrillation and Delirium After Cardiac Surgery: A DECADE Sub-Study

İnce, İlker; Chiu, Andrew T.; Sagir, Afrin; Chahar, Praveen; Lin, Jia Wei; Douglas, Aaron; Adi, Ahmad; Fang, Jonathan; Mao, Guangmei; Turan, Alparslan

doi:10.1053/j.jvca.2021.05.013

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…Sympathetic drive in the heart results from norepinephrine or epinephrine binding to β1-adrenergic receptors, which is stimulated from the cervical and upper thoracic sympathetic chain ganglia to the deep and superficial cardiac plexus. An increase in adrenergic drive and a decrease in vagal tone could shorten the PR interval and atrial wavelength, increase the inotropic state and preload, and may potentially trigger POAF [ 17 - 19 ]. A mechanism of unrelieved pain, which typically occurs after surgery, involves the mobilization of the sympathetic nervous system.…”

Section: Methodsmentioning

confidence: 99%

Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication

Lopes¹,

Agrawal²

2022

J Surg Res

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Post-operative atrial fibrillation (POAF) is a persistent and serious surgical complication that occur in 20-55% of cardiac surgery cases. POAF may lead to adverse health outcomes such as stroke, thromboembolism, cardiac arrest, and mortality, and may develop long-term. Patients have a 2-fold increase in mortality risk and spend about 3.7 more days in the hospital and $16,000 more in medical costs during their visit. The mechanisms and risk factors of POAF are still poorly understood, yet a strong foundation of how a disease process occurs is needed to provide the most effective treatment. Current mechanisms that are postulated to contribute to POAF include an increase in sympathetic tone, oxidative stress, local and systemic inflammation, a trigger that induces atrial substrate changes, a driver to sustain POAF, and electrolyte disturbances such as hypomagnesemia. While needing more research, current risk factors include age, male sex, history of myocardial infarction or heart failure, hypertension, diabetes, obesity, and COPD. Treatments mostly include prophylaxis of repurposed drugs such as beta-blockers, statins, oral anticoagulants, antiarrhythmics, and Vitamin D and electrolyte supplementation. Autonomic denervation has also been a promising preventative measure for patients undergoing cardiac surgery. This critical review article provides an up-to-date and comprehensive summary of the pathophysiology of POAF, current clinical risk factors and management for POAF and discusses new pathways for further investigation.

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Section: Methodsmentioning

confidence: 99%

Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication

Lopes¹,

Agrawal²

2022

J Surg Res

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“…Ince et al studied the effect of pain control on the incidence of atrial fibrillation and delirium after open cardiac surgery. 34 Using data from the Dexmedetomidine for Reduction of Atrial Fibrillation and Delirium after Cardiac Surgery (DECADE) trial, 35 this retrospective secondary analysis studied the association of postoperative pain with atrial fibrillation and delirium in 605 patients receiving intraoperative dexmedetomidine infusion vs placebo during coronary artery bypass grafting. A total of 206 patients (34%) had atrial fibrillation and 92 (15%) had delirium.…”

Section: Introductionmentioning

confidence: 99%

Year in Review 2021: Noteworthy Literature in Cardiothoracic Anesthesia

Smoroda

Douin

Morabito

et al. 2022

Semin Cardiothorac Vasc Anesth

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In 2021, progress in clinical science related to Cardiac Anesthesiology continued, but at a slower rate due to the ongoing pandemic and disruptions to clinical research. Most progress was incremental and addressed persistent questions related to our field. To identify articles for this review, we completed a structured review using our previously reported methods (1). Specifically, we used the search terms: “cardiac anesthesiology and outcomes” (n = 177), “cardiothoracic anesthesiology” (n = 34), “cardiac anesthesia,” and “clinical outcomes” (n = 42) filtered on clinical trials and the year 2021 in PubMed. We also reviewed clinical trials from the most prominent clinical journals to identify additional studies for a narrative review. We then selected the most noteworthy publications for inclusion in this review and identified key themes.

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“…수술 전 요인은 나이 [5,7,8,[11][12][13], 성별 [5], 교육수준 [5,13], 인지장애 [7,11], 동반질환 (당뇨병, 뇌졸중, 심방세동, 만성 폐쇄성 폐질환, 불면증 등) [5,7,11,13,14], 체질량 지수(body mass index, BMI) [13], 우울 [5], 알코올 및 약물 남용 [14], 흡연 [14]이, 수술 중 요인은 혈액 손실 정도 [5], 수술명 [5,6,13], 마취 약물 [5], 심폐우회술 시간 [5,13], 그리 고 수술 후 요인은 혈액학적 수치 albumin, creatinine, C-reactive protein (CRP) [5,6,12], 기계 환기시간 [5,7,12,15], 중환자실 재실 기간 [6,15,16], 억제대 사용 [5] 등이 유의하게 보고되었다. 심장 수술 후 섬망 발생의 위험요인으로 유의하지는 않았지만 수술 후 통 증 [6,17], 미국 마취과 학회 신체 상태(American Society of Anesthesiologists Physical Status, ASAPS) 등급 [8], 급성 생리학 및 만성 건강 평가(Acute Physiology And Chronic Health Evaluation II, APACHEⅡ) 점수 [10], 수술시간 [14], 마취제 [14], 진통제 종류 [17]는 섬망 발생과 관련된 변수로 언급되었다.…”

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Prevalence and risk factors of delirium of older adults after cardiac surgery at the intensive care unit: A retrospective study

Ryu,

Son Hong

2024

J Korean Gerontol Nurs

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Purpose: The purpose of this study is to identify the prevalence and risk factors of delirium of older adults after cardiac surgery at the intensive care unit (ICU). Methods: A retrospective descriptive correlational study design was used. Among 675 older adults who admitted to ICU after cardiac surgery in a tertiary hospital from May 2021 to April 2022, 528 were selected for data analysis. Data were collected through electronic medical records. Delirium and pain intensity were evaluated using the Confusion Assessment Method-Intensive Care Unit and Critical Care Non-verbal Pain Scale, respectively. Results: The incidence rate of delirium was 41.3% (n=218). Multivariate logistic regression analysis of the variables identified that ICU length of stay (odds ratio [OR]=1.77, p<.001), anesthesia time (OR=1.21, p=.016), pain intensity (OR=1.14, p=.044), and age (OR=1.07, p=.002) were identified as risk factors of delirium after cardiac surgery. Conclusion: ICU length of stay, anesthesia time, pain score, and advanced age should be considered as the prevention and management of delirium at the intensive care unit of older adults after cardiac surgery.

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Association of Pain With Atrial Fibrillation and Delirium After Cardiac Surgery: A DECADE Sub-Study

Cited by 3 publications

References 31 publications

Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication

Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication

Year in Review 2021: Noteworthy Literature in Cardiothoracic Anesthesia

Prevalence and risk factors of delirium of older adults after cardiac surgery at the intensive care unit: A retrospective study

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