Association between Use of Angiotensin-converting Enzyme Inhibitors or Angiotensin Receptor Blockers and Postoperative Delirium.

Abstract:

BACKGROUND:Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers improve cognitive function. The authors therefore tested the primary hypothesis that preoperative use of angiotensin inhibitors is associated with less delirium in critical care patients. Post hoc, the association between postoperative use of angiotensin system inhibitors and delirium was assessed. METHODS:The authors conducted a single-site cohort study of adults admitted to Cleveland Clinic critical care units after noncardiac procedures between 2013 and 2018 who had at least one Confusion Assessment Method delirium assessment. Patients with preexisting dementia, Alzheimer's disease or other cognitive decline, and patients who had neurosurgical procedures were excluded. For the primary analysis, the confounder-adjusted association between preoperative angiotensin inhibitor use and the incidence of postoperative delirium was assessed. Post hoc, the confounder-adjusted association between postoperative angiotensin system inhibitor use and the incidence of delirium was assessed. RESULTS:The incidence of delirium was 39% (551 of 1,396) among patients who were treated preoperatively with angiotensin system inhibitors and 39% (1,344 of 3,468) in patients who were not. The adjusted odds ratio of experiencing delirium during critical care was 0.98 (95% CI, 0.86 to 1.10; P = 0.700) for preoperative use of angiotensin system inhibitors versus control. Delirium was observed in 23% (100 of 440) of patients who used angiotensin system inhibitors postoperatively before intensive care discharge, and in 41% (1,795 of 4,424) of patients who did not (unadjusted P < 0.001). The confounder-adjusted odds ratio for experiencing delirium in patients who used angiotensin system inhibitors postoperatively was 0.55 (95% CI, 0.43 to 0.72; P < 0.001). CONCLUSIONS:Preoperative use of angiotensin system inhibitors is not associated with reduced postoperative delirium. In contrast, treatment during intensive care was associated with lower odds of delirium. Randomized trials of postoperative angiotensin-converting enzymes inhibitors and angiotensin receptor blockers seem justified.

journal_name

Anesthesiology

journal_title

Anesthesiology

authors

Farag E,Liang C,Mascha EJ,Argalious MY,Ezell J,Maheshwari K,Esa WAS,Troianos CA,Sessler DI

doi

10.1097/ALN.0000000000003329

subject

Has Abstract

pub_date

2020-07-01 00:00:00

pages

119-132

issue

1

eissn

0003-3022

issn

1528-1175

journal_volume

133

pub_type

杂志文章
  • Ineffectiveness of burst suppression therapy in mitigating perioperative cerebrovascular dysfunction. Multicenter Study of Perioperative Ischemia (McSPI) Research Group.

    abstract:BACKGROUND:Cerebral injury is among the most common and disabling complications of open heart surgery. Attempts to provide neuroprotection have yielded conflicting results. We assessed the potential of propofol-induced burst suppression during open heart surgery to provide cerebral protection as determined by postopera...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1097/00000542-199905000-00006

    authors: Roach GW,Newman MF,Murkin JM,Martzke J,Ruskin A,Li J,Guo A,Wisniewski A,Mangano DT

    更新日期:1999-05-01 00:00:00

  • Effects of halothane, propofol, and thiopental on peripheral airway reactivity.

    abstract:BACKGROUND:General anesthetics modify airway responsiveness by several mechanisms, including direct effects on airway smooth muscle and reductions in neural reflex activity. Halothane has been shown to reduce responsiveness through both of these mechanisms. The airway effects of barbiturates are controversial, and the ...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199308000-00014

    authors: Mehr EH,Lindeman KS

    更新日期:1993-08-01 00:00:00

  • A Clinical Trial to Detect Subclinical Transfusion-induced Lung Injury during Surgery.

    abstract:BACKGROUND:Transfusion-related acute lung injury incidence remains the leading cause of posttransfusion mortality. The etiology may be related to leukocyte antibodies or biologically active compounds in transfused plasma, injuring susceptible recipient's lungs. The authors have hypothesized that transfusion could have ...

    journal_title:Anesthesiology

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/ALN.0000000000000689

    authors: Feiner JR,Gropper MA,Toy P,Lieberman J,Twiford J,Weiskopf RB

    更新日期:2015-07-01 00:00:00

  • Antinociceptive effect of low-dose intrathecal neostigmine combined with intrathecal morphine following gynecologic surgery.

    abstract:BACKGROUND:The purpose of this study was to determine whether combination of 1-5 microg intrathecal neostigmine would enhance analgesia from a fixed intrathecal dose of morphine. METHODS:A total of 60 patients undergoing gynecologic surgery were randomized to one of five groups. Patients received 15 mg bupivacaine plu...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-200302000-00031

    authors: Almeida RA,Lauretti GR,Mattos AL

    更新日期:2003-02-01 00:00:00

  • Spinal alpha 2-adrenoceptor-mediated analgesia in neuropathic pain reflects brain-derived nerve growth factor and changes in spinal cholinergic neuronal function.

    abstract:INTRODUCTION:Spinal alpha2-adrenoceptor stimulation produces analgesia in neuropathic pain states, and this effect in animals is blocked by the inhibitors of brain-derived neurotrophic factor (BDNF) function. In rats, alpha2-adrenoceptor stimulation normally inhibits acetylcholine release, but it excites release after ...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e3181de6d2c

    authors: Hayashida K,Eisenach JC

    更新日期:2010-08-01 00:00:00

  • Ketamine Alters Hippocampal Cell Proliferation and Improves Learning in Mice after Traumatic Brain Injury.

    abstract:WHAT WE ALREADY KNOW ABOUT THIS TOPIC:WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Traumatic brain injury induces cellular proliferation in the hippocampus, which generates new neurons and glial cells during recovery. This process is regulated by N-methyl-D-aspartate-type glutamate receptors, which are inhibite...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0000000000002197

    authors: Peters AJ,Villasana LE,Schnell E

    更新日期:2018-08-01 00:00:00

  • Heparinase I (neutralase) reversal of systemic anticoagulation.

    abstract:BACKGROUND:Protamine causes multiple adverse reactions. Heparinase I, a specific enzyme that inactivates heparin, is a possible alternative to protamine. In this study, the authors examined the efficacy of heparinase I to reverse heparin-induced anticoagulation in vitro and compared heparinase I to protamine as an anta...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199608000-00016

    authors: Michelsen LG,Kikura M,Levy JH,Lee MK,Lee KC,Zimmermann JJ,Szlam F

    更新日期:1996-08-01 00:00:00

  • Hepatic plasma flow during sodium nitroprusside-induced hypotension in humans.

    abstract::Changes in hepatic plasma flow (HPF) during sodium nitroprusside (SNP) induced hypotension were studied in 14 patients undergoing intracranial aneurysm surgery under neurolept anesthesia. Patients were monitored with the use of a radial artery catheter and a thermistor-tipped Swan-Ganz catheter. Hypotension was induce...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-198509000-00008

    authors: Chauvin M,Bonnet F,Montembault C,Lafay M,Curet P,Viars P

    更新日期:1985-09-01 00:00:00

  • Low reticulocyte hemoglobin content is associated with a higher blood transfusion rate in critically ill patients: a cohort study.

    abstract:BACKGROUND:Intensive care unit (ICU) patients often need blood transfusion, but no reliable predictors of transfusion requirements are available at ICU admission. The authors hypothesized that ICU patients with functional iron deficiency may be at higher risk for developing anemia, requiring blood transfusion. Their ob...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e3181d74f87

    authors: Fernandez R,Tubau I,Masip J,Muñoz L,Roig I,Artigas A

    更新日期:2010-05-01 00:00:00

  • The "educated hand". Can anesthesiologists assess changes in neonatal pulmonary compliance manually?

    abstract::To determine whether anesthesiologists can manually detect significant changes in pulmonary compliance in neonates using an "educated hand," the authors tested whether clinicians could detect clamping of an endotracheal tube connecting a neonatal lung model to one of three anesthesia breathing circuits. The test lungs...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199110000-00022

    authors: Spears RS Jr,Yeh A,Fisher DM,Zwass MS

    更新日期:1991-10-01 00:00:00

  • Effects of intravenous or subarachnoid morphine on cerebral and spinal cord hemodynamics and antagonism with naloxone in dogs.

    abstract::In order to elucidate the possible mechanism(s) by which opiates may affect cerebral and spinal circulation, and cerebral metabolism, cerebral blood flow (CBF) and spinal cord blood flow (SCBF) were measured simultaneously following intravenous or subarachnoid administration of morphine in dogs lightly anesthetized wi...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:

    authors: Matsumiya N,Dohi S

    更新日期:1983-09-01 00:00:00

  • Propofol: the challenges of formulation.

    abstract::Propofol is a potent lipophilic anesthetic that was initially formulated in Cremophor El for human use. Because of the occurrence of Cremophor EL anaphylaxis and improvements in the quality of lipid emulsions, it was ultimately brought to market as 1% propofol formulated in 10% soybean oil emulsion. Emulsions represen...

    journal_title:Anesthesiology

    pub_type: 杂志文章,评审

    doi:10.1097/00000542-200510000-00026

    authors: Baker MT,Naguib M

    更新日期:2005-10-01 00:00:00

  • Cognitive Decline after Delirium in Patients Undergoing Cardiac Surgery.

    abstract:WHAT WE ALREADY KNOW ABOUT THIS TOPIC:Cardiac surgery is associated with cognitive decline and postoperative delirium. The relationship between postoperative delirium and cognitive decline after cardiac surgery is unclear WHAT THIS ARTICLE TELLS US THAT IS NEW:The development of postoperative delirium is associated wi...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0000000000002253

    authors: Brown CH 4th,Probert J,Healy R,Parish M,Nomura Y,Yamaguchi A,Tian J,Zehr K,Mandal K,Kamath V,Neufeld KJ,Hogue CW

    更新日期:2018-09-01 00:00:00

  • Effects of nitrous oxide on human regional cerebral blood flow and isolated pial arteries.

    abstract:BACKGROUND:Results from previous studies on the effect of nitrous oxide (N2O) on the cerebral circulation are conflicting. Early reports claim N2O to have no effect whereas recent findings demonstrate a cerebral cortical vasodilatation during N2O inhalation, but the regional cerebral blood flow (CBF) in the subcortical...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199408000-00018

    authors: Reinstrup P,Ryding E,Algotsson L,Berntman L,Uski T

    更新日期:1994-08-01 00:00:00

  • Cysteine reversal of the novel neuromuscular blocking drug CW002 in dogs: pharmacodynamics, acute cardiovascular effects, and preliminary toxicology.

    abstract:BACKGROUND:CW002 is a neuromuscular blocking drug that is inactivated by endogenous L-cysteine. This study determined the exogenous L-cysteine dose-response relationship for CW002 reversal along with acute cardiovascular effects and organ toxicity in dogs. METHODS:Six dogs were each studied four times during isofluran...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e3181d31f8c

    authors: Sunaga H,Malhotra JK,Yoon E,Savarese JJ,Heerdt PM

    更新日期:2010-04-01 00:00:00

  • Goal-directed colloid administration improves the microcirculation of healthy and perianastomotic colon.

    abstract:BACKGROUND:The aim of this study was to compare the effects of goal-directed colloid fluid therapy with goal-directed crystalloid and restricted crystalloid fluid therapy on healthy and perianastomotic colon tissue in a pig model of colon anastomosis surgery. METHODS:Pigs (n = 27, 9 per group) were anesthetized and me...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e31819841f6

    authors: Kimberger O,Arnberger M,Brandt S,Plock J,Sigurdsson GH,Kurz A,Hiltebrand L

    更新日期:2009-03-01 00:00:00

  • Induction of malignant hyperthermia in susceptible swine by 3,4-methylenedioxymethamphetamine ("ecstasy").

    abstract:BACKGROUND:3,4-Methylenedioxymethamphetamine (MDMA, "ecstasy") can mediate acute toxic effects such as muscle rigidity, metabolic acidosis, and hyperthermia. Because of close clinical similarities, an association between MDMA intoxication and malignant hyperthermia (MH) was suggested. The aim of this study was to inves...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200311000-00020

    authors: Fiege M,Wappler F,Weisshorn R,Gerbershagen MU,Menge M,Schulte Am Esch J

    更新日期:2003-11-01 00:00:00

  • Continuous cardiac output in septic shock by simulating a model of the aortic input impedance: a comparison with bolus injection thermodilution.

    abstract:BACKGROUND:To compare continuous cardiac output obtained by simulation of an aortic input impedance model to bolus injection thermodilution (TDCO) in critically ill patients with septic shock. METHODS:In an open study, mechanically ventilated patients with septic shock were monitored for 1 (32 patients), 2 (15 patient...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199905000-00016

    authors: Jellema WT,Wesseling KH,Groeneveld AB,Stoutenbeek CP,Thijs LG,van Lieshout JJ

    更新日期:1999-05-01 00:00:00

  • Taming the ketamine tiger. 1965.

    abstract::Pharmacologic actions of CI-581, a chemical derivative of phencyclidine, were determined in 20 volunteers from a prison population. The results indicate that this drug is an effective analgesic and anesthetic agent in doses of 1.0 to 2.0 mg per kilogram. With intravenous administration the onset of action is within 1 ...

    journal_title:Anesthesiology

    pub_type: 传,古典文章,历史文章,杂志文章

    doi:10.1097/ALN.0b013e3181ed09a2

    authors: Domino EF

    更新日期:2010-09-01 00:00:00

  • Cardioprotective trafficking of caveolin to mitochondria is Gi-protein dependent.

    abstract:BACKGROUND:Caveolae are a nexus for protective signaling. Trafficking of caveolin to mitochondria is essential for adaptation to cellular stress though the trafficking mechanisms remain unknown. The authors hypothesized that G protein-coupled receptor/inhibitory G protein (Gi) activation leads to caveolin trafficking t...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0000000000000295

    authors: Wang J,Schilling JM,Niesman IR,Headrick JP,Finley JC,Kwan E,Patel PM,Head BP,Roth DM,Yue Y,Patel HH

    更新日期:2014-09-01 00:00:00

  • Effect of combined mouth closure and chin lift on upper airway dimensions during routine magnetic resonance imaging in pediatric patients sedated with propofol.

    abstract:BACKGROUND:In pediatric patients, obstruction of the upper airway is a common problem during general anesthesia. Chin lift is a commonly used technique to improve upper airway patency. However, little is known about the mechanism underlying this technique. METHODS:The authors studied the effect of the chin lift maneuv...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199906000-00018

    authors: Reber A,Wetzel SG,Schnabel K,Bongartz G,Frei FJ

    更新日期:1999-06-01 00:00:00

  • Volatile anesthetics enhance flash-induced gamma oscillations in rat visual cortex.

    abstract:BACKGROUND:The authors sought to understand neural correlates of anesthetic-induced unconsciousness. Cortical gamma oscillations have been associated with neural processes supporting conscious perception, but the effect of general anesthesia on these oscillations is controversial. In this study, the authors examined th...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200505000-00012

    authors: Imas OA,Ropella KM,Ward BD,Wood JD,Hudetz AG

    更新日期:2005-05-01 00:00:00

  • Spinal ropivacaine for cesarean section: a dose-finding study.

    abstract:BACKGROUND:The dose-response relation for spinal ropivacaine is undetermined, and there are few data available for obstetric patients. METHODS:In a prospective, randomized, double-blind investigation, the authors studied 72 patients undergoing elective cesarean delivery. An epidural catheter was placed at the L2-L3 ve...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-200112000-00011

    authors: Khaw KS,Ngan Kee WD,Wong EL,Liu JY,Chung R

    更新日期:2001-12-01 00:00:00

  • Derivation and diagnostic accuracy of the surgical lung injury prediction model.

    abstract:BACKGROUND:Acute lung injury (ALI) is a serious postoperative complication with limited treatment options. A preoperative risk-prediction model would assist clinicians and scientists interested in ALI. The objective of this investigation was to develop a surgical lung injury prediction (SLIP) model to predict risk of p...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e31821b5839

    authors: Kor DJ,Warner DO,Alsara A,Fernández-Pérez ER,Malinchoc M,Kashyap R,Li G,Gajic O

    更新日期:2011-07-01 00:00:00

  • Systolic blood pressure variation is a sensitive indicator of hypovolemia in ventilated dogs subjected to graded hemorrhage.

    abstract::Systolic pressure variation (SPV) is defined as the difference between the maximum and minimum values of systolic blood pressure following a single positive pressure breath. An increase in the SPV is known to occur clinically during hypovolemia. This study aims to quantify SPV during graded hemorrhage in ventilated do...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-198710000-00009

    authors: Perel A,Pizov R,Cotev S

    更新日期:1987-10-01 00:00:00

  • Halothane, enflurane, and isoflurane decrease calcium sensitivity and maximal force in detergent-treated rat cardiac fibers.

    abstract::This study was designed to test the hypothesis that the volatile anesthetics directly affect cardiac contractile proteins. For this purpose, the effects of various anesthetic doses of halothane, enflurane, and isoflurane on myocardial calcium sensitivity and maximal calcium-activated force were examined in rat cardiac...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-198812000-00015

    authors: Murat I,Ventura-Clapier R,Vassort G

    更新日期:1988-12-01 00:00:00

  • Spontaneous breathing improves lung aeration in oleic acid-induced lung injury.

    abstract:BACKGROUND:Experimental and clinical studies have shown reduction in intrapulmonary shunt with improved oxygenation by spontaneous breathing with airway pressure release ventilation (APRV) in acute lung injury. The mechanisms of these findings are not clear. The authors hypothesized that spontaneous breathing results i...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200308000-00019

    authors: Wrigge H,Zinserling J,Neumann P,Defosse J,Magnusson A,Putensen C,Hedenstierna G

    更新日期:2003-08-01 00:00:00

  • Identifying and Treating Opioid Side Effects: The Development of Methylnaltrexone.

    abstract::Methylnaltrexone Reverses Chronic Opioid-induced Constipation: A Randomized, Controlled Trial. By Yuan CS, Foss JF, O'Connor M, Osinski J, Karrison T, Moss J, Roizen MF. JAMA 2000; 130:142-8. Reprinted with permission. CONTEXT:Constipation is the most common chronic adverse effect of opioid pain medications in patien...

    journal_title:Anesthesiology

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/ALN.0000000000002428

    authors: Moss J

    更新日期:2019-01-01 00:00:00

  • Prediction of Bispectral Index during Target-controlled Infusion of Propofol and Remifentanil: A Deep Learning Approach.

    abstract:BACKGROUND:The discrepancy between predicted effect-site concentration and measured bispectral index is problematic during intravenous anesthesia with target-controlled infusion of propofol and remifentanil. We hypothesized that bispectral index during total intravenous anesthesia would be more accurately predicted by ...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0000000000001892

    authors: Lee HC,Ryu HG,Chung EJ,Jung CW

    更新日期:2018-03-01 00:00:00

  • Early exposure to anesthesia and learning disabilities in a population-based birth cohort.

    abstract:BACKGROUND:Anesthetic drugs administered to immature animals may cause neurohistopathologic changes and alterations in behavior. The authors studied association between anesthetic exposure before age 4 yr and the development of reading, written language, and math learning disabilities (LD). METHODS:This was a populati...

    journal_title:Anesthesiology

    pub_type: 杂志文章,多中心研究

    doi:10.1097/01.anes.0000344728.34332.5d

    authors: Wilder RT,Flick RP,Sprung J,Katusic SK,Barbaresi WJ,Mickelson C,Gleich SJ,Schroeder DR,Weaver AL,Warner DO

    更新日期:2009-04-01 00:00:00