Prevalence of delirium in opium users after coronary artery bypass graft surgery

Background: Postoperative cognitive dysfunction, especially delirium commonly occurs after cardiac surgery. Clinical evidences suggest an increase in delirium in opium abusers after Coronary Artery Bypass Graft [CABG] surgery. In this study, the prevalence of delirium in addict [opium user] and nonaddict patients after CABG were compared

Methods: In a cross-sectional study after obtaining institutional approval and informed consent, 325 patients candidate for elective CABG were included in the study. All patients with history of opium abuse met the criteria for opioid dependence using Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition definitions. Delirium after CABG was assessed in addict [opium user] and nonaddict patients up to a maximum of 5 days after surgery with the Intensive Care Delirium Screening Checklist

Results: A total of 325 patients were evaluated [208 without and 117 with a history of opium abuse]. Postoperative delirium occurred within 72 h after surgery in 44.31% of all patients. There was a significant difference in the prevalence of postoperative delirium between the opium users [80.7%] and nonaddict patients [25%] in the intensive care unit [P < 0.001]. Opium addiction was a risk factor for postoperative delirium after CABG Surgery

Conclusions: Delirium after CABG surgery is more prevalent in opium users compared with nonaddict patients. Therefore, opium abuse is a possible risk factor for postoperative delirium in cardiac surgical patients

Can selection of mechanical ventilation mode prevent increased intra-abdominal pressure in patients admitted to the intensive care unit?

Increased intra-abdominal pressure [IAP] results in dysfunction of vital organs. The aim of the present study was to evaluate the effect of mechanical ventilation mode on IAP. In a cohort study, a total of 60 patients aged 20-70 years who were admitted to the ICU and underwent mechanical ventilation were recruited. Mechanical ventilation included one of the three modes: Biphasic positive airway pressure [BIPAP] group, synchronize intermittent mandatory ventilation [SIMV] group, or continuous positive airway pressure [CPAP] group. For each patient, mechanical ventilation mode and its parameters, blood pressure, SpO2, and status of tube feeding and IAP were recorded. Our findings indicate that the study groups were not significantly different in terms of anthropometric characteristics including age [64.5 +/- 4, P = 0.1], gender [male/female 31/29, P = 0.63], and body mass index [24 +/- 1.2, P = 0.11]. Increase IAP was related to the type of respiratory mode with the more increased IAP observed in SIMV mode, followed by BIPAP and CPAP modes [P = 0.01]. There were significant correlations between increased IAP and respiratory variables including respiratory rate, pressure support ventilation, and inspiratory pressure [P < 0.05]. Tube feeding tolerance through NG-tube was lower in SIMV group, followed by BIPAP and CPAP groups [P < 0.05]. There is a significant relationship between respiratory modes and IAP; therefore, it is better to utilize those types of mechanical ventilation like CPAP and BIPAP mode in patients who are prone to Intra-abdominal hypertension

Delayed presentation of ventricular septal defect secondary to penetrating cardiac trauma following stab wound to the chest

Ventricular septal defect represents an uncommon sequel of penetrating cardiac trauma. A high index of suspicion, follow-up, and a complete evaluation of the patient who survives a penetrating heart injury is required. We report an unusual case of posttraumatic ventricular septal defect in a patient who had a stab injury to the chest requiring emergency operation. After the first surgery, the patient presented with dyspnea and signs of heart failure. Intraoperative assessment revealed ventricular septal defect

Preoperative sub-tenon block decreases perioperative pain severity and adveres complications

This study was designed to evaluate the efficacy of sub-tenon block [preemptive analgesia] after general anesthesia and before beginning the repair of retinal detachment [RD] surgery by using scleral buckle and cryopexy. Sixty eight patients scheduled for RD surgical repair with "American Society of Anesthesiologists" [ASA] I or II were included in this clinical trial study. The patients were randomly and blindly divided into two equal groups. The surgery was done under general anesthesia in both groups, but in the case group, sub-tenon block was given as preemptive analgesia after the induction of general anesthesia with similar methods and before the start of surgery. The incidences of intra and postoperative [up to 24 hours] oculocardiac reflex [OCR], ischemic heart disease [IHD] changes, nausea and vomiting [PONV], delirium, total analgesic drug consumption and ocular severity of pain were significantly lower in the case group compared with the control group [p<0.05]. Mean blood pressure, heart rate, time of discharge from the hospital, frequency of requirement to analgesic drug, intra and postoperatively were significantly lower in the case group compared with the control group [p<0.05]. According to this research, the use of sub-tenon block in RD surgery effectively reduces PONV, postoperative pain, analgesic drug requirements, delirium, discharge time from the hospital, IHD, hemodynamic changes and OCR, therefore it is recommended for daily routine ophthalmologic surgeries