Voie d’abord endovasculaire contre voie d’abord ouverte pour la chirurgie de l’anévrysme de l’aorte: incidence de delirium postopératoire

Salata, Konrad; Katznelson, Rita; Beattie, W. Scott; Carroll, Jo; Lindsay, Thomas F.; Djaiani, George

doi:10.1007/s12630-012-9695-7

Cited by 43 publications

(28 citation statements)

References 16 publications

(13 reference statements)

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“…Various studies on outcome after endovascular aneurysm repair compared with open aneurysm repair report significantly lower rates of POD in favor of endovascular aneurysm repair. 25,30,31 Finally, we included only patients subjected to elective procedures, whereas emergency surgery is a known risk factor for POD. 16 In this study, we identified cognitive impairment, open aortic surgery or amputation surgery, current smoking, hypertension, and age $80 years as independent risk factors for the occurrence of POD.…”

Section: Discussionmentioning

confidence: 99%

Predicting postoperative delirium after vascular surgical procedures

Visser

Prent

Laan

et al. 2015

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Predicting postoperative delirium after vascular surgical procedures

Visser

Prent

Laan

et al. 2015

Journal of Vascular Surgery

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“…57,60–65 In addition, open versus endovascular surgery, emergency versus elective surgery, increased blood transfusion and increased surgical duration all have increased surgical burden and increased risk of POD. 60–62,65–68 Specific to cardiac surgery, balloon pump support, valve surgery and prolonged cardiopulmonary bypass also increase the risk of POD, 65,69–71 whereas conflicting evidence exists as to whether off-pump coronary bypass is protective or carries the same risk of POD as on-pump coronary bypass. 72,73 …”

Section: Risk Factors For Podmentioning

confidence: 99%

Epidemiology and risk factors for delirium across hospital settings

Vasilevskis

Han

Hughes

et al. 2012

Best Practice & Research Clinical Anaesthesiology

284

220

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Delirium is one of the most common causes of acute end-organ dysfunction across hospital settings, occurring in as high as 80% of critically ill patients that require intensive care unit (ICU) care. The implications of this acute form of brain injury are profound. Across many hospital settings (emergency department, general medical ward, postoperative and ICU), a patient who experiences delirium is more likely to experience increased short- and long-term mortality, decreases in long-term cognitive function, increases in hospital length of stay and increased complications of hospital care. With the development of reliable setting-specific delirium-screening instruments, researchers have been able to highlight the predisposing and potentially modifiable risk factors that place patients at highest risk. Among the large number of risk factors discovered, administration of potent sedative medications, most notably benzodiazepines, is most consistently and strongly associated with an increased burden of delirium. Alternatively, in both the hospital and ICU, delirium can be prevented with the application of protocols that include early mobility/exercise. Future studies must work to understand the epidemiology across settings and focus upon modifiable risk factors that can be integrated into existing delirium prevention and treatment protocols.

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“…Independent predictors of delirium include older age, history of cerebrovascular accident and pre-operative beta-adrenoceptor antagonist administration [120]. Endovascular repair of AAA was associated with significantly lower postoperative delirium when compared with an open approach, irrespective of age [121].…”

Section: Postoperative Managementmentioning

confidence: 94%

Anaesthesia for vascular emergencies

Ellard¹,

Djaiani

2012

Anaesthesia

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SummaryPatients presenting with vascular emergencies including acute aortic syndrome, ruptured thoracic or abdominal aortic aneurysms, thoracic aortic trauma and acute lower limb ischaemia have a high risk of peri-operative morbidity and mortality. Although anatomical suitability is not universal, endovascular surgery may improve mortality and the results of ongoing randomised controlled trials are awaited. Permissive hypotension pre-operatively should be the standard of care with the systolic blood pressure kept to 50-100 mmHg as long as consciousness is maintained. The benefit of local anaesthesia over general anaesthesia is not definitive and this decision should be tailored for a given patient and circumstance. Cerebrospinal fluid drainage for prevention of paraplegia is often impractical in the emergency setting and is not backed by strong evidence; however, it should be considered postoperatively if symptoms develop. We discuss the pertinent anaesthetic issues when a patient presents with a vascular emergency and the impact that endovascular repair has on anaesthetic management. In-hospital mortality after open repair of ruptured abdominal aortic aneurysm (rAAA) approaches 40-50% with total mortality, including pre-hospital deaths, closer to 80% [1][2][3]. Traumatic thoracic aortic injury is often immediately fatal with a 30-40% mortality in those who arrive alive to hospital and an overall mortality of 90% [4]. Thirty-day mortality rates are > 50% following ruptured thoracic aneurysm [5], 13% for acute type B dissection [6] and > 25% following embolectomy for acute limb ischaemia [7,8].We define a 'vascular emergency', for the purpose of this review, as an acute condition requiring intervention within hours, involving the descending aorta and its main lower limb branches. Specific pathologies meeting these criteria include acute aortic syndrome, ruptured thoracic and abdominal aneurysms, traumatic injuries of the thoracic aorta and acute lower limb ischaemia. Pathology involving the ascending aorta or aortic arch that is generally managed by cardiac surgeons is excluded.This review aims to discuss the optimal anaesthetic management to minimise morbidity and mortality and the impact of a move towards endovascular repair. An English language electronic search using Medline and Embase databases identified relevant scientific literature from the last 10 years and was supplemented with a manual search of reference lists from reviewed articles. Overview of vascular emergenciesAcute aortic syndrome Acute aortic syndrome consists of three interrelated conditions: penetrating atherosclerotic ulcer; intramural haematoma; and aortic dissection. Penetrating athero-

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Voie d’abord endovasculaire contre voie d’abord ouverte pour la chirurgie de l’anévrysme de l’aorte: incidence de delirium postopératoire

Cited by 43 publications

References 16 publications

Predicting postoperative delirium after vascular surgical procedures

Predicting postoperative delirium after vascular surgical procedures

Epidemiology and risk factors for delirium across hospital settings

Anaesthesia for vascular emergencies

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