Delirio posoperatorio en pacientes geriátricos sometidos a Anestesia General versus Neuroaxial, en dos hospitales de Quito - Ecuador
Postoperative delirium in geriatric patients subjected to general anesthesia, compared to those subjected to neuraxial anesthesia, in two hospitals of the city of Quito
Keywords:
Delirium, general anesthesia, neuraxial anesthesia, Confusion Assessment Method, older adultAbstract
Objective: To determine the prevalence of POD in patients from the age of 65 and over, 72 hours after undergoing surgery under general or neuraxial anesthesia. The assessment will be conducted using the Confusion Assessment Method (CAM) in two hospitals of the city of Quito. Methodology: This study had an epidemiological, observational, cross-sectional and analytical design that included 162 elderly patients
that met the study’s inclusion criteria. The data was collected throughout the period between August and September 2016. Results: The overall prevalence of POD in this study was 36.4% (n=59). General anesthesia was associated with an increased risk of delirium compared to neuraxial, the analysis found an adjusted OR of: 4.07 (95% CI: 1.89 - 9.33). In the multivariate analysis, the transfusion of blood components was strongly associated with the development of postoperative delirium, with an OR adj: 0.65 (95% CI: 0.24 - 1.64; p = 0.37). Interpretation: General anesthesia and transfusion of blood products were identified as independent risk factors for the development of postoperative delirium. Conclusions: Geriatric patients undergoing general anesthesia have four times the risk of triggering postoperative delirium than those undergoing surgery under neuraxial anesthesia. Blood transfusion is an independent risk factor for postoperative delirium.
Downloads
References
Sanders Robert D, Pandharipande Pratik P, Davidson Andrew J, Ma Daqing, Maze Mervyn. Anticipating and managing postoperative delirium and cognitive decline in adults. BMJ. 2011 JULIO; 343.
J. Steinmetz, V. Siersma, L. V. Kessing, L. S. Rasmussen. Is postoperative cognitive dysfunction a risk factor for dementia? A cohort follow-up study. British Journal of Anesthesia. 2012 diciembre; 110(1).
Kempton, James ; Kennedy, Maura ; Lengt, Jacqueline. Clinical Practice Guideline for Postoperative Delirium in Older Adults. Journal of the American Geriatrics Society. 2015. January; 63, Issue 1(1).
Inouye K, Robinson T. Postoperative Delirium in Older Adults: Best Practice Statement from the American Geriatrics Society. Journal of the American College of Surgeons. 2015 February; Volume 220(2).
Gonzales G, Ortiz J. Incidencia de delirium post-operatorio en mayores de 65 años. Centro de Investigación (CIHUS). 2012 AGOSTO; 12(2).
Inouye. Hospital Elder Life Program (HELP) for Prevention of Delirium. [Online].; 2014 [cited 2016 Febrero 12. Available from: http://www.hospitalelderlifeprogram.org/.
Center VUM. ICU delirium and cognitive Impairment study group. [Online].; 2016 [cited 2016 MARZO 5. Available from: http://www.icudelirium.org/.
Robinson TN, Raeburn CD, Tran ZV, Angles EM, Brenner LA, Moss M. Postoperative delirium in the elderly: risk factors and outcomes. Annals of Surgery. 2009 ENERO; 249(1).
Ansalon L, Catena F, Chattat R, Fortuna D, Franceschi C, Mascitti P. Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. British Journal of Surgery. British. 2010 FEBRERO; 97(2).
Moller DJ, Cluitmans P, Rassmussen L, Houx P. Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. The Lancet. 1998; 351(9106).
Tomaszewski. Biomarkers of Brain Damage and Postoperative Cognitive Disorders in Orthopedic Patients: An Update. BioMed Research International. 2015; 402959.
Martin H. Pathophysiology of postoperative delirium: systemic inflammation as a response to surgical trauma causes diffuse microcirculatory impairment. Medical Hipotheses. 2016 DICIEMBRE; 68(1).
Vega P Eduardo, Nazar J Claudio, Rattalino F Marcos, Pedemonte T Juan,Carrasco G Marcela. Delirium postoperatorio: una consecuencia del envejecimiento poblacional. Revista Médica de Chile. 2014 ABRIL; 142(4).
Rundshagen I. Postoperative Cognitive Dysfunction. Deutsches Ärzteblatt International. 2014 MAYO; II(2).
Deiner S, Silverstein J. Postoperative delirium and cognitive dysfunction. British Journal of Anesthesia. 2009 DICIEMBRE; 103(1).
Mason S, Noel-Storr A, Ritchie C. The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. Journal Alzheimer Disease. 2010 Agosto; 22.
Hao Zhang†, Yan Lu†, Meng Liu, Zui Zou, Long Wang, Feng-Ying Xu and Xue-Yin Shi. Strategies for prevention of postoperative delirium: a systematic review and meta-analysis of randomized trials. Critical Care. 2013 MARZO; 17(R47).
O. Tabatabaie, N. Matin A. Heidari A. Tabatabaie , A. Hadaegh. Spinal anesthesia reduces postoperative delirium in opium dependent. Acta Anaesth. Belg. 2015; 66(2).
Mason SENSARCW. The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. Journal Alzheimer Disease. 2010; 22(3).
TOH GW, SEMPLE. Anaesthesia and Hip fracture: A Review of the Current Literature Anaesthesia and Hip Fracture: A Review of the Current Literature. FANZCA. 2007 ENERO; 23(2).
Chantal J. Slor. Anesthesia and Postoperative Delirium in Older Adults Undergoing Hip Surgery. Journal of the American Geriatrics Society. 2011 JULIO; 59(7).
Tobar A. E, Abedrapo M, Godoy V. J, Romero P. C. Delirium postoperatorio. Una ventana hacia una mejoría de la calidad y seguridad en la atención de. Revista Chilena de Cirugía. 2012 JULIO; 64(3).
S. Rasmussen, T. Johnson, H. M. Kuipers, D. Kristensen, V. D. Siersma, P. Vila, J. Jolles, A. Papaioannou, H. Abildstrom, J. H. Silverstein, J. A. Bonal, J. Raeder, I. K. Nielsen, K. Korttila, L. Munoz, C. Dodds, C. D. Hanning and J. T. Moller. Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients ISPOCD2. Acta Anaesthesiol Scand. 2003 Mar; 47(3):260-6.
Neuman MD, Ellenberg, Sieber, Magaziner, Feng R, Carson JL. Regional versus General Anesthesia for Promoting Independence after Hip Fracture (REGAIN): protocol for a pragmatic, international multicentre trial. British Medical Journal. 2016; 6(11). https://www.ncbi.nlm.nih.gov/pubmed/27852723. (Último acceso 17 de Octubre del 2020).
Joyce Yeung1, Vanisha Patel, Rita Champaneria and Janine Dretzke. Regional versus general anaesthesia in elderly patients undergoing surgery for hip fracture: protocol for a systematic review. BioMed Central, Systematic Reviews, 2016; 5:66. https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-016-0246-0. (Último acceso 16 de Diciembre del 2018).
Jan Jakobsson, and Mark Z. Johnson. Perioperative regional anaesthesia and postoperative longer-term outcomes. F1000 Faculty Reviews. 2016; pg 1-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063036/. (Último acceso 17 de Octubre 2020).
Nicholas Davis, Melissa Lee, Albert Y. Lin, Lisa Lynch, Matthew Monteleone, Louise Falzon, Nighat Ispahany, and Susan Lei. Postoperative cognitive function following general versus regional anesthesia, a systematic review. The Journal of Neurosurgical Anesthesiology. 2014; 26(4): 369–376. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4156882/. (Último acceso 17 de Octubre del 2020).
Louise Ellard, Rita Katznelson, Marcin Wasowicz, Alan Ashworth, Jo Carroll, Thomas Lindsay, and George Djaiani. Type of Anesthesia and Postoperative Delirium After Vascular Surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2014; vol 28(3) pp 458–461. https://www.researchgate.net/publication/261219101_Type_of_Anesthesia_and_Postoperative_Delirium_After_Vascular_Surgery. (Último acceso 17 de Octubre del 2020).
Guo Y, Jia P, Zhang J, Wang X, Jiang H, Jiang W. Prevalence and risk factors of postoperative delirium in elderly hip fracture patients. Journal of International Medical Research. 2016; 44(2):317-27.
Matthias Behrends, Glen DePalma, Laura Sands, and Jacqueline Leung. Intraoperative Blood Transfusions are Associated with Early Postoperative Delirium in Older Patients. Journal of the American Geriatrics Society. 2013; 61(3): 365–370.
Elizabeth L. Whitlock, Matthias Behrends. Blood Transfusion and Postoperative Delirium. Current Anesthesiology Reports. 2015; Vol 5(1).
Pinar Soysal, Derya Kaya, Ahmet Turan Isik. Current Concepts in the Diagnosis, Pathophysiology, and Treatment of Delirium: A European Perspective. Current Geriatrics Reports. 2015, Vol 4(4). http://link.springer.com/article/10.1007/s13670-015-0142-9. (Último acceso 5 de Diciembre del 2018).
Raats JW, van Eijsden WA, Crolla RM, Steyerberg EW, van der Laan L. Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients. PLOS ONE. 2015; 10(8). https://www.ncbi.nlm.nih.gov/pubmed/26291459. (Último acceso 17 de Octubre del 2020).
Dalila Veiga 1, Clara Luis, Daniela Parente , Vera Fernandes , Miguela Botelho , Patricia Santos , Fernando Abelha. Postoperative Delirium in Intensive Care Patients: Risk Factors and Outcome. Revista Brasileña de Anestesiología. 2012; 62: 4: 469-483.
Alan J. Chaput, PharmD, Gregory L. Bryson. Postoperative delirium: risk factors and management: Continuing Professional Development. Canadian Journal of Anesthesia. 2012; 59:304–320.
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 Julia Yangari, Paúl Espinosa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The authors retain the copyright and guarantee the journal the right to be the first publication of the work as well as licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License that allows others to share the work with an acknowledgment of the authorship of the work and the initial publication in this magazine. Authors may separately establish additional agreements for the non-exclusive distribution of the version of the work published in the journal (for example, placing it in an institutional repository or publishing it in a book), with an acknowledgment of its initial publication in this journal.
La U Investiga by La U Investiga is licensed under a Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional License.You can find permissions beyond those granted with this license athttp://revistasojs.utn.edu.ec/index.php/lauinvestiga/index
