ABSTRACT
The aim of this study was to evaluate the effect of a geriatric-anesthesiologic intervention program for the prevention and treatment of acute confusional states (ACS) in elderly patients treated for femoral neck fractures. The intervention program was based on the results of previous prospective studies in similar patient populations. The outcome of the intervention, comprising 103 patients, was compared with that of an earlier study comprising 111 patients. The intervention program consisted of pre- and post-operative geriatric assessments, oxygen therapy, early surgery, prevention and treatment of peri-operative blood pressure falls and treatment of post-operative complications. The incidence of ACS was lower, 47.6%, in the intervention study compared with 61.3% (P less than 0.05) in the control study. Furthermore, the ACS that occurred in the intervention study was less severe and of shorter duration than that in the control study. The incidence of post-operative decubital ulcers, severe falls, and urinary retention was also lower. The mean duration of orthopedic ward stay was 17.4 days in the control study and 11.6 days in the intervention study (P less than 0.001). It can be concluded that the intervention program reduced the incidence, severity, and duration of ACS which resulted in a shortened orthopedic ward stay.
Subject(s)
Confusion/therapy , Femoral Neck Fractures/surgery , Oxygen/therapeutic use , Postoperative Complications/therapy , Aged , Aged, 80 and over , Confusion/prevention & control , Female , Geriatric Assessment , Humans , Length of Stay , Male , Morphine/administration & dosage , Postoperative Complications/prevention & control , Preanesthetic MedicationABSTRACT
The neurotoxic potential of benzylpenicillin administered intravenously as a continuous infusion was studied in rabbits with experimental Escherichia coli meningitis. As controls a group of rabbits was injected with saline into the cisterna magna. The concentrations of benzylpenicillin in serum, CSF and brain tissue fluid were studied at onset of epileptogenic electroencephalographic activity (thirteen rabbits) or convulsions (ten rabbits), with a previously developed method for neurotoxicity studies. E. coli meningitis did not increase the neurotoxicity of benzylpenicillin, despite high concentrations of the drug in both CSF and brain tissue fluid. The intracisternal injection of saline in the control group produced slight pleocytosis in some rabbits indicating some degree of damage of the blood-CSF barrier.
