DiseasesChemicals and DrugsAnalytical, Diagnostic and Therapeutic Techniques and EquipmentPsychiatry and PsychologyPhenomena and ProcessesHealth Care
DeliriumAnalgesiaAnalgesia, EpiduralAnalgesia, ObstetricalAnalgesia, Patient-ControlledAnalgesics, OpioidPain, PostoperativeAlcohol Withdrawal DeliriumMorphinePain MeasurementBupivacaineAnesthetics, LocalAcupuncture AnalgesiaFentanylAnalgesicsAnesthesia, EpiduralMeperidinePainConfusionLabor PainSufentanilNerve BlockInjections, SpinalIntensive Care UnitsHypnotics and SedativesProspective StudiesLabor, ObstetricAnesthesia, ObstetricalConscious SedationDouble-Blind MethodAnesthesia, SpinalPsychomotor AgitationAmidesHydromorphoneTramadolPostoperative ComplicationsAnalgesics, Non-NarcoticHaloperidolAnesthesia, GeneralCritical IllnessNaloxoneIntensive CareCesarean SectionPostoperative Nausea and VomitingNursing DiagnosisPain ThresholdNursing AssessmentInterpleural AnalgesiaBenzodiazepinesDrug ToleranceAnesthesia Recovery PeriodReceptors, Opioid, muDexmedetomidineKetorolacLabor Stage, FirstPsychoses, AlcoholicLidocaine
Sedation and analgesiaAnesthesiaOutcomesEffects includingEmergence deliriumAnalgesicAmnesiaTremensIncidencePostoperative AnalgesiaOpioidImmobilityPrevent deliriumLumbar FusionOpioidsMultimodalSedativesAdequateFracturePreventionPatients in the intensive carePainHospitalizationDurationDexmedetomidineDosesAnestheticCritically ill patientsMorphinePrevalenceRiskAnesthesiologyPatientFentanylSurgicalRespiratoryDementiaComplicationsMorbidityMortalityCognitiveSurgeryCardiacManagementElderly
Sedation and analgesia3
  • We also wanted to examine the knowledge the intensive care nurse needs regarding sedation protocol, sedation and analgesia, patient experience and patient awareness associated with being awakened daily with mechanical ventilation. (ntnu.no)
  • 06-Apr-2022 sedation and analgesia are necessary(1-3). (bvsalud.org)
  • However, it is difficult to achieve adequate sedation and analgesia in children, and it is observed that only 60% of this population can maintain moderate levels of sedation and analgesia(6). (bvsalud.org)
Anesthesia14
  • But it does bring to light an oft-overlooked truth: Anesthesia carries risks that increase as patients age. (mainlinetoday.com)
  • Two recent studies in the medical journal, Anesthesia & Analgesia, document the phenomenon-a state of confusion that can last for two or more days and involve memory loss, hallucinations and trouble speaking. (mainlinetoday.com)
  • The results showed that, regardless of the kind of anesthesia used or the duration of the sedation, 45 percent experienced postoperative delirium. (mainlinetoday.com)
  • Optimizing the depth of anesthesia may represent a modifiable strategy for delirium prevention. (biomedcentral.com)
  • The primary aim of this study is to determine whether reduced depth of anesthesia using spinal anesthesia reduces the incidence of delirium after lumbar fusion surgery compared with general anesthesia. (biomedcentral.com)
  • The results of this study will examine whether reduced depth of anesthesia using spinal anesthesia with targeted depth of sedation represents a modifiable intervention to reduce the incidence of delirium and other long-term outcomes. (biomedcentral.com)
  • Optimizing depth of anesthesia may represent a modifiable strategy for the prevention of delirium, with the hypothesis that excessive depth of anesthesia may have deleterious consequences for older adults. (biomedcentral.com)
  • 51 Does Anesthesia Increase the Risk to the Parturient Undergoing Nonobstetric Surgery? (icebe.es)
  • it achieves sedation, analgesia, and sympathetic activation 12 with a relatively low risk of side effects to mothers or infants, 13 making it an optimum choice as an IV adjuvant for spinal anesthesia during cesarean delivery. (researchsquare.com)
  • The advantages of IT opioids for analgesia, especially if spinal anesthesia is already planned, include its simplicity, lack of need for catheter care or pumps, low cost, and easy supplementation with low-dose patient-controlled analgesia (PCA) opioids as needed. (medscape.com)
  • The level of analgesia was recorded continuously using the proprietary index IOC2 (Index of consciousness 2,namely qNOX) (Angel-6000D Multi-parameter Anesthesia Monitor, Shenzhen Weihaokang Medical Technology Co., Ltd, Guangdong, China). (researchgate.net)
  • Orthopedic surgery was performed by fracturing the tibia of the left hindlimb with intramedullary fixation under general anesthesia and analgesia. (biomedcentral.com)
  • To clarify the pathophysiology of PNDs, we have developed an orthopedic surgery mouse model in which the left hindlimb is subjected to an open tibial fracture with intramedullary fixation under general anesthesia and analgesia [ 5 ]. (biomedcentral.com)
  • Through the game, the player is challenged to bolus and titrate sedative-hypnotic and opiate analgesia to maintain an optimal level of anesthesia. (medtronic.com)
Outcomes16
  • No increase in short term adverse outcomes in the intervention group identified but patients were not evaluated for subtle or long-term adverse outcomes. (thoracic.org)
  • Delay in adequate analgesia for hip fracture in geriatric patients leads to worse outcomes, including increased rate of delirium and increased hospital length of stay. (asra.com)
  • Children undergoing anaesthetic induction experience peri-operative anxiety associated with negative outcomes including emergence delirium, short- and long-term maladaptive behaviour and increased postoperative analgesic requirements. (biomedcentral.com)
  • Secondary outcomes include post-operative pain, emergence delirium, parental satisfaction, cost-effectiveness, parent and child psychological well-being at 3 months post procedure and video intervention acceptability. (biomedcentral.com)
  • Dr. Barr has previously participated in several national collaboratives to improve ICU patient care and outcomes, including the IHI's 100k Lives and the 5 Million Lives Campaigns. (stanford.edu)
  • Improving ABCDEF Bundle Compliance and Clinical Outcomes in the ICU: Randomized Control Trial to Assess the Impact of Performance Measurement, Feedback, and Data Literacy Training. (stanford.edu)
  • Depending on the individual patient's conditions and on interactions between drugs and diseases, multimedication increases the risk of unwanted outcomes and serious harm [ 4 ]. (biomedcentral.com)
  • The secondary outcomes (all in early postoperative period) were pain at rest, opioid consumption, incidence of pruritus, nausea and vomiting, sedation, delirium, constipation, impairment of sleep and physical activity, patient satisfaction with analgesia, and the length of Acute Pain Service follow-up. (nih.gov)
  • The results of this study will be presented at national meetings and published in peer-reviewed journals with the goal of improving perioperative outcomes for older adults. (biomedcentral.com)
  • Dr. Chlan's patient-centered program of research seeks to improve care and post-ICU outcomes for critically ill patients receiving mechanical ventilatory support. (mayo.edu)
  • The authors assessed the effect of group assignment on preoperative anxiety levels and postoperative outcomes such as analgesic consumption and emergence delirium. (asahq.org)
  • 1-3 It may increase the risk of adverse maternal and foetal outcomes, such as maternal nausea, vomiting, dyspnoea, low Apgar scores, and foetal acidosis. (researchsquare.com)
  • These initiatives have been shown to improve outcomes and reduce ED re-attendances, hospitalisations, and functional decline. (ttsh.com.sg)
  • While many factors must be considered when treating the primary care patient receiving an opioid in accordance with clinical practice guidelines, 1,2 clinical decision-making must take into account the unique considerations for treating older adults, including age-related physiologic changes, multimorbidity, frailty, sensory and/or cognitive impairment, and polypharmacy-all of which can increase the risk for adverse treatment outcomes. (consultant360.com)
  • In an accompanying segment, we discussed modern multimodal analgesia and how incorporating it into clinical practice can enhance pain control and improve outcomes. (medscape.com)
  • Reductions of even 20% of baseline are associated with improved analgesic outcomes after surgery. (medscape.com)
Effects including1
  • In man, morphine produces a variety of effects including analgesia, constipation from decreased gastrointestinal motility, suppression of the cough reflex, respiratory depression from reduced responsiveness of the respiratory centre to CO2, nausea and vomiting via stimulation of the CTZ, changes in mood including euphoria and dysphoria, sedation, mental clouding, and alterations of the endocrine and autonomic nervous systems. (rxmed.com)
Emergence delirium2
  • POCD is distinct from emergence delirium. (wikipedia.org)
  • Children in the ADVANCE group exhibited a lower incidence of emergence delirium after surgery (P=0.038), required significantly less analgesia in the recovery room (P=0.016), and were discharged from the recovery room earlier (P=0.04) as compared with children in the three other groups. (asahq.org)
Analgesic2
  • Ageing-related changes in physiology, the accumulation of multimorbidity, frailty and the risk of inducing delirium secondary to analgesic medication present a suite of challenges in the older trauma patient. (iasp-pain.org)
  • https://doi.org/10.17665/1676-4285.20246684 increased morbidity and mortality, inadequate sedative and long-acting analgesic agents, pain management, increased risk of nosocom- preferably in enteric presentation. (bvsalud.org)
Amnesia1
  • He has also pioneered investigations of how general anesthetic drugs work in the brain to induce and maintain simultaneous but reversible states of unconsciousness, amnesia, immobility, and analgesia. (mit.edu)
Tremens1
  • Unrecognized alcohol withdrawal can lead to potentially life-threatening consequences including seizures and delirium tremens. (ebmedicine.net)
Incidence2
  • There was no difference in time to successful extubation, length of ICU stay, length of hospital stay, or incidence of delirium. (thoracic.org)
  • The risk of POCD increases with age, and the type of surgery is also important because there is a very low incidence associated with minor surgery. (wikipedia.org)
Postoperative Analgesia2
Opioid3
  • Despite these concerns, prescription claims data indicate that opioid use is increasing across all age groups, including among older adults. (consultant360.com)
  • This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death. (cdc.gov)
  • Opioid prescriptions per capita increased 7.3% from 2007 to 2012, with opioid prescribing rates increasing more for family practice, general practice, and internal medicine compared with other specialties ( 3 ). (cdc.gov)
Immobility1
  • An important nuance of treating pain in older trauma patients is the challenge of balancing iatrogenic adverse effects of analgesia against the harms of undertreated pain, the complications and consequences of which include immobility, pneumonia, sarcopenia, pressure ulcers, long-term functional decline, increased long-term care needs and mortality. (iasp-pain.org)
Prevent delirium2
  • In spite of the importance of postoperative delirium, there are few effective strategies to prevent delirium and long-term complications in older adults undergoing surgery. (biomedcentral.com)
  • Patients receive interventions to prevent delirium and to promote recovery if delirium is present. (hqontario.ca)
Lumbar Fusion1
  • Postoperative Use of the Muscle Relaxants Baclofen and/or Cyclobenzaprine Associated with an Increased Risk of Delirium Following Lumbar Fusion. (metajournal.com)
Opioids1
  • Opioids remain the mainstay for pain relief, but patient-controlled analgesia, NSAIDs, standardization of pain management, bio/behavioral interventions, modification of head dressings as well as patient-centric management are useful opportunities that potentially improve patient care. (surgicalneurologyint.com)
Multimodal3
  • Postoperative use of muscle relaxants as part of a multimodal analgesia regimen was associated with an increased risk of delirium in older adults after lumber fusion surgery. (metajournal.com)
  • This is probably where multimodal analgesia can play an important role throughout the perioperative phase. (medscape.com)
  • We have several opportunities to exploit multimodal analgesia in this case. (medscape.com)
Sedatives1
  • After adjusting for co-morbidities, illness severity, coma, and use of sedatives and analgesics, delirium was also associated with prolonged ICU and hospital stays, as well as cognitive impairment at hospital discharge. (thoracic.org)
Adequate1
  • Prompt, adequate analgesia is a major priority in hip fracture management to reduce the risk of delirium and facilitate earlier return to mobility and independence. (iasp-pain.org)
Fracture3
  • Educational e-Learning Tool to Improve Fascia Iliac Block Uptake for Neck of Femur Fracture Patients: A Multi-Disciplinary Approach. (iasp-pain.org)
  • After surgery, patients with hip fracture are mobilized on a daily basis to increase their functional tolerance. (hqontario.ca)
  • Patients with hip fracture are screened for delirium using a validated tool as part of their initial assessment and then at least once every 12 hours while in hospital, after transitions between settings, and after any change in medical status. (hqontario.ca)
Prevention1
  • In the next section of the podcast we discuss the PAD mnemonic for post-intubation analgesia and sedation, the prevention of delirium, and medication choices to minimize time on the ventilator, and improve prognosis. (emergencymedicinecases.com)
Patients in the intensive care2
  • Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. (thoracic.org)
  • Dr. Barr was the lead author of the Society of Critical Care Medicine's (SCCM) 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adults Patients in the Intensive Care Unit. (stanford.edu)
Pain8
  • Optimizing doses of general anesthetic drugs can improve patient care in many ways, including by minimizing side effects such as post-operative delirium and by improving post-operative pain management. (mit.edu)
  • When he returned for his next treatment, however, he still complained of increasing persistent right shoulder pain. (ceufast.com)
  • Acute pain has a prevalence of approximately 5% across all age groups, whereas the prevalence of chronic pain increases with age. (racgp.org.au)
  • 1, 2 As the population ages, the number of people with chronic pain is expected to increase. (racgp.org.au)
  • All patients are evaluated for delirium using the Confusion Assessment Method for 3 days after surgery or until discharge and undergo assessments of cognition, function, health-related quality of life, and pain at 3- and 12-months after surgery. (biomedcentral.com)
  • Various regional analgesia techniques exist that can be used to promote postoperative pain relief. (medscape.com)
  • Improves pain control: Regional techniques can block or reduce pain anywhere from several hours to several days, depending on the technique used. (medscape.com)
  • Greater pain control has the potential to allow for earlier hospital discharge and may improve the patient's ability to tolerate physical therapy. (medscape.com)
Hospitalization1
  • This condition is related to increased hospitalization, prolonged use of mechanical ventilation (MV), How to cite: Klein K, Pereira JS, Curtinaz KALJ, Jantsch JB, Souza NS de, Carvalho PRA. (bvsalud.org)
Duration3
Dexmedetomidine1
Doses1
  • If initial recommended doses provide inadequate analgesia, a higher dose is given, up to the conventional safe maximum dose. (merckmanuals.com)
Anesthetic2
  • Building on these improvements in fundamental understanding, his lab engineers systems to improve monitoring of patient state and anesthetic dosing during surgery. (mit.edu)
  • These are coated with anesthetic to provide epidural analgesia. (thepainlesspush.com)
Critically ill patients1
  • She is passionate about improving the lives of critically ill patients. (stanford.edu)
Morphine1
  • When administered every 12 hours, the sustained-release tablets provide equivalent analgesia to morphine oral solution given 4-hourly. (rxmed.com)
Prevalence2
  • This study confirmed a high prevalence of ICU delirium (over 80% as identified by I-CAM) and was the first to show delirium is an independent risk factor for mortality. (thoracic.org)
  • Older age is commonly associated with changes in physiology, as well as an increased prevalence of frailty and multimorbidity, including cardiac, renal and liver disease. (iasp-pain.org)
Risk8
  • Patients with POCD are at an increased risk of death in the first year after surgery. (wikipedia.org)
  • This should be considered when prescribing or dispensing KADIAN ® in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse or diversion. (nih.gov)
  • Although muscle relaxants may be beneficial in select patients, they should be used with caution in individuals at high risk for postoperative delirium. (metajournal.com)
  • The risk of drug-drug interactions in individual patients increases with the number of co-existing diseases and the number of (prescribed) medicines taken [ 3 ]. (biomedcentral.com)
  • Dr. Heidi Lindroth's program of research focuses on innovative, scalable and sustainable solutions to individualize care and mitigate the symptoms and severity of delirium, a form of acute brain dysfunction among hospitalized patients, including vulnerability to delirium, identifying at-risk individuals, and predicting delirium. (mayo.edu)
  • 31 Does Perioperative Hyperglycemia Increase Risk? (icebe.es)
  • Aspirin is the least expensive NSAID, but it has irreversible antiplatelet effects and increases the risk of gastrointestinal (GI) bleeding. (merckmanuals.com)
  • Studies suggest that inhibition of COX-2, which occurs with both nonselective COX inhibitors and coxibs, has a prothrombotic effect that can increase risk of myocardial infarction, stroke, and claudication. (merckmanuals.com)
Anesthesiology1
  • She has led efforts to reduce bias and improve the educational environment for rotators and trainees in anesthesiology, engages in research to uncover disparities in the perioperative environment, and mentors through multiple pipeline program for undergraduate and high school students from underrepresented backgrounds. (ucsf.edu)
Patient3
  • These factors can complicate the safe and effective administration of analgesia in the older trauma patient. (iasp-pain.org)
  • Ces molécules sont surtout utilisées pour la sédation, l'analgésie et la prise en charge du delirium chez le patient critique. (bvsalud.org)
  • 42 Is There a Best Technique in the Patient With Increased Intracranial Pressure? (icebe.es)
Fentanyl1
Surgical1
  • Surgical treatment for RAS is rare but increased over a 19-year period. (metajournal.com)
Respiratory1
  • This study randomized 566 patients with acute respiratory failure or shock and hypoactive (89%) or hyperactive delirium (11%) to receive intravenous boluses of haloperidol (maximum dose, 20 mg daily), ziprasidone (maximum dose, 40 mg daily), or placebo. (thoracic.org)
Dementia1
  • Perioperative neurocognitive disorders (PND), including delirium and postoperative cognitive dysfunction, are serious complications that can result in increased 1-year mortality when superimposed on dementia. (biomedcentral.com)
Complications1
  • Although previously thought to be transient, it is now recognized that delirium is associated with both short- and long-term complications. (biomedcentral.com)
Morbidity1
  • Because RAS cases appear to be increasing in number, future studies should emphasize methods to reduce morbidity and investigate deformity-specific metrics to help better understand this population. (metajournal.com)
Mortality1
Cognitive1
  • Multicenter RCT of 422 patients found no difference in delirium, ventilator-free days, survival, or cognitive function at 6 months with use of the 2 agents. (thoracic.org)
Surgery3
  • Delirium is an important complication after surgery in older adults. (biomedcentral.com)
  • Post-operative delirium is a common occurrence in the elderly, with frequency estimates ranging from 10 to 50%, depending on the type of surgery [ 1 ]. (biomedcentral.com)
  • A RECENT survey reported increases in the number of children in the United States who receive various treatments to reduce their anxiety before surgery. (asahq.org)
Cardiac1
  • After that period, a hyperdynamic state develops with an increased cardiac output (provided there is no hypovolemia) and decreased SVR. (renalandurologynews.com)
Management2
Elderly1
  • Research interest has increased since early 2000, especially as more elderly patients are able to undergo successful minor and major surgeries. (wikipedia.org)