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 Light sedation with propofol may reduce delirium 
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Light sedation with propofol may reduce delirium
(Kim mentioned she had seen a recent article on the use of anesthesia. Perhaps this is it. Not sure since there are so many.)

http://www.newswise.com/articles/mayo-c ... y-patients


Decrease in Postoperative Delirium in Elderly Patients
Released: 1/18/2010 10:30 AM EST
Source: Mayo Clinic

Newswise — A recent study, published in the January issue of Mayo Clinic Proceedings, demonstrates that in elderly patients undergoing hip fracture repair under spinal anesthesia with propofol sedation, the prevalence of delirium can be decreased by 50 percent with light sedation, compared to deep sedation.

“These data show that, for every 3.5 to 4.7 patients treated in this manner, one incident of delirium will be prevented,” says Frederick Sieber, M.D., primary investigator of the study from the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine in Baltimore. “Therefore, interventions capable of reducing the occurrence of postoperative delirium would be important from a public health perspective.”

Several demographic and perioperative variables are associated with postoperative delirium in elderly patients after hip fracture repair. The most important is preoperative dementia. Other risk factors for postoperative delirium include age, systemic disease and functionality. Inhalational and intravenous anesthetics, opioids, benzodiazepines and anticholinergic drugs are all known or suspected risk factors for postoperative delirium.

Although postoperative delirium usually resolves within 48 hours of onset, delirium can persist and is associated with poor functional recovery, increased length of stay in hospitals, higher costs, and greater likelihood of placement in an assisted-living facility after surgery.

In addition to decreasing the prevalence of delirium, lighter sedation in this group of elderly surgical patients was associated with a reduction in delirium that averaged almost one day for each patient in the light sedation group. The effects of lighter sedation were observed in patients with or without preoperative cognitive dysfunction.

Limiting depth of sedation during spinal anesthesia is a simple, safe and cost-effective intervention for preventing postoperative delirium in elderly patients that could be widely and readily adopted, say Dr. Sieber.
A peer-reviewed journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally. Articles are available online at www.mayoclinicproceedings.com.

About Mayo Clinic
Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. Doctors from every medical specialty work together to care for patients, joined by common systems and a philosophy of “the needs of the patient come first.” More than 3,700 physicians, scientists and researchers and 50,100 allied health staff work at Mayo Clinic, which has sites in Rochester, Minn., Jacksonville, Fla., and Scottsdale/Phoenix, Ariz. Collectively, the three locations treat more than half a million people each year. To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. For information about research and education visit www.mayo.edu. MayoClinic.com (www.mayoclinic.com) is available as a resource for your health stories.


Mon Mar 01, 2010 12:25 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
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Here's the abstract for the study:

Sedation Depth During Spinal Anesthesia and the Development of Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Repair

Frederick E. Sieber, MD, Khwaji J. Zakriya, MBBS, Allan Gottschalk, MD, PhD, Mary-Rita Blute, RN, Hochang B. Lee, MD, Paul B. Rosenberg, MD and Simon C. Mears, MD, PhD

From the Department of Anesthesiology & Critical Care Medicine (F.E.S., K.J.Z., A.G., M.-R.B.), Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry (H.B.L., P.B.R.), and Orthopaedic Surgery (S.C.M.), Johns Hopkins Medical Institutions, Baltimore, MD

Abstract

OBJECTIVE: To determine whether limiting intraoperative sedation depth during spinal anesthesia for hip fracture repair in elderly patients can decrease the prevalence of postoperative delirium.

PATIENTS AND METHODS: We performed a double-blind, randomized controlled trial at an academic medical center of elderly patients (≥65 years) without preoperative delirium or severe dementia who underwent hip fracture repair under spinal anesthesia with propofol sedation. Sedation depth was titrated using processed electroencephalography with the bispectral index (BIS), and patients were randomized to receive either deep (BIS, approximately 50) or light (BIS, ≥80) sedation. Postoperative delirium was assessed as defined by Diagnostic and Statistical Manual of Mental Disorders (Third Edition Revised) criteria using the Confusion Assessment Method beginning at any time from the second day after surgery.

RESULTS: From April 2, 2005, through October 30, 2008, a total of 114 patients were randomized. The prevalence of postoperative delirium was significantly lower in the light sedation group (11/57 [19%] vs 23/57 [40%] in the deep sedation group; P=.02), indicating that 1 incident of delirium will be prevented for every 4.7 patients treated with light sedation. The mean ± SD number of days of delirium during hospitalization was lower in the light sedation group than in the deep sedation group (0.5±1.5 days vs 1.4±4.0 days; P=.01).

CONCLUSION: The use of light propofol sedation decreased the prevalence of postoperative delirium by 50% compared with deep sedation. Limiting depth of sedation during spinal anesthesia is a simple, safe, and cost-effective intervention for preventing postoperative delirium in elderly patients that could be widely and readily adopted.

Trial Registration: clinicaltrials.gov Identifier: NCT00590707

© 2010 Mayo Foundation for Medical Education and Research


Mon Mar 01, 2010 12:42 pm
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