Risk factors and prevalence of perioperative cognitive dysfunction in abdominal aneurysm patients

Benoit, Archie G.; Campbell, Barry; Tanner, John R.; Staley, J. Doug; Wallbridge, Hal R.; Biehl, Diane R.; Bradley, Barry D.; Louridas, George; Guzman, Randolph; Fromm, Rebecca A.

doi:10.1016/j.jvs.2005.07.032

Cited by 132 publications

(126 citation statements)

References 21 publications

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“…Delirium is a common and well-recognized complication after vascular surgery that affects over 30% of patients [1][2][3][4] and is associated with prolonged length of stay, 5 increased health care costs, 6 and higher morbidity and mortality. [7][8][9][10] Furthermore, patients with delirium are more likely to be discharged to either intermediate-or long-term care facilities, 5 increasing the primary admission health care costs to the community.…”

mentioning

confidence: 99%

Delirium following vascular surgery: increased incidence with preoperative β-blocker administration

Katznelson

Djaiani

Mitsakakis

et al. 2009

Can J Anesth/J Can Anesth

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Purpose To determine if there is an association between perioperative administration of beta-blockers and postoperative delirium in patients undergoing vascular surgery. Methods After Institutional Review Board approval, data were retrospectively collected on patients who underwent vascular surgery in an academic hospital during the period January 2006 to January 2007. Patients with preoperative altered level of consciousness, carotid endarterectomy, or discharge within 24 h of surgery were excluded from the study. Identification of delirium was based on evaluation of the level of consciousness with the NEECHAM Confusion Scale and/or a chart-based instrument for delirium. Multivariable logistic regression analysis was used to identify independent perioperative predictors of postoperative delirium. Beta-blockers were tested for a potential effect. Conclusions Preoperative administration of beta-blockers is associated with an increased risk of postoperative delirium after vascular surgery. Conversely, preoperative statin administration is associated with a lower risk of postoperative delirium. A randomized prospective controlled trial is required to validate these findings. RésuméObjectif De´terminer s'il existe un lien entre l'administration pe´riope´ratoire de beˆta-bloquants et le delirium postope´ratoire chez les patients subissant une chirurgie vasculaire.

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mentioning

confidence: 99%

Delirium following vascular surgery: increased incidence with preoperative β-blocker administration

Katznelson

Djaiani

Mitsakakis

et al. 2009

Can J Anesth/J Can Anesth

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“…The first papers were observational and were carried out in patients who were not treated with oxygen postoperatively [18,20]. At present, the postoperative period is one of the major indications for oxygen therapy; thus, studies evaluating the incidence of hypoxia episodes in patients who were not treated with oxygen are incidental.…”

Section: Discussionmentioning

confidence: 99%

“…Patients undergoing vascular procedures most commonly develop postoperative cardiac complications in the form of hypo-or hypertension, cardiac arrhythmias, circulatory failure or myocardial infarction; postoperative hypoxaemia is an additional factor that enhances the symptoms and deterioration prognosis [3,7,8,9,18,20].…”

Section: Discussionmentioning

confidence: 99%

Czy znieczulenie zewnątrzoponowe zmniejsza częstość incydentów desaturacji w okresie pooperacyjnym u chorych operowanych z powodu tętniaka aorty brzusznej?

Dylczyk-Sommer

Owczuk²,

Wujtewicz³

et al. 2015

Anaesthesiol Intensive Ther

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Background: Postoperative desaturation can lead to severe hypoxaemia and even tissue hypoxia, followed by cardiological and neurological complications. Opioid usage is the one of the most important risk factors of postoperative desaturation and hypoxemia. Epidural anaesthesia is recommended for vascular surgery for many reasons; the reduction or elimination of opioid doses is one reason. The aims of the study were to evaluate the incidence of desaturation episodes in patients after surgical procedures with abdominal aortic clamping, to determine whether the episodes in question lead to clinical symptoms of hypoxia and to determine whether epidural anaesthesia decreases the incidence of desaturation episodes. Methods: After abdominal aortic repair, 58 patients who did not have any respiratory disease, were classified as ASA II−III, and were aged from 46 to 80 years were observed in the ICU during spontaneous breathing with oxygen supplementation. Non-invasive O 2 saturation measurements were taken continuously, and all desaturation incidents (defined as O 2 saturation ≤ 93% for 4 min) were noted. Patients were divided into two equal groups: A -epidural blockade used after the operation for pain relief and B -intravenous opioids administered during the postoperative period. We evaluated and compared the desaturation frequency during the postoperative period. Results: Desaturation was observed among 26 (89%) patients in group A and 27 (93%) patients in group B. There were no statistical differences among the groups (P = 1.0). Severe hypoxemia (O 2 saturation ≤ 84%) was observed among 7 (24.1%) patients in group A and 10 patients in group B (34.5%) (P = 0.38). Clinical symptoms of hypoxia were similar in both groups (P = 1.0). Conclusions: Epidural anaesthesia did not protect against postoperative desaturation. Though oxygen therapy was used, desaturation was observed in approximately 90% of patients.

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“…4 Rates of delirium after major vascular surgery vary from 30% to more than 50%. [5][6][7][8] In this study, we compared the incidence of postoperative delirium in patients undergoing OPEN aortic aneurysm repair surgery with the incidence in patients undergoing the EVAR approach. We hypothesized that the EVAR approach would be associated with a reduced incidence of postoperative delirium.…”

Section: Résumémentioning

confidence: 99%

Endovascular versus open approach to aortic aneurysm repair surgery: rates of postoperative delirium

Salata

Katznelson

Beattie

et al. 2012

Can J Anesth/J Can Anesth

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Purpose Our objective was to compare open and endovascular aortic aneurysm repair with respect to postoperative delirium. Methods After Institutional Ethics Review Board approval, we conducted a retrospective review of all patients who underwent abdominal and thoraco-abdominal aortic aneurysm repair surgery at Toronto General Hospital during June 2006 to December 2007. Patients were classed into either the OPEN or the endovascular (EVAR) group based on the type of surgery and were assessed for the presence of delirium after surgery. The NEECHAM Confusion Scale and the validated chart review instrument were used for diagnosis of delirium. Patients with dementia and/or abnormal levels of consciousness preoperatively were excluded. Results There were 256 patients included in the study, 149 (58%) in the OPEN group and 107 (42%) in the EVAR group. Patients in the EVAR group were considerably older, 74 (10) yr vs 68 (9) RésuméObjectif Notre objectif e´tait de comparer la chirurgie de l'ane´vrysme de l'aorte par voie ouverte ou endovasculaire en termes de delirium postope´ratoire. Méthodes Apre`s avoir obtenu l'accord du comited 'e´thique de la recherche de l'e´tablissement, nous avons effectue´une analyse re´trospective de tous les patients ayant subi une re´paration chirurgicale d'un ane´vrysme de l'aorte thoraco-abdominale et abdominale a`l'hôpital ge´ne´ral de Toronto entre juin 2006 et de´cembre 2007. Les patients ont e´te´classe´s dans un groupe OUVERT (OPEN) ou dans le groupe endovasculaire (EVAR) selon le type de chirurgie; la survenue d'un delirium postope´ratoire a e´teŕ echerche´e. L'e´chelle de confusion de NEECHAM et l'instrument valide´d'analyse des dossiers ont e´te´utilise´s Author contributions Scott Beattie and George Djaiani contributed to the conception of the study. Rita Katznelson, Scott Beattie, Jo Carroll, Thomas Lindsay, and George Djaiani contributed to the study design. Scott Beattie took an active part in setting up the inclusion and exclusion criteria. George Djaiani supervised the acquisition, analysis, and interpretation of data. Konrad Salata participated in the analysis of data and drafted the first version of the manuscript. Konrad Salata, Rita Katznelson, and Thomas Lindsay were involved in the interpretation of the data.

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Risk factors and prevalence of perioperative cognitive dysfunction in abdominal aneurysm patients

Cited by 132 publications

References 21 publications

Delirium following vascular surgery: increased incidence with preoperative β-blocker administration

Delirium following vascular surgery: increased incidence with preoperative β-blocker administration

Czy znieczulenie zewnątrzoponowe zmniejsza częstość incydentów desaturacji w okresie pooperacyjnym u chorych operowanych z powodu tętniaka aorty brzusznej?

Endovascular versus open approach to aortic aneurysm repair surgery: rates of postoperative delirium

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