Behavioral changes after hospital discharge in preschool children experiencing emergence delirium after general anesthesia: a prospective observational study

2021 ◽  
Author(s):  
Jonghae Kim ◽  
Sung Hye Byun ◽  
Jun Won Kim ◽  
Ji‐Yoon Kim ◽  
Yun Jin Kim ◽  
...  
Keyword(s):  
Preschool Children ◽  
Observational Study ◽  
General Anesthesia ◽  
Hospital Discharge ◽  
Prospective Observational Study ◽  
Behavioral Changes ◽  
Emergence Delirium

scholarly journals Emergence delirium is associated with increased postoperative delirium in elderly: a prospective observational study

2020 ◽  
Vol 34 (5) ◽  
pp. 675-687
Author(s):  
Yan Zhang ◽  
Shu-Ting He ◽  
Bin Nie ◽  
Xue-Ying Li ◽  
Dong-Xin Wang
Keyword(s):  
Observational Study ◽  
General Anesthesia ◽  
Postoperative Delirium ◽  
Prospective Observational Study ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Emergence Delirium ◽  
Confusion Assessment ◽  
Increased Risk ◽  
Pacu Stay

Abstract Background The clinical significance of emergence delirium remains unclear. The purpose of this study was to investigate the association between emergence delirium and postoperative delirium in elderly after general anesthesia and surgery. Methods This prospective observational study was done in a tertiary hospital in Beijing, China. Elderly patients (65–90 years) who underwent major noncardiac surgery under general anesthesia and admitted to the postanesthesia care unit (PACU) after surgery were enrolled. Emergence delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit during PACU stay. Postoperative delirium was assessed with the Confusion Assessment Method during the first 5 postoperative days. The association between emergence delirium and postoperative delirium was analyzed with a multivariable logistic regression model. Results A total of 942 patients were enrolled and 915 completed the study. Emergence delirium developed in 37.0% (339/915) of patients during PACU stay; and postoperative delirium developed in 11.4% (104/915) of patients within the first 5 postoperative days. After adjusted confounding factors, the occurrence of emergence delirium is independently associated with an increased risk of postoperative delirium (OR 1.717, 95% CI 1.078–2.735, P = 0.023). Patients with emergence delirium stayed longer in PACU and hospital after surgery, and developed more non-delirium complications within 30 days. Conclusions Emergence delirium in elderly admitted to the PACU after general anesthesia and major surgery is independently associated with an increased risk of postoperative delirium. Patients with emergence delirium had worse perioperative outcomes. Chinese Clinical Trial Registry (chictr.org.cn) ChiCTR-OOC-17012734

Abstract 14868: Incidence and Outcomes of Cardiopulmonary Resuscitation in Pediatric Intensive Care Units

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Robert Berg ◽  
Amy Clark ◽  
Vinay M Nadkarni ◽  
Frank Moler ◽  
Robert M Sutton ◽  
...  
Keyword(s):  
Intensive Care ◽  
Observational Study ◽  
Hospital Discharge ◽  
Administrative Data ◽  
Neurological Outcome ◽  
Prospective Observational Study ◽  
Pediatric Intensive Care ◽  
Cardiac Patients ◽  
Neurologic Outcomes ◽  
Favorable Neurological Outcome

Introduction: Although registry and administrative data suggest that >6000 children have in-hospital cardiac arrests each year, most occur in pediatric intensive care units (PICUs), and 39% survive to hospital discharge, prospective research quality data on the incidence and outcomes of PICU CPR are not currently available. Objectives: To determine the incidence and outcomes CPR provided in PICUs. Methods: Multi-center prospective observational study of children <18 years old randomly selected and intensively followed from PICU admission to hospital discharge in the NICHD-funded Collaborative Pediatric Critical Care Research Network from December 2011 to April 2013. Results: Among 10,078 children enrolled, 139 (1.4%) received CPR for ≥1 minute and/or defibrillation. Of these children, 78% attained return of circulation, 45% survived to hospital discharge, and 89% of survivors had favorable neurological outcomes. The relative incidence of CPR events was higher for cardiac patients compared with non-cardiac patients (3.4% versus 0.8%, p<0.001), but survival rate to hospital discharge with favorable neurological outcome was not statistically different (41% versus 39%, respectively). Shorter duration of CPR was associated with higher survival rates: 66% [29/44] survived to hospital discharge after 1-3 minutes of CPR versus 28% [9/32] after >30 minutes, p<0.001. Among survivors, 26/29 (90%) had a favorable neurological outcome after 1-3 minutes versus 8/9 (89%) after >30 minutes of CPR. Conclusions: These data establish that contemporary PICU CPR, including long durations of CPR, results in high rates of survival to hospital discharge (45%) and favorable neurologic outcomes among survivors (89%). Rates of survival with favorable neurologic outcomes were similar among cardiac and non-cardiac patients. The rigorous prospective, observational study design avoided the limitations of missing data and potential selection biases inherent in registry and administrative data.

scholarly journals Integrated pulmonary index can predict respiratory compromise in high‐risk patients in the post‐anesthesia care unit: a prospective, observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yasutoshi Kuroe ◽  
Yuko Mihara ◽  
Shuji Okahara ◽  
Kenzo Ishii ◽  
Tomoyuki Kanazawa ◽  
...  
Keyword(s):  
High Risk ◽  
Observational Study ◽  
General Anesthesia ◽  
Prospective Observational Study ◽  
Elective Surgery ◽  
Anesthesia Care ◽  
Respiratory Compromise ◽  
Prolonged Stay ◽  
Pacu Stay ◽  
The Relationship

Abstract Background Respiratory compromise (RC) including hypoxia and hypoventilation is likely to be missed in the postoperative period. Integrated pulmonary index (IPI) is a comprehensive respiratory parameter evaluating ventilation and oxygenation. It is calculated from four parameters: end-tidal carbon dioxide, respiratory rate, oxygen saturation measured by pulse oximetry (SpO2), and pulse rate. We hypothesized that IPI monitoring can help predict the occurrence of RC in patients at high-risk of hypoventilation in post-anesthesia care units (PACUs). Methods This prospective observational study was conducted in two centers and included older adults (≥ 75-year-old) or obese (body mass index ≥ 28) patients who were at high-risk of hypoventilation. Monitoring was started on admission to the PACU after elective surgery under general anesthesia. We investigated the onset of RC defined as respiratory events with prolonged stay in the PACU or transfer to the intensive care units; airway narrowing, hypoxemia, hypercapnia, wheezing, apnea, and any other events that were judged to require interventions. We evaluated the relationship between several initial parameters in the PACU and the occurrence of RC. Additionally, we analyzed the relationship between IPI fluctuation during PACU stay and the occurrences of RC using individual standard deviations of the IPI every five minutes (IPI-SDs). Results In total, 288 patients were included (199 elderly, 66 obese, and 23 elderly and obese). Among them, 18 patients (6.3 %) developed RC. The initial IPI and SpO2 values in the PACU in the RC group were significantly lower than those in the non-RC group (6.7 ± 2.5 vs. 9.0 ± 1.3, p < 0.001 and 95.9 ± 4.2 % vs. 98.3 ± 1.9 %, p = 0.040, respectively). We used the area under the receiver operating characteristic curves (AUC) to evaluate their ability to predict RC. The AUCs of the IPI and SpO2 were 0.80 (0.69–0.91) and 0.64 (0.48–0.80), respectively. The IPI-SD, evaluating fluctuation, was significantly greater in the RC group than in the non-RC group (1.47 ± 0.74 vs. 0.93 ± 0.74, p = 0.002). Conclusions Our study showed that low value of the initial IPI and the fluctuating IPI after admission to the PACU predict the occurrence of RC. The IPI might be useful for respiratory monitoring in PACUs and ICUs after general anesthesia.

scholarly journals Ultrasound assessment of gastric emptying time after intake of clear fluids in children scheduled for general anesthesia—A prospective observational study

2020 ◽  
Vol 30 (12) ◽  
pp. 1384-1389
Author(s):  
Christiane E. Beck ◽  
Thurgkai Chandrakumar ◽  
Robert Sümpelmann ◽  
Katja Nickel ◽  
Oliver Keil ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Observational Study ◽  
General Anesthesia ◽  
Prospective Observational Study ◽  
Gastric Emptying Time ◽  
Ultrasound Assessment ◽  
Emptying Time

Evaluation of pH in Double-Lumen Tubes Removed After General Anesthesia: A Prospective Observational Study

2016 ◽  
Vol 30 (5) ◽  
pp. e46-e47
Author(s):  
Shiho Deguchi ◽  
Nobuyasu Komasawa ◽  
Tomoki Yamasaki ◽  
Michi Omori ◽  
Toshiaki Minami
Keyword(s):  
Observational Study ◽  
General Anesthesia ◽  
Prospective Observational Study ◽  
Double Lumen

scholarly journals Feasibility of Anesthesiologist-Performed Preoperative Echocardiography for the Prediction of Postinduction Hypotension: A Prospective Observational Study

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Babar Fiza ◽  
Neal Duggal ◽  
Caitlin E. McMillan ◽  
Graciela Mentz ◽  
Michael D. Maile
Keyword(s):  
Body Mass Index ◽  
Observational Study ◽  
General Anesthesia ◽  
Body Mass ◽  
Prospective Observational Study ◽  
Medical Center ◽  
Academic Medical Center ◽  
Vena Cava ◽  
Left Ventricular ◽  
Point Of Care Ultrasound

Purpose. To determine if left ventricular or inferior vena cava (IVC) measurements are easier to obtain on point-of-care ultrasound by anesthesiologists in preoperative patients, and to assess the relationship between preoperative cardiac dimensions and hypotension with the induction of general anesthesia. Methods. This prospective observational study was conducted at a large academic medical center. Sixty-three patients undergoing noncardiac surgeries under general anesthesia were enrolled. Ultrasound examinations were performed by anesthesiologists in the preoperative area. To ensure that hypotension represented both a relative and absolute decrease in blood pressure, both a mean arterial pressure (MAP) < 65 mmHg and a MAP decrease of >30% from preoperative value defined this outcome. Results. Left ventricular measurements were more likely to be acquired than IVC measurements (97% vs. 79%). Subjects without adequate images to assess IVC collapsibility tended to have a higher body mass index (33.6 ± 5.5 vs. 28.5 ± 4.5, p = 0.001 ). While high left ventricular end-diastolic diameter values were associated with a decreased odds of MAP < 65 mmHg (OR: 0.24, 95% CI: 0.07–0.83, p = 0.023 ) or a MAP decrease of >30% from baseline alone (OR: 0.25, 95% CI: 0.07–0.83, p = 0.023 ), the primary endpoint of both relative and absolute hypotension was not associated with preoperative left ventricular dimensions. Conclusions. Preoperative cardiac ultrasound may be a more reliable way for anesthesiologists to assess patients’ volume status compared to ultrasound of the IVC, particularly for patients with a higher body mass index.

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