The efficacy of peri-operative interventions to decrease postoperative delirium in non-cardiac surgery: a systematic review and meta-analysis.

Z. Moyce Registrar, et al

Anaesthesia

Volume 69, Issue 3, pages 259–269, March 2014

Meta-analysis revealed that peri-operative geriatric consultation (OR 0.46, 95% CI 0.32–0.67) and lighter anaesthesia (OR 2.66, 95% CI 1.27–5.56) were associated with a decreased incidence of postoperative delirium. For the other interventions, the point estimate suggested possible protection with prophylactic haloperidol (OR 0.62, 95% CI 0.36–1.05), bright light therapy (OR 0.20, 95% CI 0.03–1.19) and general as opposed to regional anaesthesia (OR 0.76, 95% CI 0.47–1.23). This meta-analysis has shown that peri-operative geriatric consultations with multicomponent interventions and lighter anaesthesia are potentially effective in decreasing the incidence of postoperative delirium

Pharyngeal Function and Breathing Pattern during Partial Neuromuscular Block in the Elderly: Effects on Airway Protection

Cedborg, Anna I. Hårdemark M.D.; Sundman, Eva M.D., Ph.D.; Bodén, Katarina M.D., Ph.D.; Hedström, Hanne Witt M.D., Ph.D.; Kuylenstierna, Richard M.D., Ph.D.; Ekberg, Olle M.D., Ph.D.; Eriksson, Lars I. M.D., Ph.D., F.R.C.A.

 

Anesthesiology:

February 2014 - Volume 120 - Issue 2 - p 312–325

Incidence of swallowing dysfunction increased more than double during partial neuromuscular block in healthy elderly individuals without impairment of coordination between swallowing and breathing. Reduced upper esophageal sphincter tone did not recover even at the train-of-four ratio of 0.9. 

Sedation Depth During Spinal Anesthesia and Survival in Elderly Patients Undergoing Hip Fracture Repair   Brown, Charles H. IV MD MHS; Azman, Andrew S. MS; Gottschalk, Allan MD, PhD Mears, Simon C. MD, PhD; Sieber, Frederick E. MD

Anesthesia & Analgesia:

May 2014 - Volume 118 - Issue 5 - p 977–980

Low intraoperative Bispectral Index (BIS) values may be associated with increased mortality. Among all patients, mortality was equivalent across sedation groups. However, among patients with serious comorbidities (Charlson score >4), 1-year mortality was reduced in the light (22.2%) vs deep (43.6%) sedation group (hazard ratio [HR], 0.43; 95% confidence interval, 0.19–0.97; P = 0.04) during spinal anesthesia. Similarly, among patients with Charlson score >6, 1-year mortality was reduced in the light (28.6%) vs deep (52.6%) sedation group (HR 0.33; 95% confidence interval, 0.12–0.94; P = 0.04) during spinal anesthesia.