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Postoperative delirium goes hand in hand with a diversity of disturbances involving consciousness, attention and orientation. Patients have to be cared for longer in hospital. Sometimes they cause self-injury and decide to remove their catheters.
Incidence varies from 5 to 15 percent in elderly patients and from 10 to 80 percent with children. US anaesthetists employ ketamine bolus doses in adults, their reasoning being based on results of animal experiments and a Cochrane reviewamong other studies.
Avidan, based on the results of his randomised, double-blinded study, raises doubts about this practice. He randomised patients in three groups: Surprisingly, 20 or 28 percent of those in the verum group hallucinated, compared to 18 percent of those who had only been given the pretend medication.
Avidan therefore urges that current practice be reconsidered. The situation looks better for clonidine use after general anaesthesia using sevoflurane and fentanyl. Mogens Ydemann from the University of Copenhagen included children between one and five years of age in her study. They received either clonidine or saline intraoperatively.
In the verum group, wake-up delirium was much less common than with placebo, namely 25 versus 47 percent. If the patient wakes up, further dangers threaten over cat subsequent few days or weeks.
Even in the absence of any irregularities, myocardial damage and markedly increased mortality occur following non-cardiac procedures. Two research groups independently of one another have now shown that troponine is suitable as a marker. These proteins enter the bloodstream, should cardiac muscle cells be damaged.
Devereaux from McMaster University in Hamilton, Canada, evaluated data from 21, patients for an observational study.
The patients were on average 63 years old and were operated for varied reasons. Cardiological indications were not among these reasons.
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