Episode 266: Live from ASA 2023! Post-op Delirium and Patient Monitoring with Drs. Culley and Eichorn
Oct 19, 2023
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Live from ASA 2023! Dr. Deb Culley talks about post-op delirium and Dr. John Eichorn discusses patient monitoring. Topics include the relationship between post-op delirium and cognitive impairment, the importance of good medical and anesthetic care, and the impact of Madazalam on older patients. Other topics include managing benzodiazepines, advocating for change in healthcare settings, and the role of anesthesiologists in prehabilitation.
Collaboration and a multidisciplinary approach are essential in implementing prehabilitation and rehabilitation in anesthesia.
Individualized pharmacological approaches, such as using dexmedetomidine, show promise in managing delirium for high-risk patients.
Agreeing upon standardized definitions and terminology for delirium facilitates accurate diagnosis and effective management, improving communication and research in the field of anesthesia.
Deep dives
Importance of Prehabilitation and Rehabilitation in Anesthesia
Prehabilitation and rehabilitation play a crucial role in optimizing patient outcomes before and after a procedure. The idea of extending the role of anesthesiologists beyond the operating room to include prehabilitation and rehabilitation is gaining importance. However, it requires collaboration with other healthcare professionals and a multidisciplinary approach. Taking into account the individual needs of each patient, interventions such as cognitive screening, addressing anxiety, and patient education can be implemented to improve outcomes. It is vital for physicians to communicate and agree upon standardized definitions and terminology to facilitate accurate diagnosis and management of conditions like postoperative delirium. Embracing new technologies, such as artificial intelligence, can potentially aid in predicting and capturing delirium episodes. Overall, recognizing the value of prehabilitation and rehabilitation in anesthesia and working collaboratively with other healthcare professionals can lead to improved patient care and outcomes.
Exploring New Pharmacological Agents for Delirium Prevention
While non-pharmacologic interventions, such as optimizing sleep, maintaining good nutrition, and reducing environmental stressors, remain critical in managing delirium, the exploration of new pharmacological agents is also underway. Dexmedetomidine has shown potential in managing delirium, especially for high-risk patients. However, the decision to use pharmacological agents should be individualized based on patient-specific factors and risk-benefit assessments. Continued research and development of new agents, together with a better understanding of the mechanisms underlying delirium, could pave the way for more effective and tailored pharmacological approaches in the future.
Standardizing Nomenclature for Delirium
Agreeing upon standard definitions and terminology for delirium is vital for accurate diagnosis and effective management. This can help improve communication between healthcare professionals and facilitate research in the field. Efforts are being made to develop standardized frameworks, such as the CAM (Confusion Assessment Method), to aid in the identification and diagnosis of delirium. Enhancing the clarity of nomenclature will contribute to a better understanding of delirium and its subtypes, leading to improved management strategies.
Expanding the Role of Anesthesiologists in Pre- and Post-procedure Care
The role of anesthesiologists is extending beyond the operating room, with increasing emphasis on prehabilitation and rehabilitation. Collaborating with other healthcare professionals, anesthesiologists can identify patients who would benefit from prehabilitation interventions, such as optimizing cardiovascular and respiratory function, and providing necessary support. A multidisciplinary approach involving anesthesiologists, physiotherapists, nutritionists, and other healthcare professionals can help optimize patient outcomes and enhance recovery after procedures. By integrating pre- and post-procedure care into their practice, anesthesiologists can contribute to improved patient care and outcomes.
Challenges and Opportunities in Anesthesia Research
Challenges exist in advocating for change and implementing new approaches in anesthesia. Overcoming structural barriers, such as resistance to change, requires gathering robust evidence to support the proposed interventions and presenting persuasive arguments, including potential cost savings. Collaboration, effective communication, and data-driven evidence are critical in advocating for change and implementing new approaches. The future of anesthesia research lies in the hands of current and upcoming professionals, who have the opportunity to explore new ideas, challenge existing practices, and contribute to the evolution of the field.
This special 266th episode was recorded before a live audience at the Anesthesiology 2023 Annual Meeting in San Francisco. I interviewed Dr. Deb Culley about post-op delirium and Dr. John Eichorn about the history and future of patient monitoring.