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Ruck JM, King EA, Chu NM, Segev DL, McAdams-DeMarco M. Delirium in Liver Transplantation. CURRENT TRANSPLANTATION REPORTS 2023. [DOI: 10.1007/s40472-023-00391-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Zhang L, Cui LL, Yang WH, Xue FS, Zhu ZJ. Effect of intraoperative dexmedetomidine on hepatic ischemia-reperfusion injury in pediatric living-related liver transplantation: A propensity score matching analysis. Front Surg 2022; 9:939223. [PMID: 35965870 PMCID: PMC9365069 DOI: 10.3389/fsurg.2022.939223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHepatic ischemia-reperfusion injury (HIRI) is largely unavoidable during liver transplantation (LT). Dexmedetomidine (DEX), an α2-adrenergic agonist, exerts a variety of organ-protective effects in pediatric populations. However, evidence remains relatively limited about its hepatoprotective effects in pediatric living-related LT.MethodsA total of 121 pediatric patients undergoing living-related LT from June 2015 to December 2018 in our hospital were enrolled. They were classified into DEX or non-DEX groups according to whether an infusion of DEX was initiated from incision to the end of surgery. Primary outcomes were postoperative liver graft function and the severity of HIRI. Multivariate logistic regression and propensity score matching (PSM) analyses were performed to identify any association.ResultsA 1:1 matching yielded 35 well-balanced pairs. Before matching, no significant difference was found in baseline characteristics between groups except for warm ischemia time, which was longer in the non-DEX group (44 [38–50] vs. 40 [37–44] min, p = 0.017). After matching, the postoperative peak lactic dehydrogenase levels decreased significantly in the DEX group than in the non-DEX group (622 [516–909] vs. 970 [648–1,490] IU/L, p = 0.002). Although there was no statistical significance, a tendency toward a decrease in moderate-to-extreme HIRI rate was noted in the DEX group compared to the non-DEX group (68.6% vs. 82.9%, p = 0.163). Patients in the DEX group also received a significantly larger dosage of epinephrine as postreperfusion syndrome (PRS) treatment (0.28 [0.17–0.32] vs. 0.17 [0.06–0.30] µg/kg, p = 0.010). However, there were no significant differences between groups in PRS and acute kidney injury incidences, mechanical ventilation duration, intensive care unit, and hospital lengths of stay. Multivariate analysis revealed a larger graft-to-recipient weight ratio (odds ratio [OR] 2.657, 95% confidence interval [CI], 1.132–6.239, p = 0.025) and intraoperative DEX administration (OR 0.333, 95% CI, 0.130–0.851, p = 0.022) to be independent predictors of moderate-to-extreme HIRI.ConclusionThis study demonstrated that intraoperative DEX could potentially decrease the risk of HIRI but was associated with a significant increase in epinephrine requirement for PRS in pediatric living-related LT. Further studies, including randomized controlled studies, are warranted to provide more robust evidence.
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Affiliation(s)
- Liang Zhang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ling-Li Cui
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wen-He Yang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Correspondence: Fu-Shan Xue Zhu-Jun Zhu
| | - Zhi-Jun Zhu
- Division of Liver Transplantation, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China
- Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing, China
- Correspondence: Fu-Shan Xue Zhu-Jun Zhu
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Chomat MR, Said AS, Mann JL, Wallendorf M, Bickhaus A, Figueroa M. Changes in Sedation Practices in Association with Delirium Screening in Infants After Cardiopulmonary Bypass. Pediatr Cardiol 2021; 42:1334-1340. [PMID: 33891134 DOI: 10.1007/s00246-021-02616-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
Sedation in the cardiac intensive care unit (CICU) is necessary to keep critically ill infants safe and comfortable. However, long-term use of sedatives may be associated with adverse neurodevelopmental outcomes. We aimed to examine sedation practices in the CICU after the implementation of the Cornell Assessment of Pediatric Delirium (CAPD). We hypothesize the use of the CAPD would be associated with a decrease in sedative weans at CICU discharge. This is a single institution, retrospective cohort study. The study inclusion criteria were term infants, birthweight > 2.5 kg, cardiopulmonary bypass (CPB), and mechanical ventilation (MV) on postoperative day zero. During the study period, 50 and 35 patients respectively, met criteria pre- and post-implementation of CAPD screening. Our results showed a statistically significant increase in the incidence of sedative habituation wean at CICU discharge after CAPD implementation (24% vs. 45.7%, p = 0.036). There was a statistically significant increase in exposure to opiate (56% vs. 88.6%, p = 0.001) and dexmedetomidine infusions (52% vs 80%, p = 0.008), increased likelihood of clonidine use at CICU discharge (OR 9.25, CI 2.39-35.84), and increase in the duration of intravenous sedative infusions (8.1 days vs. 5.1 days, p = 0.04) No statistical difference was found in exposure to fentanyl (42% vs. 58.8%, p = 0.13) or midazolam infusions (22% vs. 25.7%, p = 0.691); and there was no change in benzodiazepine or opiate use at CICU discharge or dosage. The prevalence of delirium in the CAPD cohort was 92%. CAPD implementation in the CICU was associated with changes in sedation practices, specifically an increase in the use of dexmedetomidine, which possibly explains the increased clonidine weans at CICU discharge. This is the first report of the association between CAPD monitoring and changes in sedative practices. Multi-center prospective studies are recommended to evaluate sedative practices, delirium, and its effects on neurodevelopment.
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Affiliation(s)
- Michael R Chomat
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, USA
- Division of Pediatric Critical Care Medicine, Washington University in St. Louis, St. Louis, USA
| | - Ahmed S Said
- Division of Pediatric Critical Care Medicine, Washington University in St. Louis, St. Louis, USA
| | - Jessica L Mann
- St. Louis Children's Hospital, Washington University in St. Louis, St. Louis, USA
| | - Michael Wallendorf
- Division of Biostatistics, Washington University in St. Louis, St. Louis, USA
| | - Alexandra Bickhaus
- St. Louis Children's Hospital, Washington University in St. Louis, St. Louis, USA
| | - Mayte Figueroa
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, USA.
- Division of Pediatric Critical Care Medicine, Washington University in St. Louis, St. Louis, USA.
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave., Campus Box 8116, St. Louis, MO, 63110-1093, USA.
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Shayan S, DE Wolf AM. Delirious after liver transplantation: are we oblivious? Minerva Anestesiol 2021; 87:630-633. [PMID: 33688702 DOI: 10.23736/s0375-9393.21.15623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Shahriar Shayan
- Feinberg School of Medicine, Department of Anesthesiology, Northwestern University, Chicago, IL, USA
| | - Andre M DE Wolf
- Feinberg School of Medicine, Department of Anesthesiology, Northwestern University, Chicago, IL, USA -
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Use of Dexmedetomidine in Liver Disease: A Systematic Review and Meta-Analysis. HEPATITIS MONTHLY 2019. [DOI: 10.5812/hepatmon.98530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Sun Y, Jiang M, Ji Y, Sun Y, Liu Y, Shen W. Impact of postoperative dexmedetomidine infusion on incidence of delirium in elderly patients undergoing major elective noncardiac surgery: a randomized clinical trial. Drug Des Devel Ther 2019; 13:2911-2922. [PMID: 31695323 PMCID: PMC6707367 DOI: 10.2147/dddt.s208703] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/19/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Postoperative delirium is a serious and common complication, it occurs in 13-50% of elderly patients after major surgery, and presages adverse outcomes. Emerging literature suggests that dexmedetomidine sedation in critical care units (intensive care unit) is associated with reduced incidence of delirium. However, few studies have investigated whether postoperative continuous infusion of dexmedetomidine could safely decrease the incidence of delirium in elderly patients admitted to general surgical wards after noncardiac surgery. PATIENTS AND METHODS This double-blind, randomized, placebo-controlled trial was conducted in patients aged 65 years or older undergoing major elective noncardiac surgery without a planned ICU stay. Eligible patients were randomly assigned to receive either dexmedetomidine (0.1 μg/kg/h) or placebo (0.9% normal saline) immediately after surgery though patient-controlled intravenous analgesia device. The primary outcome was the incidence of delirium during the first 5 postoperative days. Secondary outcomes included postoperative subjective pain scores and subjective sleep quality. The study dates were from January 2018 to January 2019. RESULTS A total of 557 patients were randomly assigned to receive either dexmedetomidine (n=281) or placebo (n=276). The incidence of postoperative delirium had no difference between the dexmedetomidine and placebo groups (11.7% [33 of 281] vs 13.8% [38 of 276], P=0.47). Compared with placebo group, patients in dexmedetomidine group reported significant lower numerical rating score pain scores at 3, 12, 24, and 48 hrs after surgery (all P<0.05) and significant improved Richards Campbell Sleep Questionnaire results during the first 3 postoperative days (all P<0.0001). Dexmedetomidine-related adverse events were similar between the two groups. CONCLUSION Postoperative continuous infusion of dexmedetomidine did not decrease the incidence of postoperative delirium in elderly patients admitted to general surgical wards after elective noncardiac surgery.
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Affiliation(s)
- Yuanyuan Sun
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Mingming Jiang
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Yunjing Ji
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Yue Sun
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Yao Liu
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Wen Shen
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
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Lee SI, Choi GS, Park J, Lee YJ, Hong KS. Posterior Reversible Encephalopathy Syndrome after Hypovolemic Shock Which Is Required Differential Diagnosis with Delirium in the Intensive Care Unit. Acute Crit Care 2018; 33:282-285. [PMID: 31723899 PMCID: PMC6849026 DOI: 10.4266/acc.2018.00262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/11/2018] [Accepted: 09/15/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Seo In Lee
- Department of Critical Care Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Gyeong Seon Choi
- Department of Neurology and Critical Care Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jin Park
- Department of Neurology and Critical Care Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Young-Joo Lee
- Department of Anesthesiology and Critical Care Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kyung Sook Hong
- Department of Surgery and Critical Care Medicine, Ewha Womans University College of Medicine, Seoul, Korea
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