Breaking News
May 3, 2019 - Vaping and Smoking May Signal Greater Motivation to Quit
May 3, 2019 - Dementia looks different in brains of Hispanics
May 3, 2019 - Short-Staffed Nursing Homes See Drop In Medicare Ratings
May 3, 2019 - Study of teens with eating disorders explores how substance users differ from non-substance users
May 3, 2019 - Scientists develop new video game that may help in the study of Alzheimer’s
May 3, 2019 - Arc Bio introduces Galileo Pathogen Solution product line at ASM Clinical Virology Symposium
May 3, 2019 - Cornell University study uncovers relationship between starch digestion gene and gut bacteria
May 3, 2019 - How to Safely Use Glucose Meters and Test Strips for Diabetes
May 3, 2019 - Anti-inflammatory drugs ineffective for prevention of Alzheimer’s disease
May 3, 2019 - Study tracks Pennsylvania’s oil and gas waste-disposal practices
May 3, 2019 - Creating a better radiation diagnostic test for astronauts
May 3, 2019 - Vegans are often deficient in these four nutrients
May 3, 2019 - PPDC announces seed grants to develop medical devices for children
May 3, 2019 - Study maps out the frequency and impact of water polo head injuries
May 3, 2019 - Research on Reddit identifies risks associated with unproven treatments for opioid addiction
May 3, 2019 - Good smells may help ease tobacco cravings
May 3, 2019 - Medical financial hardship found to be very common among people in the United States
May 3, 2019 - Researchers develop multimodal system for personalized post-stroke rehabilitation
May 3, 2019 - Study shows significant mortality benefit with CABG over percutaneous coronary intervention
May 3, 2019 - Will gene-editing of human embryos ever be justifiable?
May 3, 2019 - FDA Approves Dengvaxia (dengue vaccine) for the Prevention of Dengue Disease in Endemic Regions
May 3, 2019 - Why Tonsillitis Keeps Coming Back
May 3, 2019 - Fighting the opioid epidemic with data
May 3, 2019 - Maggot sausages may soon be a reality
May 3, 2019 - Deletion of ATDC gene prevents development of pancreatic cancer in mice
May 2, 2019 - Targeted Therapy Promising for Rare Hematologic Cancer
May 2, 2019 - Alzheimer’s disease is a ‘double-prion disorder,’ study shows
May 2, 2019 - Reservoir bugs: How one bacterial menace makes its home in the human stomach
May 2, 2019 - Clinical, Admin Staff From Cardiology Get Sneak Peek at Epic
May 2, 2019 - Depression increases hospital use and mortality in children
May 2, 2019 - Vicon and NOC support CURE International to create first gait lab in Ethiopia
May 2, 2019 - Researchers use 3D printer to make paper organs
May 2, 2019 - Viral infection in utero associated with behavioral abnormalities in offspring
May 2, 2019 - U.S. Teen Opioid Deaths Soaring
May 2, 2019 - Opioid distribution data should be public
May 2, 2019 - In the Spotlight: “I’m learning every single day”
May 2, 2019 - 2019 Schaefer Scholars Announced
May 2, 2019 - Podcast: KHN’s ‘What The Health?’ Bye-Bye, ACA, And Hello ‘Medicare-For-All’?
May 2, 2019 - Study describes new viral molecular evasion mechanism used by cytomegalovirus
May 2, 2019 - SLU study suggests a more equitable way for Medicare reimbursement
May 2, 2019 - Scientists discover first gene involved in lower urinary tract obstruction
May 2, 2019 - Researchers identify 34 genes associated with increased risk of ovarian cancer
May 2, 2019 - Many low-income infants receive formula in the first few days of life, finds study
May 2, 2019 - Global study finds high success rate for hip and knee replacements
May 2, 2019 - Taking depression seriously: What is it?
May 2, 2019 - With Head Injuries Mounting, Will Cities Put Their Feet Down On E-Scooters?
May 2, 2019 - Scientists develop small fluorophores for tracking metabolites in living cells
May 2, 2019 - Study casts new light into how mothers’ and babies’ genes influence birth weight
May 2, 2019 - Researchers uncover new brain mechanisms regulating body weight
May 2, 2019 - Organ-on-chip systems offered to Asia-Pacific regions by Sydney’s AXT
May 2, 2019 - Adoption of new rules drops readmission penalties against safety net hospitals
May 2, 2019 - Kids and teens who consume zero-calorie sweetened beverages do not save calories
May 2, 2019 - Improved procedure for cancer-related erectile dysfunction
May 2, 2019 - Hormone may improve social behavior in autism
May 2, 2019 - Alzheimer’s disease may be caused by infectious proteins called prions
May 2, 2019 - Even Doctors Can’t Navigate Our ‘Broken Health Care System’
May 2, 2019 - Study looks at the impact on criminal persistence of head injuries
May 2, 2019 - Honey ‘as high in sugars as table sugar’
May 2, 2019 - Innovations to U.S. food system could help consumers in choosing healthy foods
May 2, 2019 - FDA Approves Mavyret (glecaprevir and pibrentasvir) as First Treatment for All Genotypes of Hepatitis C in Pediatric Patients
May 2, 2019 - Women underreport prevalence and intensity of their own snoring
May 2, 2019 - Concussion summit focuses on science behind brain injury
May 2, 2019 - Booker’s Argument For Environmental Justice Stays Within The Lines
May 2, 2019 - Cornell research explains increased metastatic cancer risk in diabetics
May 2, 2019 - Mount Sinai study provides fresh insights into cellular pathways that cause cancer
May 2, 2019 - Researchers to study link between prenatal pesticide exposures and childhood ADHD
May 2, 2019 - CoGEN Congress 2019: Speakers’ overviews
May 2, 2019 - A new strategy for managing diabetic macular edema in people with good vision
May 2, 2019 - Sagent Pharmaceuticals Issues Voluntary Nationwide Recall of Ketorolac Tromethamine Injection, USP, 60mg/2mL (30mg per mL) Due to Lack of Sterility Assurance
May 2, 2019 - Screen time associated with behavioral problems in preschoolers
May 2, 2019 - Hormone reduces social impairment in kids with autism | News Center
May 2, 2019 - Researchers synthesize peroxidase-mimicking nanozyme with low cost and superior catalytic activity
May 2, 2019 - Study results of a potential drug to treat Type 2 diabetes in children announced
May 2, 2019 - Multigene test helps doctors to make effective treatment decisions for breast cancer patients
May 2, 2019 - UNC School of Medicine initiative providing unique care to dementia patients
May 2, 2019 - Nestlé Health Science and VHP join forces to launch innovative COPES program for cancer patients
May 2, 2019 - Study examines how our brain generates consciousness and loses it during anesthesia
May 2, 2019 - Transition Support Program May Aid Young Adults With Type 1 Diabetes
May 2, 2019 - Study shows how neutrophils exacerbate atherosclerosis by inducing smooth muscle-cell death
May 2, 2019 - Research reveals complexity of how we make decisions
Lighter sedation fails to reduce risk of postoperative delirium in older patients

Lighter sedation fails to reduce risk of postoperative delirium in older patients

Johns Hopkins Medicine researchers say a study designed to see if reducing the amount of anesthesia reduces the risk of postoperative delirium in older patients surprisingly found that lighter sedation failed to do so in severely ill people undergoing hip fracture repair.

But the study of 200 men and women also showed that for those in relatively better health, deep sedation more than doubled the risk of postoperative delirium compared with those having light sedation.

“Contrary to what we expected, sedation levels do not appear to affect postoperative delirium for sicker patients,” says Frederick Sieber, M.D., professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, and the study’s first author.

A report of the findings, published Aug. 8 in JAMA Surgery, underscores the need for tailoring the amount and type of anesthesia to each individual’s overall health status, the study leaders say.

“These findings add to growing evidence that clinicians must match sedation levels to each patient’s health, especially in the management of older surgical patients, and must work to optimize each person’s health before surgery if possible,” he adds, “especially those with heart and blood vessel disease, and diabetes.”

Postoperative delirium–marked by usually reversible memory disturbances, confusion and hallucinations–has long been observed as a too-frequent outcome of surgery in older patients. Levels of anesthesia, Sieber says, have been seen as one potentially modifiable risk factor in efforts to prevent the condition, or reduce its duration and impact.

To explore that idea further, Sieber and colleagues examined the effects of two levels of anesthesia on delirium risk in patients getting a hip fracture repair, a common procedure performed an estimated 200,000 to 300,000 times each year in the United States, mainly on older, debilitated patients.

Sieber says of the many complications that can result from this operation, delirium is the most common, affecting an average 35 percent of all patients.

For the study, Sieber and his team designed a double-blind randomized trial called A Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients (STRIDE). Between Nov. 18, 2011, and May 19, 2016, 200 patients at The Johns Hopkins Hospital undergoing a hip fracture repair were randomly assigned (100 each in two groups) to receive either deep sedation (the common practice for this procedure in which the patient is unconscious) or lighter sedation (in which patient is sedated and may be sleeping, but will respond if spoken to) for the study.

The researchers followed up each patient for symptoms of delirium for one to five days postoperation or until hospital discharge, as well as for 30 days postoperatively overall. They gathered information about not only delirium, but also other outcomes such as intensive care unit admission rates, opioid consumption and pain scores.

The average age of the STRIDE study participants was 82 years. Of the 200 participants, 146 (73 percent) were women, 194 (97 percent) were white and the average Charlson Comorbidity Index (CCI) score was 1.8. The CCI score is a measure of estimated survival over the next 10 years and is calculated by the presence of 17 so-called comorbidities such as liver disease, diabetes and AIDS.

Each comorbidity is assigned a weight based on the statistical risk of death over a decade; the higher a person’s total score, the greater risk of death. A score of zero does not mean that someone is completely healthy, but that they do not have any of the 17 severe, predefined comorbidities used for CCI score calculation.

Overall, the researchers report, 39 percent of patients who received deep sedation had a postoperative delirium diagnosis one to five days after surgery, while the incidence of delirium was 34 percent in the light sedation group, a difference considered statistically insignificant.

However, after accounting for comorbidities–that is, how sick in general patients were–the researchers found that patients who had a baseline CCI score of zero were 2.3 times more likely to experience postoperative delirium if they received deeper sedation.

Additionally, the researchers found that a history of vascular comorbidities, particularly those included in the CCI such as strokes, severe diabetes and heart attacks were most associated with postoperative delirium.

Sieber says it is unclear why less sedation failed to reduce the risk of delirium in the sickest patients, as this was not what we expected. However, it is possible that they did not account for other factor(s) associated with delirium in the subgroup of sickest patients that may have masked the benefits of lighter sedation.

He says more research must be done to confirm his team’s findings, but moving forward with the new information in hand, he believes caregivers must focus on helping certain subsets of patients with vascular disease particularly get as healthy as possible before operation.

Source:

https://www.hopkinsmedicine.org/news/media/releases/surprise_finding_for_very_sick_elderly_lighter_sedation_wont_drop_risk_of_postoperative_delirium_study_suggests

Tagged with:

About author

Related Articles