Genel Cerrahi Hastalarında Postoperatif Deliryum Erken Tanısı

Yıl 2023, Cilt: 9 Sayı: 2, 192 - 198, 01.05.2023

Fatih Oluş Emel Gündüz Ayşe Gülbin Arıcı

https://doi.org/10.53394/akd.1071358

Öz

ÖZ
Giriş/Amaç: Postoperatif deliryum (POD) sık görülen bir postoperatif komplikasyondur. Bu çalışmada öncelikle Genel Cerrahi uygulanan hastalarda POD tanısının erken konulması amaçlanmıştır.
Gereç ve Yöntem: Mart 2018-Mayıs 2018 tarihleri arasında Genel Cerrahi Kliniği tarafından ameliyat edilen ve genel anestezi uygulanan 18 yaş ve üzeri 303 hastanın verileri çalışmaya dahil edildi.
Hastaların demografik verileri, mesleği, eğitim durumu, gelir düzeyi, ek hastalıkları, ASA (Amerikan Anestezi Derneği) skoru, geçirilmiş ameliyatları, psikiyatrik veya nörolojik hastalık öyküsü, alkol, sigara veya uyuşturucu madde kullanım öyküsü ve hafıza sorunları sorgulandı. kaydedildi. Hastaların ameliyat öncesi mental düzeylerini belirlemek için Mini Mental Durum Muayenesi (MMSE) kullanıldı.
Hastanın teşhisi, adı, yapılacak ameliyatın süresi ve özellikleri, ameliyatın acil veya elektif olup olmadığı, kullanılan ilaçlar, kateterizasyon tipi kaydedilir. Hastalarda POD tanısı Konfüzyon Değerlendirme Yöntemi (CAM) ile değerlendirildi.
Bulgular: Hastaların %2-6'sında (8 hasta) POD gelişti. Sonuçlar, hastaların eğitim düzeyi arttıkça deliryum riskinin azaldığını gösterdi. Kullanılan anestezik ajanlar arasında deliryum ile sadece midazolam arasında anlamlı ilişki saptanmıştır.
Sonuç: Postoperatif erken dönemde CAM ile POD tanısı koymak avantajlıydı. POD hastalarının tedavi planlaması erken dönemde yapılabilmektedir. Bu sayede POD tanısının atlanması sonucu mortalite, morbidite ve maliyet artışının önüne geçilmiştir.
Anahtar Kelimeler: Postoperatif Deliryum, Genel Cerrahi, Bilişsel Bozukluklar

Anahtar Kelimeler

Postoperative Delirium, General Surgery, Cognitive Disorders

Early Diagnosis Of Postoperative Delirium in Patients Who Underwent General Surgery

Öz

ABSTRACT
Objective: Postoperative delirium (POD) is a common postoperative complication. This study aimed to diagnose POD early primarily in patients who underwent General Surgery.
Material and Method: Data of 303 patients at the age of 18 and above who were operated by General Surgery Clinic between March 2018 and May 2018,who received general anesthesia were included in the study.
Patients’ demographic data, occupation, educational status, income level, additional diseases, ASA (American Society of Anesthesia) score, previous surgeries, history of a psychiatric or neurological disease, history of alcohol, cigarette, or drug use, and memory problems were recorded. Mini Mental State Examination (MMSE) was used to identify preoperative mental levels of the patients.
Diagnosis of the patient, name, duration and features of the surgery to be performed, whether the surgery was urgent or elective, drugs used, type of catheterization recorded. The diagnosis of POD in patients was evaluated with Confusion Assessment Method (CAM).
Results: POD developed in 2-6% (8 patients) of the patients. Results showed that the risk of delirium decreased as the education levels of the patients increased. A significant relationship was recorded between delirium and only midazolam among anesthetic agents used.
Conclusion: Diagnosing POD with CAM in an early postoperative period was advantageous. The treatment planning of the patients for POD could be done in the early period. By doing this, increase in mortality, morbidity and cost as a result of missing the diagnosis of POD was prevented.
Key Words: Postoperative Delirium, General Surgery, Cognitive Disorders

Anahtar Kelimeler

Postoperative Delirium, General Surgery, Cognitive Disorders

Kaynakça

• 1- Dasgupta M, Dumbrell AC. Preoperative Risk Assessment for Delirium After Noncardiac Surgery: A Systematic Review. J Am Geriatr Soc 2006; 54: 1578-89.
• 2- Gill D, Mayou R. Deliryum. Ed: Gelder MG, Lopez-Ibor JJ, Andreasen NC. New Oxford Textbook of Psychiatry. Oxford University Press Inc, New York, USA, 2000; 382-7.
• 3- Furlaneto ME, Garcez-Leme LE. Impact of Delirium on Mortality and Cognitive and Functional Performance among Elderly People with Femoral Fractures. Clinics 2007; 62: 545-52.
• 4- Juliebo V, Bjøro K, Krogseth M, Skovlund E, et al. Risk Factors for Preoperative and Postoperative Deliryum in Elderly Patients with Hip Fracture. J Am Geriatr Soc 2009; 57: 1354-61.
• 5- Saniova B, Drobny M, Sulaj M. Delirium and postoperative cognitive dysfunction after general anesthesia. Med Sci Monit 2009; 15: 81-7.
• 6- Steinmetz J, Rasmussen LS. Cognitive deterioration after surgery. Ugeskr Laeger 2008; 170: 4032-4.
• 7- Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990; 113: 941-8.
• 8- Benoit AG, Campbell BI, Tanner JR, Staley JD, et al. Risk factors and prevalence of perioperative cognitive dysfunction in abdominal aneurysm patients. J Vasc Surg 2005; 42: 884-90.
• 9- Furlaneto ME, Garcez-Leme LE. Delirium in Elderly Individuals with Hip Fracture: Causes, Incidence, Prevalence, and Risk Factors. Clinics 2006; 61: 35-40.
• 10- Holroyd-Leduc JM, Abelseth GA, Khandwala F. A pragmatic study exploring the prevention of delirium among hospitalized older hip fracture patients: Applying evidence to routine clinical practice using clinical decision support. Implementation Science 2010; 5: 81.
• 11- Pratico C, Quattrone D, Lucanto T, Amato A, Pena O, Roscitano C, Fodale V. Drugs of anesthesia acting on central cholinergic system may cause postoperative cognitive dysfunction and deliryum. Med Hypotheses 2005; 65: 972-82.
• 12- Kalisvaart KJ, de Jonghe JF, Bogaards MJ, Vreeswijk R, Egberts TC, Burger BJ, Eihelenboom P, Van Gool WA. Haloperidol Prophylaxis for Elderly Hip-Surgery Patients at Risk for Deliryum: A Randomized Placebo-Controlled Study. J Am Geriatr Soc 2005; 53: 1658-66.
• 13- Lyketsos CG, Sheppard JM, Rabins PV. Dementia in elderly persons in a general hospital. Am J Psychiatry 2000; 157: 704–7.
• 14- Kyziridis TC. Post-operative delirium after hip fracture treatment: a review of the current literature. GMS Psycho-Social-Medicine 2006; 3: 1-12.
• 15- Sprung RO, Warner J, Roberts TN, Weingarten A, Nunes Cavalcante DS, Knopman RC, et al. Postoperative delirium in elderly patients is associated with subsequent cognitive impairment. BJA 2017; 119(2): 316-23.
• 16- Raats JW, van Eijsden VA, Rogier Crolla MPH, Steyerberg EW, van der Laan L. Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients. PLoS One 2015; 10(8).
• 17- Abelha FJ, Luís C, Veiga D, Parente D, Fernandes V, Santos P, et al. Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery. Critical Care 2013; 17(1): 257.
• 18- Maldonado JR, Wysong A, van der Starre PJ, Block T, Miller C, Reitz BA. Dexmedetomidine and the reduction of postoperativedelirium after cardiac surgery. Psychosomatics 2009; 50(3): 206-17.
• 19- Peng W, Shimin S, Hongli W, Yanli Z, Ying Z. Delirium Risk of Dexmedetomidine and Midazolam in Patients Treated with Postoperative Mechanical Ventilation: a Meta-analysis. Open Med (Wars) 2017; 12: 252-6.
• 20- Brummel NE, Girard TD. Preventing delirium in the intensive care unit. Critical Care Clinic 2013; 29: 51-65.
• 21- Nazemi AK, Gowd AK, Carmouche JJ, Kates SL, Albert TJ, Behrend CJ. Prevention and Management of Postoperative Delirium in Elderly Patients Following Elective Spinal Surgery. Clin Spine Surg 2017; 30(3): 112-9.
• 22- Robinson TN, Eiseman B. Postoperative delirium in the elderly: diagnosis and management. Clin Interv Aging 2008; 3(2): 351-5.
• 23- Järvelä K, Porkkala H, Karlsson S, Martikainen T, Selander T, Bendel S. Postoperative Delirium in Cardiac Surgery Patients. J Cardiothorac Vasc Anesth. 2018;32(4):1597-1602.
• 24- Huang C, Mårtensson J, Gögenur I, Asghar MS. Exploring Postoperative Cognitive Dysfunction and Delirium in Noncardiac Surgery Using MRI: A Systematic Review. Neural Plast 2018; 2018: 1281657.
• 25- Kobayashi K, et al. Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature: Japan Association of Spine Surgeons with Ambition Multicenter Study. Global Spine Journal 2017; 7(6): 560-6.