Study of post-operative delirium in cardiothoracic surgery patients

Postgraduate Thesis uoadl:2673187 641 Read counter

Unit:
ΠΜΣ Διασυνδετική Ψυχιατρική: Απαρτιωμένη Φροντίδα Σωματικής και Ψυχικής Υγείας
Library of the School of Health Sciences
Deposit date:
2018-03-01
Year:
2018
Author:
Michailidou Άννα-Μαρία
Supervisors info:
Ρ. Γουρνέλλης, Αναπλ. Καθηγητής Β' Ψυχιατρικής Κλινικής ΕΚΠΑ
Χρ. Χριστοδούλου, Αναπλ. Καθηγητής Β' Ψυχιατρικής Κλινικής ΕΚΠΑ
Α. Κουζούπης Επικ. Καθηγητής Α' Ψυχιατρικής Κλινικής ΕΚΠΑ
Original Title:
Μελέτη του μετεγχειρητικού ντελίριου σε καρδιοχειρουργικούς ασθενείς
Languages:
Greek
Translated title:
Study of post-operative delirium in cardiothoracic surgery patients
Summary:
Study of post-operative delirium in cardiothoracic surgery patients
Introduction: Delirium is a syndrome defined as an acute state of confusion, which includes change in cognition, disturbance of the sleep-wake cycle, perceptual distortions, inattention, which may be accompanied by an altered level of consciousness and disorganized thinking. Post-operative delirium is a common sequel of cardiothoracic surgery at a percentage varying from 3% to 72%. Purpose of this study is to evaluate the usage of anticholinergic drugs to those patients diagnosed with post-operative delirium during perioperative period .
Methodos: Two-hundred consecutive patients undergoing cardiac surgery were evaluated for post-operative delirium according to DSM-IV, DSM-5, ICD-10 criteria, as well as CAM and the SQID, being examined based on their sex, age, family status, usage of alcohol and tobacco. Furthermore, the patients were also tested regarding the comorbidity, type of surgery, anesthesia, postoperative pain, postoperative incidents, as well as the postoperative and preoperative medications.
Results: Among the patients who were examined, 76% were men aged 66,5 years old ± 10,7 years. As far as their family status is concerned, 73,3% were married, 11% widowers, 7,9% unmarried and 7,9% divorced. Regarding the usage of alcohol and tobacco, 51,9% of the patients had been drinking alcohol and 30,9% were smokers. Concerning the type of surgery, 52% had undergone by pass, 25% valve replacement and 10,5% both bypass and valve replacement. As far as postoperative implications are concerned, 38,7% did not present anything, while the remaining 61,3% presented arrhythmias at a percentage of 60%, respiratory distress at 15%, bleeding at 11% and infections at 7%. The average score of anticholinergic drugs was 2,55 ± 1,54. Regarding the evaluation of postoperative delirium, most of the patients were diagnosed with delirium taking into account the diagnostic criteria of DSM-IV (54,9%), followed by DSM-5 (41,7%), CAM and SQID 26,4% and 25,8% respectively and finally according to ICD-10, 18,1% of the patients were diagnosed with delirium.
Conclusions: The presentation of delirium is a multifactorial procedure, which is influenced by preoperative, intraoperative and postoperative factors. The differences in the evaluation of delirium are a result of the more restrictive criteria of ICD-10 and the more inclusive criteria of DSM-IV. Another major conclusion is that anticholinergic drugs appear to be a decisive element in the presentation of delirium, however, there is difference based on the preoperative medications, intraoperative medications and postoperative medications. The above information aims to a deeper understanding of delirium, considering that under-diagnosis of postoperative delirium has detrimental consequences and therefore the prompt recognition is essential.
Main subject category:
Health Sciences
Keywords:
Post-operative delirium, Anticholinergic drugs
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
111
Number of pages:
60
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