BACKGROUND\nAntipsychotic therapy is widely used to treat behavioral problems in older adults with dementia. Cohort studies evaluating the safety of antipsychotic therapy generally focus on a single adverse event. We compared the rate of developing any serious event, a composite outcome defined as an event serious enough to lead to an acute care hospital admission or death within 30 days of initiating antipsychotic therapy, to better estimate the overall burden of short-term harm associated with these agents.\n\n\nMETHODS\nIn this population-based, retrospective cohort study, we identified 20 682 matched older adults with dementia living in the community and 20 559 matched individuals living in a nursing home between April 1, 1997, and March 31, 2004. Propensity-based matching was used to balance differences between the drug exposure groups in each setting. To examine the effects of antipsychotic drug use on the composite outcome of any serious event we used a conditional logistic regression model. We also estimated adjusted odds ratios using models that included all covariates with a standard difference greater than 0.10.\n\n\nRESULTS\nRelative to those who received no antipsychotic therapy, community-dwelling older adults newly dispensed an atypical antipsychotic therapy were 3.2 times more likely (95% confidence interval, 2.77-3.68) and those who received conventional antipsychotic therapy were 3.8 times more likely (95% confidence interval, 3.31-4.39) to develop any serious event during the 30 days of follow-up. The pattern of serious events was similar but less pronounced among older adults living in a nursing home.\n\n\nCONCLUSIONS\nSerious events, as indicated by a hospital admission or death, are frequent following the short-term use of antipsychotic drugs in older adults with dementia. Antipsychotic drugs should be used with caution even when short-term therapy is being prescribed.

Antipsychotic Therapy and Short-term Serious Events in Older Adults With Dementia.

Background
Most previous studies on the efficacy of antipsychotic medication for the treatment of delirium have reported that there is no significant difference between typical and atypical antipsychotic medications. It is known, however, that older age might be a predictor of poor response to antipsychotics in the treatment of delirium. The objective of this study was to compare the efficacy and safety of haloperidol versus three atypical antipsychotic medications (risperidone, olanzapine, and quetiapine) for the treatment of delirium with consideration of patient age.

https://ir.ymlib.yonsei.ac.kr/bitstream/22282913/88080/1/T201303443.pdf

Efficacy and safety of haloperidol versus atypical antipsychotic medications in the treatment of delirium

BACKGROUND It is unclear whether intraoperative arterial hypotension is associated with postoperative delirium. We hypothesized that intraoperative hypotension within a range frequently observed in clinical practice is associated with increased odds of delirium after surgery. METHODS Adult noncardiac surgical patients undergoing general anesthesia at 2 academic medical centers between 2005 and 2017 were included in this retrospective cohort study. The primary exposure was intraoperative hypotension, defined as the cumulative duration of an intraoperative mean arterial pressure (MAP) 30% from baseline and postoperative delirium. Multivariable logistic regression adjusted for patient- and procedure-related factors, including demographics, comorbidities, and markers of procedural severity, was used. RESULTS Among 316,717 included surgical patients, 2183 (0.7%) were diagnosed with delirium within 30 days after surgery; 41.7% and 2.6% of patients had a MAP 3 hours: ORadj, 1.40; 95% CI, 1.23-1.61; P 30% from baseline was not associated with postoperative delirium compared to no hypotension, also when additionally adjusted for the cumulative duration of a MAP 30%: ORadj, 1.13; 95% CI, 0.91-1.40; P = .262 and prolonged duration of MAP decrease >30%: ORadj, 1.19; 95% CI, 0.95-1.49; P = .141). CONCLUSIONS In patients undergoing noncardiac surgery, a MAP <55 mm Hg was associated with a duration-dependent increase in odds of postoperative delirium. This association was magnified in patients who underwent surgery of long duration.

Association Between Intraoperative Arterial Hypotension and Postoperative Delirium After Noncardiac Surgery: A Retrospective Multicenter Cohort Study.

Perioperative neurocognitive disorders (NCDs) refer to neurocognitive abnormalities detected during the perioperative periods, including preexisting cognitive impairment, preoperative delirium, delirium occurring up to 7 days after surgery, delayed neurocognitive recovery, and postoperative NCD. The Diagnostic and Statistical Manual of Mental Disorders‐5th edition (DSM‐5) is the golden standard for diagnosing perioperative NCDs. Given the impracticality of using the DSM‐5 by non‐psychiatric practitioners, many diagnostic tools have been developed and validated for different clinical scenarios. The etiology of perioperative NCDs is multifactorial and includes predisposing and precipitating factors. Identifying these risk factors is conducive to preoperative risk stratification and perioperative risk reduction. Prevention for perioperative NCDs should include avoiding possible contributors and implementing nonpharmacologic and pharmacological interventions. The former generally includes avoiding benzodiazepines, anticholinergics, prolonged liquid fasting, deep anesthesia, cerebral oxygen desaturation, and intraoperative hypothermia. Nonpharmacologic measures include preoperative cognitive prehabilitation, comprehensive geriatric assessment, implementing fast‐track surgery, combined use of regional block, and sleep promotion. Pharmacological measures including dexmedetomidine, nonsteroidal anti‐inflammatory drugs, and acetaminophen are found to have beneficial effects. Nonpharmacological treatments are the first‐line measures for established perioperative NCDs. Pharmacological treatments are still limited to severely agitated or distressed patients.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/cns.13873

Perioperative neurocognitive disorders: A narrative review focusing on diagnosis, prevention, and treatment

Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery: A prospective cohort clinical trial.

Summary Postoperative delirium is a relatively common and serious complication. It increases hospital stay by 2–3 days and is associated with a 30-day mortality of 7–10%. It is most prevalent in older patients, those with existing neurocognitive disorders, and those undergoing complex or emergency procedures. Preclinical and clinical research in recent years has uncovered more about the pathophysiology of postoperative delirium and may yield more potential therapeutic options. Using the enhanced recovery pathway framework of risk stratification, risk reduction, and rescue treatment, we have reviewed the current clinical evidence on the validity of delirium prediction scores for the surgical population, the effectiveness of perioperative delirium risk reduction interventions, and management options for established delirium. Effective perioperative interventions include depth of anaesthesia monitoring, intraoperative dexmedetomidine infusion, and multimodal analgesia. Choice of general anaesthetic agent may not be associated with significant difference in delirium risk. Several other factors, such as preoperative fasting, temperature control, and blood pressure management have some association with the risk of postoperative delirium; these will require further studies. Because of the limited treatment options available for established delirium, we propose that risk assessment and perioperative risk reduction may be the most effective approaches in managing postoperative delirium.

Postoperative delirium: perioperative assessment, risk reduction, and management

OBJECTIVE
To evaluate the effects of high-quality nursing intervention on negative emotions, postoperative complications and gastrointestinal function of patients underwent gastric cancer (GC) surgery.


METHODS
From November 2017 to February 2019, a total of 164 GC patients who underwent operative treatment in our hospital were selected as the research subjects. Thereinto, 86 patients were given high-quality nursing intervention (research group, RG), and the other 78 received routine nursing intervention (control group, CG). The hospitalization time, expenses and the incidence of postoperative complications were compared between the two groups. After operation, the gastrointestinal function, negative emotions, postoperative pain, quality of life, nursing satisfaction, and ESCA and PSQI scores were compared between the two groups.


RESULTS
The hospitalization time was significantly shorter and expenses were obviously lower in patients of the RG than those in the CG. The incidence of postoperative complications in the RG was obviously lower than that in the CG. The gastrointestinal function indexes (time to anal exhaust, time to defecation, time to start eating, recovery time of bowel sounds, indwelling time of gastric tube, time of getting out of bed) of patients in the RG were obviously better. The SAS, SDS, PSQI scores and VAS scores at 24 h after operation of patients in the RG were obviously lower than those in the CG. The score of quality of life, scores of ESCA and nursing satisfaction of patients in the RG were obviously higher than those in the CG.


CONCLUSION
High-quality nursing intervention can dramatically improve negative emotions, reduce postoperative complications, ameliorate sleep quality, enhance self-care ability, relieve postoperative pain and improve quality of life and nursing satisfaction for patients undergoing GC surgery.

Effects of high-quality nursing intervention on negative emotions, postoperative complications and gastrointestinal function in patients with gastric cancer surgery.

Dexmedetomidine (DEX) has a pharmacological profile that should allow rapid recovery and prevent undesirable outcomes such as pulmonary complications.This large retrospective study compared the beneficial effects of perioperative infusion of DEX with propofol on the postoperative outcome after coronary artery bypass graft surgery. We reviewed patients' medical notes at Luoyang Central Hospital from 1st January 2012 to 31st December 2019. All continuous variables, if normally distributed, were presented as mean ± SD; Otherwise, the non-normally distributed data and categorical data were presented as median (25-75 IQR) or number (percentage). The Mann-Whitney U test and Chi-square test were used to evaluate the difference of variables between the DEX and propofol groups. Multivariate logistic regression analysis was performed on the main related and differential factors in the perioperative period.A total of 1388 patients were included in the study; of those, 557 patients received propofol infusion, and 831 patients received dexmedetomidine. DEX significantly reduced postoperative pulmonary complications compared with propofol, 7.82% vs 13.29%; P < 0.01, respectively. When compared with propofol, DEX significantly shortened the duration of mechanical lung ventilation, 18 (13,25) hours vs 21 (16,37) hours; P < 0.001, the length of stay in the intensive care unit, 51 (42,90) vs 59 (46,94.5) hours; P = 0.001 and hospital stay, 20 (17,24) vs 22 (17,28) days; P < 0.001, respectively. The incidences of postoperative wound dehiscence and infection were significantly reduced with DEX compared with propofol groups, 2.53% vs 6.64%; P < 0.001, respectively. Interestingly, patients receiving DEX had significantly shorter surgical time compared to propofol; 275 (240,310) vs 280 (250,320) minutes respectively (P = 0.005) and less estimated blood loss (P = 0.001).Perioperative infusion of dexmedetomidine improved the desirable outcomes in patients who had coronary artery bypass graft surgery compared with propofol. 

https://bmcanesthesiol.biomedcentral.com/track/pdf/10.1186/s12871-022-01589-6

Comparison between dexmedetomidine and propofol on outcomes after coronary artery bypass graft surgery: a retrospective study

: To explore the application of meticulous and predictive management in pediatric emergency nursing. 280 pediatric patients were randomly divided into observation group and control group according to time, with 140 children in each group. There were 95 women and 45 men in the observation group, and 82 women and 58 men in the control group. The control group was given routine nursing, while the observation group was given meticulous and predictable management. The results were statistically analyzed using SPSS 22.0 software. The management quality of the observation group in business assessment, safety management, management records and basic management was much higher than that of the control group, with statistical significance (P<0.05). The nursing satisfaction of the observation group was significantly higher than that of the control group (P<0.05). And the incidence of risk events in the observation group was significantly lower than that in the control group, and the difference was statistically significant (P<0.05). The application of meticulous and predictive management in pediatric emergency nursing can effectively improve the comprehensive quality of nursing staff, improve the quality and safety of nursing, and reduce the incidence of adverse events, which has wide clinical promotion value.

Jie Hu

Papers

Postoperative delirium: perioperative assessment, risk reduction, and management

Effects of high-quality nursing intervention on negative emotions, postoperative complications and gastrointestinal function in patients with gastric cancer surgery.

Comparison between dexmedetomidine and propofol on outcomes after coronary artery bypass graft surgery: a retrospective study

Study on the Application of Meticulous and Predictive Management in Pediatric Emergency Nursing