These data suggest that
a patient’s odds of developing postoperative delirium were up to twice as high for general anesthesia patients compared with those who received neuraxial anesthesia, noted Ms. Weinstein, who added that further research is needed to validate these results and demonstrate the extent to which these findings are generalizable to other patient cohorts.
“These results are a portion of an ongoing study,” Ms. Weinstein said. “We’re interested in expanding this cohort to include other types of orthopedic patients. We’re also working on adding covariates from pharmacologic and laboratory data sets.”
David Birnbach, MD, MPH, vice provost and professor of anesthesiology, obstetrics and gynecology, and public health at the University of Miami Miller School of Medicine, asked whether the use of ketamine infusions was associated with an increased risk for delirium.
“We are looking at this question in a separate data set,” Ms. Weinstein said.
“In previous analyses, though, we have found that ketamine was associated with increased risk for delirium. It’s only a small number of patients, but there was an association.”
“How do you control for changing sedation and multimodal techniques over time?” Dr. Birnbach asked. “Delirium outcomes may be influenced by use of less opioids, for example.”
“We try to adjust for these things by taking different time periods into account,” said Stavros G. Memtsoudis, MD, PhD, attending anesthesiologist and director of critical care at the Hospital for Special Surgery. “But there is ongoing work to tease out the use of multimodal, nonopioid analgesics and how that changes over time. So far, our conclusions haven’t changed when we add these modifiers.”
http://www.anesthesiologynews.com/C...-Postoperative-Delirium-in-TKR-Patients/41484
