Araştırma Makalesi
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Frequency of delirium after carotid endarterectomy

Yıl 2024, Cilt: 17 Sayı: 2, 36 - 43, 01.07.2024

Öz

Internal carotid artery stenosis is a consequence of systemic atherosclerotic disease. Internal carotid artery endarterectomy is a treatment method used to prevent life-threatening strokes in patients with severe internal carotid artery stenosis. Delirium may occur in patients after carotid endarterectomy due to hemodynamic changes due to cerebral perfusion deficiency. This study was conducted to determine the frequency and risk factors of delirium in patients who undergoing carotid endarterectomy.
The research was a descriptive and cross-sectional prospective study. Research data were collected in 2 years and 83 patients who agreed to participate in the study were reached. Sociodemographic and clinical characteristics data collection form, intensive care delirium screening checklist, and pain scale were used.
Delirium was detected in 2.07% of the patients after carotid endarterectomy. The mean oxygen saturation values of the patients with and without delirium in the 2-4 hours after carotid endarterectomy were found to be a statistically significant difference (p<0.05). After carotid endarterectomy oxygen saturation means of the patients who developed delirium was lower than the other patients in the 2-4 hours postoperatively. In patients who sleep 4 hours or more, delirium was less common than other patients. It was found that the means pain scores of patients who developed and did not develop delirium on the 1st postoperative day were statistically significant (p<0.05)
In conclusion, after internal carotid artery endarterectomy, advanced age, low arterial partial oxygen pressure and oxygen saturation, presence of postoperative pain and short sleep duration are risk factors for delirium.

Kaynakça

  • 1. Aboyans V, Ricco JB, Bartelink MLEL, et al. 2017 ESC guidelines on diagnosing and treating peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). European Heart Journal 2018;39:763–821.
  • 2. Qaja E, Tadi P, Kariyanna PT. Carotid artery steosis. 2021 (online). https://www.ncbi.nlm.nih.gov/books/NBK442025/ access date: 23.04.2023
  • 3. Ge Y, Li Q, Nie Y, et al. Dexmedetomidine improves cognition after carotid endarterectomy by inhibiting cerebral inflammation and enhancing brain-derived neurotrophic factor expression. Journal of International Medical Research 2019;47(6):2471–2482.
  • 4. Swarbrick CJ, Partridge JSL. Evidence‐based strategies to reduce the incidence of postoperative delirium: a narrative review. Anaesthesia 2022; 77:92-101.
  • 5. Salluh JIF, Wang H, Schneider EB, et al. Outcome of delirium in critically ill patients; systematic review and meta-analysis. BMJ 2015;350:h2538.
  • 6. Wang H, Guo X, Zhu X, et al. Gender differences and postoperative delirium in adult patients undergoing cardiac valve surgery. Frontiers in Cardiovascular Medicine 2021:1737
  • 7. Thisayakorn P, Tangwongchai S, Tantavisut S, et al. Immune, blood cell, and blood gas bio-markers of delirium in elderly individuals with hip fracture surgery. Dementia and Geriatric Cognitive Disorders 2021:50(2);161-169.
  • 8. Xu N, Li LX, Wang TL, et al. Processed multiparameter electroencephalogram-guided general anesthesia management can reduce postoperative delirium following carotid endarterectomy; A randomized clinical trial. Frontiers in Neuro-logy 2021:12.
  • 9. Wan T, Wei P, Yao Y, Liu H, Li J. Association of carotid plaque and serum lipoprotein-associated phospholipase A2 (LP-PLA2) with postoperative delirium in geriatric patients undergoing hip replacement: a prospective cohort study. Medical Science Monitor 2020:26;e927763.
  • 10. Köse G, Bolu A, Özdemir L, Açıkel C, Hatipoglu S. Reliability and validity of the intensive care delirium screening checklist in Turkish. International Journal of Nursing Knowledge 2016:27(2).
  • 11. Böhner H, Hummel TC, Habel U, et al. Predicting delirium after vascular surgery; a model based on pre- and intraoperative data. Annals of Surgery 2003;238(1):149–156.
  • 12. Raats JW, Steunenberg SL, de Lange DC, van der Laan L. Risk factors of postoperative delirium after elective vasculary surgery in elderly; a systematic review. International Journal of Surgery 2016;35:1-6.
  • 13. Trzepacz PT, Franco JG, Meagher DJ, et al. Delirium phenotype by age and sex in a pooled data set of adult patients. The Journal of Neuropsychiatry and Clinical Neurosciences 2018;30(4):294-301.
  • 14. Yang Y, Zhao X, Gao L, Wang Y, Wang J. Incidence and associated factors of delirium after orthopedic surgery in elderly patients: a systematic review and meta-analysis. Aging Clinical and Experimental Research 2021;33(6):1493-1506.
  • 15. Lee SS, Lo Y, Verghese J. Physical activity and risk of postoperative delirium. Journal of American Geriatrics Society 2019;67:2260-2266.
  • 16. Saller T, Hubig L, Seibold H, et al. Association between postoperative delirium and use of volatile anesthetics in the elderly: a real-world big data approach. Journal of Clinical Anesthesia 2022;83:110957.
  • 17. Liu Z, Pang X, Zhang X, Cao G, Fang C, Wu S. Incidence and risk factors of delirium in patients after type-A aortic dissection surgery. Journal of Cardiothoracic and Vascular Anesthesia 2017;31(6):1996-1999.
  • 18. Slater JP, Guarino T, Stack J, et al. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stays after cardiac surgery. The Annals of Thoracic Surgery 2009;87(1):36-45.
  • 19. Mu DL, Zhang DZ, Wang DX, et al. Parecoxib supplementation to morphine analgesia decreases the incidence of delirium in elderly patients after hip or knee replacement surgery; a randomized controlled trial. Anesthesia & Analgesia. 2017;124(6):1992–2000.
  • 20. Lee SY, Liu CY, Wu TY. The effects of pain, agitation, delirium, immobility, and sleep disruption education on novice nurses in adult ICUs. Healthcare 2022;10(8):1538.
  • 21. Ulsa MC, Xi Z, Li P, et al. Association of poor sleep burden in middle age and older adults with risk for delirium during hospitalization. The Journals of Gerontology 2022;77(3):507-516.
  • 22. Pisani MA, Friese RS, Gehlbach BK, et al. Sleep in the ICU. American journal of respiratory and critical care medicine 2015;191(7);731-738.
  • 23. Aizawa K, Kanai T, Saikawa Y, et al. A novel approach to the prevention of postoperative delirium in the elderly after gastrointestinal surgery. Surg Today. 2002;32(4):310–314.
  • 24. Ida M, Takeshita Y, Kawaguchi M. Preoperative serum biomarkers in the prediction of postoperative delirium following abdominal surgery. Geriatrics & Gerontology International 2020;(12);1208-1212.

Karotis endarterektomi sonrası deliryum sıklığı

Yıl 2024, Cilt: 17 Sayı: 2, 36 - 43, 01.07.2024

Öz

Giriş: İnternal karotis arter stenozu sistemik aterosklerotik hastalığın bir sonucudur. İnternal karotis arter endarterektomisi, ciddi internal karotis arter stenozu olan hastalarda hayatı tehdit eden inmeleri önlemek için kullanılan bir tedavi yöntemidir. Karotis endarterektomi sonrası hastalarda serebral perfüzyon eksikliğine bağlı hemodinamik değişiklikler nedeniyle deliryum görülebilir. Bu çalışma karotis endarterektomi yapılan hastalarda deliryum sıklığını ve risk faktörlerini belirlemek amacıyla yapıldı.
Yöntem: Araştırma tanımlayıcı ve kesitsel prospektif bir çalışmadır. Araştırma verileri 2 yılda toplandı ve çalışmaya katılmayı kabul eden 83 hastaya ulaşıldı. Sosyodemografik ve klinik özellikler veri toplama formu, yoğun bakım deliryum tarama kontrol listesi ve ağrı ölçeği kullanıldı.
Bulgular: Karotis endarterektomi sonrası hastaların %2.07'sinde deliryum saptandı. Karotis endarterektomi sonrası 2-4 saat içinde deliryum gelişen ve gelişmeyen hastaların oksijen satürasyon ortalamaları arasında istatistiksel olarak anlamlı fark bulundu (p<0.05). Karotis endarterektomi sonrası deliryum gelişen hastaların ameliyat sonrası 2-4. saatlerdeki oksijen satürasyon ortalamaları diğer hastalara göre daha düşüktü. Dört saat ve daha fazla uyuyan hastalarda deliryum diğer hastalara göre daha azdı. Ameliyat sonrası 1. günde deliryum gelişen ve gelişmeyen hastaların ağrı skoru ortalamaları istatistiksel olarak anlamlı bulundu (p<0.05)
Sonuç: İnternal karotis arter endarterektomisi sonrası ileri yaş, düşük arteriyel parsiyel oksijen basıncı ve oksijen saturasyonu, postoperatif ağrı varlığı ve kısa uyku süresi deliryum için risk faktörleridir.

Kaynakça

  • 1. Aboyans V, Ricco JB, Bartelink MLEL, et al. 2017 ESC guidelines on diagnosing and treating peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). European Heart Journal 2018;39:763–821.
  • 2. Qaja E, Tadi P, Kariyanna PT. Carotid artery steosis. 2021 (online). https://www.ncbi.nlm.nih.gov/books/NBK442025/ access date: 23.04.2023
  • 3. Ge Y, Li Q, Nie Y, et al. Dexmedetomidine improves cognition after carotid endarterectomy by inhibiting cerebral inflammation and enhancing brain-derived neurotrophic factor expression. Journal of International Medical Research 2019;47(6):2471–2482.
  • 4. Swarbrick CJ, Partridge JSL. Evidence‐based strategies to reduce the incidence of postoperative delirium: a narrative review. Anaesthesia 2022; 77:92-101.
  • 5. Salluh JIF, Wang H, Schneider EB, et al. Outcome of delirium in critically ill patients; systematic review and meta-analysis. BMJ 2015;350:h2538.
  • 6. Wang H, Guo X, Zhu X, et al. Gender differences and postoperative delirium in adult patients undergoing cardiac valve surgery. Frontiers in Cardiovascular Medicine 2021:1737
  • 7. Thisayakorn P, Tangwongchai S, Tantavisut S, et al. Immune, blood cell, and blood gas bio-markers of delirium in elderly individuals with hip fracture surgery. Dementia and Geriatric Cognitive Disorders 2021:50(2);161-169.
  • 8. Xu N, Li LX, Wang TL, et al. Processed multiparameter electroencephalogram-guided general anesthesia management can reduce postoperative delirium following carotid endarterectomy; A randomized clinical trial. Frontiers in Neuro-logy 2021:12.
  • 9. Wan T, Wei P, Yao Y, Liu H, Li J. Association of carotid plaque and serum lipoprotein-associated phospholipase A2 (LP-PLA2) with postoperative delirium in geriatric patients undergoing hip replacement: a prospective cohort study. Medical Science Monitor 2020:26;e927763.
  • 10. Köse G, Bolu A, Özdemir L, Açıkel C, Hatipoglu S. Reliability and validity of the intensive care delirium screening checklist in Turkish. International Journal of Nursing Knowledge 2016:27(2).
  • 11. Böhner H, Hummel TC, Habel U, et al. Predicting delirium after vascular surgery; a model based on pre- and intraoperative data. Annals of Surgery 2003;238(1):149–156.
  • 12. Raats JW, Steunenberg SL, de Lange DC, van der Laan L. Risk factors of postoperative delirium after elective vasculary surgery in elderly; a systematic review. International Journal of Surgery 2016;35:1-6.
  • 13. Trzepacz PT, Franco JG, Meagher DJ, et al. Delirium phenotype by age and sex in a pooled data set of adult patients. The Journal of Neuropsychiatry and Clinical Neurosciences 2018;30(4):294-301.
  • 14. Yang Y, Zhao X, Gao L, Wang Y, Wang J. Incidence and associated factors of delirium after orthopedic surgery in elderly patients: a systematic review and meta-analysis. Aging Clinical and Experimental Research 2021;33(6):1493-1506.
  • 15. Lee SS, Lo Y, Verghese J. Physical activity and risk of postoperative delirium. Journal of American Geriatrics Society 2019;67:2260-2266.
  • 16. Saller T, Hubig L, Seibold H, et al. Association between postoperative delirium and use of volatile anesthetics in the elderly: a real-world big data approach. Journal of Clinical Anesthesia 2022;83:110957.
  • 17. Liu Z, Pang X, Zhang X, Cao G, Fang C, Wu S. Incidence and risk factors of delirium in patients after type-A aortic dissection surgery. Journal of Cardiothoracic and Vascular Anesthesia 2017;31(6):1996-1999.
  • 18. Slater JP, Guarino T, Stack J, et al. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stays after cardiac surgery. The Annals of Thoracic Surgery 2009;87(1):36-45.
  • 19. Mu DL, Zhang DZ, Wang DX, et al. Parecoxib supplementation to morphine analgesia decreases the incidence of delirium in elderly patients after hip or knee replacement surgery; a randomized controlled trial. Anesthesia & Analgesia. 2017;124(6):1992–2000.
  • 20. Lee SY, Liu CY, Wu TY. The effects of pain, agitation, delirium, immobility, and sleep disruption education on novice nurses in adult ICUs. Healthcare 2022;10(8):1538.
  • 21. Ulsa MC, Xi Z, Li P, et al. Association of poor sleep burden in middle age and older adults with risk for delirium during hospitalization. The Journals of Gerontology 2022;77(3):507-516.
  • 22. Pisani MA, Friese RS, Gehlbach BK, et al. Sleep in the ICU. American journal of respiratory and critical care medicine 2015;191(7);731-738.
  • 23. Aizawa K, Kanai T, Saikawa Y, et al. A novel approach to the prevention of postoperative delirium in the elderly after gastrointestinal surgery. Surg Today. 2002;32(4):310–314.
  • 24. Ida M, Takeshita Y, Kawaguchi M. Preoperative serum biomarkers in the prediction of postoperative delirium following abdominal surgery. Geriatrics & Gerontology International 2020;(12);1208-1212.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Kalp ve Damar Cerrahisi
Bölüm Araştırma Makalesi
Yazarlar

Meltem Ulus 0000-0001-9779-8597

Aylin Durmaz Edeer 0000-0002-0681-5863

Ertürk Karaağaç

Yayımlanma Tarihi 1 Temmuz 2024
Gönderilme Tarihi 10 Ocak 2024
Kabul Tarihi 27 Mart 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 17 Sayı: 2

Kaynak Göster

Vancouver Ulus M, Durmaz Edeer A, Karaağaç E. Frequency of delirium after carotid endarterectomy. JSurgArts. 2024;17(2):36-43.

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