ABSTRACT
Background Immediate postoperative delirium (IPD) in the post-anesthesia care unit (PACU) can cause significant morbidity affecting everyday activities and length of stay with cost implications. This study was undertaken to find the proportion of IPD in PACU and its association with anesthesia and other perioperative factors. Methods After obtaining ethical approval and informed consent, this cross-sectional study was conducted in the PACU. A total of 600 consecutive adult patients (American Society of Anesthesiologists (ASA) 1-3) posted for surgery were approached between January and March 2019, of which 402 patients without neurological diseases and language and hearing discrepancies were studied. All patients had the intervention of surgery under anesthesia in a usual manner. Delirium was assessed preoperatively, postoperatively at 15 and 30 minutes, and before discharge from the PACU. IPD was assessed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score, while sedation/agitation was assessed using the Richmond Agitation-Sedation Scale (RASS). The primary outcomes were the proportion of IPD, association with anesthesia, and perioperative risk factors. The secondary outcomes were the length of stay, delirium treatment, and mortality. Results Overall, the IPD proportion was 14.7%. A significant association was demonstrated with premedication with midazolam (odds ration (OR): 3.2; 95% confidence interval (CI): 1.42-7.35; P=0.003), general anesthesia (GA) (OR: 6.3; 95% CI: 2.23-17.8; P<0.001), duration of anesthesia (126 versus 95 minutes; P=0.001), laparoscopic mode of surgical access (OR: 3.4; 95% CI: 1.8-6.4; P<0.001), and postoperative RASS >/< 0 (OR: 10.6; 95% CI: 4.69-24.11; P<0.001) at 30 minutes and before discharge from the PACU. Multivariate analysis showed the strongest association of RASS at 30 minutes with IPD. Conclusion The proportion of IPD was found to be 14.7% in this study, and the chances of developing IPD are high if the patient is not awake and calm in the PACU, especially if midazolam is administered as premedication, followed by general anesthesia (GA) for a long duration.
ABSTRACT
BACKGROUND: Addition of glucose in the intraoperative fluid is a routine practice in infants. Under general anesthesia, due to neuroendocrine stress response, this could result in overt hyperglycemia. AIMS: The aim of this study was to find whether the addition of 2% dextrose to Ringer's lactate (RL) caused hyperglycemia compared to no addition of dextrose to RL. SETTINGS AND DESIGNS: This prospective randomized study was conducted in 100 infants undergoing facial cleft surgery at a tertiary care institution. SUBJECTS AND METHODS: Group D received RL with 2% dextrose and Group R received RL without the addition of dextrose. Blood sugars were measured at induction, 1 h and 2 h later. Hyperglycemia was defined as blood sugar >150 mg/dL and hypoglycemia as <70 mg/dL. STATISTICAL ANALYSIS USED: Pearson's Chi-square test, Paired t-test, Mann-Whitney test, and Independent sample t-test were used as applicable. RESULTS: Baseline blood sugar was comparable in both groups. A significant increase in blood sugar values from baseline was seen in both groups, but the increase was significantly more in Group D at 60 min (136.5 ± 41.9 vs. 109.2 ± 20.5) and at 120 min (150.1 ± 45.5 vs. 123.1 ± 31.7). The incidence of hyperglycemia was 50% in Group D and 12% in Group R. No patient developed hypoglycemia intraoperatively. No significant correlation between blood sugar and hours of fasting was established. CONCLUSION: Routine addition of dextrose to RL is not essential during short surgeries under general anesthesia in infants, provided preinduction blood sugar level is >70 mg/dL and intraoperative sugars are periodically monitored.
