Skip to main content
Erschienen in: Current Geriatrics Reports 2/2024

23.02.2024 | REVIEW

Postoperative Neurologic Complications in the Older Adult

Surgical Care for Current Geriatric Reports (https://www.springer.com/journal/13670)

verfasst von: Sriharsha Gummadi, Jose L. Pascual L.

Erschienen in: Current Geriatrics Reports | Ausgabe 2/2024

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

The older patient population is at increased risk of postoperative neurologic complications. With an ever-increasing proportion of older adults requiring advanced surgical interventions, surgeons should be knowledgeable in contemporary diagnostic and management paradigms. In this review, we detail neurologic complications common encountered in elderly populations, reviewing relevant literature and practices.

Recent Findings

Common postoperative neurologic complications in the elderly include delirium, cerebrovascular accidents, and seizures. The mainstay of treatment of postoperative delirium is non-pharmacologic management. Postoperative cerebrovascular disorders require prompt diagnosis and evaluation for revascularization (if ischemic) or decompressive (if hemorrhagic) therapies, recognizing certain recent updates have changed guidelines. Preoperative anti-epileptic drug optimization is the most important approach to preventing postoperative seizures in epileptic patients.

Summary

A standardized and systematic approach in managing postoperative neurologic complications is paramount, particularly in the older adult. This includes a comprehensive history (including review of preexisting medications and drug use), physical exam, chemical analysis (glucose, electrolytes, infectious evaluation, blood gas), and axial neurologic imaging, lumbar puncture, or electroencephalogram when indicated. Early expert consultation with a neurologist or neurosurgeon is often warranted.
Literatur
1.
Zurück zum Zitat Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. The lancet. 2014;383(9920):911–22.CrossRef Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. The lancet. 2014;383(9920):911–22.CrossRef
2.
Zurück zum Zitat Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, Van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304(4):443–51.PubMedCrossRef Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, Van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304(4):443–51.PubMedCrossRef
3.
Zurück zum Zitat Chang CW, Provencio JJ, Pascual J, Heavner MS, Olson D, Livesay SL, Kaplan LJ. State-of-the-art evaluation of acute adult disorders of consciousness for the general intensivist. Crit Care Med. 2023;51(7):948–63.PubMedCrossRef Chang CW, Provencio JJ, Pascual J, Heavner MS, Olson D, Livesay SL, Kaplan LJ. State-of-the-art evaluation of acute adult disorders of consciousness for the general intensivist. Crit Care Med. 2023;51(7):948–63.PubMedCrossRef
5.
Zurück zum Zitat Austin CA, O’Gorman T, Stern E, Emmett D, Stürmer T, Carson S, Busby-Whitehead J. Association between postoperative delirium and long-term cognitive function after major nonemergent surgery. JAMA Surg. 2019;154(4):328–34.PubMedPubMedCentralCrossRef Austin CA, O’Gorman T, Stern E, Emmett D, Stürmer T, Carson S, Busby-Whitehead J. Association between postoperative delirium and long-term cognitive function after major nonemergent surgery. JAMA Surg. 2019;154(4):328–34.PubMedPubMedCentralCrossRef
6.
Zurück zum Zitat •• Sadeghirad B, Dodsworth BT, Gelsomino NS, Goettel N, Spence J, Buchan TA, et al. Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery: An Individual Patient Data Meta-Analysis. JAMA Network Open. 2023;6(10):e2337239-e. This large scale meta-analysis of 21 studies identifies risk factors for postoperative delirium in surgical patients, providing insight into preventative and interventional measures. •• Sadeghirad B, Dodsworth BT, Gelsomino NS, Goettel N, Spence J, Buchan TA, et al. Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery: An Individual Patient Data Meta-Analysis. JAMA Network Open. 2023;6(10):e2337239-e. This large scale meta-analysis of 21 studies identifies risk factors for postoperative delirium in surgical patients, providing insight into preventative and interventional measures.
7.
Zurück zum Zitat • Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AM, et al. Delirium. Nat Rev Dis Prim. 2020;6(1):90. This excellent review artice on the modern understanding of delirium provides a literature review to date, illustrates potential pathophysiologic mechanisms, and identifies areas of evolving research.PubMedCrossRef • Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AM, et al. Delirium. Nat Rev Dis Prim. 2020;6(1):90. This excellent review artice on the modern understanding of delirium provides a literature review to date, illustrates potential pathophysiologic mechanisms, and identifies areas of evolving research.PubMedCrossRef
8.
Zurück zum Zitat Li T, Li J, Yuan L, Wu J, Jiang C, Daniels J, et al. Effect of regional vs general anesthesia on incidence of postoperative delirium in older patients undergoing hip fracture surgery: the RAGA randomized trial. JAMA. 2022;327(1):50–8.PubMedCrossRef Li T, Li J, Yuan L, Wu J, Jiang C, Daniels J, et al. Effect of regional vs general anesthesia on incidence of postoperative delirium in older patients undergoing hip fracture surgery: the RAGA randomized trial. JAMA. 2022;327(1):50–8.PubMedCrossRef
9.
Zurück zum Zitat Ravi B, Pincus D, Choi S, Jenkinson R, Wasserstein DN, Redelmeier DA. Association of duration of surgery with postoperative delirium among patients receiving hip fracture repair. JAMA Netw Open. 2019;2(2):e190111-e.CrossRef Ravi B, Pincus D, Choi S, Jenkinson R, Wasserstein DN, Redelmeier DA. Association of duration of surgery with postoperative delirium among patients receiving hip fracture repair. JAMA Netw Open. 2019;2(2):e190111-e.CrossRef
10.
Zurück zum Zitat Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method: a new method for detection of delirium. Ann Intern Med. 1990;113(12):941–8.PubMedCrossRef Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method: a new method for detection of delirium. Ann Intern Med. 1990;113(12):941–8.PubMedCrossRef
11.
Zurück zum Zitat Wongviriyawong T, Sura-arunsumrit P, Chaiwat O, To-Adithep P, Ramlee R, Srinonprasert V. Diagnosis of postoperative delirium in older adults using the Confusion Assessment Method for the intensive care unit in non-intensive care unit settings: a test modification might improve its diagnostic performance. Geriatr Gerontol Int. 2019;19(8):762–7.PubMedCrossRef Wongviriyawong T, Sura-arunsumrit P, Chaiwat O, To-Adithep P, Ramlee R, Srinonprasert V. Diagnosis of postoperative delirium in older adults using the Confusion Assessment Method for the intensive care unit in non-intensive care unit settings: a test modification might improve its diagnostic performance. Geriatr Gerontol Int. 2019;19(8):762–7.PubMedCrossRef
12.
Zurück zum Zitat Hufschmidt A, Shabarin V. Diagnostic yield of cerebral imaging in patients with acute confusion. Acta Neurol Scand. 2008;118(4):245–50.PubMedCrossRef Hufschmidt A, Shabarin V. Diagnostic yield of cerebral imaging in patients with acute confusion. Acta Neurol Scand. 2008;118(4):245–50.PubMedCrossRef
13.
Zurück zum Zitat • Acharya R, Kafle S, Shrestha DB, Sedhai YR, Ghimire M, Khanal K, et al. Use of computed tomography of the head in patients with acute atraumatic altered mental status: a systematic review and meta-analysis. JAMA Netw Open. 2022;5(11):e2242805-e. In this meta-analysis of 25 studies, the authors demonstrate limited value of obtaining a CT head indiscriminately for altered mental status. • Acharya R, Kafle S, Shrestha DB, Sedhai YR, Ghimire M, Khanal K, et al. Use of computed tomography of the head in patients with acute atraumatic altered mental status: a systematic review and meta-analysis. JAMA Netw Open. 2022;5(11):e2242805-e. In this meta-analysis of 25 studies, the authors demonstrate limited value of obtaining a CT head indiscriminately for altered mental status.
15.
Zurück zum Zitat Rengel KF, Pandharipande PP, Hughes CG. Postoperative delirium. La Presse Médicale. 2018;47(4):e53–64.PubMedCrossRef Rengel KF, Pandharipande PP, Hughes CG. Postoperative delirium. La Presse Médicale. 2018;47(4):e53–64.PubMedCrossRef
16.
Zurück zum Zitat Lewis K, Alshamsi F, Carayannopoulos KL, Granholm A, Piticaru J, Al Duhailib Z, et al. Dexmedetomidine vs other sedatives in critically ill mechanically ventilated adults: a systematic review and meta-analysis of randomized trials. Intensive Care Med. 2022;48(7):811–40.PubMedCrossRef Lewis K, Alshamsi F, Carayannopoulos KL, Granholm A, Piticaru J, Al Duhailib Z, et al. Dexmedetomidine vs other sedatives in critically ill mechanically ventilated adults: a systematic review and meta-analysis of randomized trials. Intensive Care Med. 2022;48(7):811–40.PubMedCrossRef
17.
Zurück zum Zitat Spence J, LeManach Y, Chan MT, Wang C, Sigamani A, Xavier D, et al. Association between complications and death within 30 days after noncardiac surgery. CMAJ. 2019;191(30):E830–7.PubMedCrossRef Spence J, LeManach Y, Chan MT, Wang C, Sigamani A, Xavier D, et al. Association between complications and death within 30 days after noncardiac surgery. CMAJ. 2019;191(30):E830–7.PubMedCrossRef
18.
Zurück zum Zitat Gaudino M, Angiolillo DJ, Di Franco A, Capodanno D, Bakaeen F, Farkouh ME, et al. Stroke after coronary artery bypass grafting and percutaneous coronary intervention: incidence, pathogenesis, and outcomes. J Am Heart Assoc. 2019;8(13): e013032.PubMedPubMedCentralCrossRef Gaudino M, Angiolillo DJ, Di Franco A, Capodanno D, Bakaeen F, Farkouh ME, et al. Stroke after coronary artery bypass grafting and percutaneous coronary intervention: incidence, pathogenesis, and outcomes. J Am Heart Assoc. 2019;8(13): e013032.PubMedPubMedCentralCrossRef
19.
Zurück zum Zitat Mashour GA, Shanks AM, Kheterpal S. Perioperative stroke and associated mortality after noncardiac, nonneurologic surgery. J Am Soc Anesthesiol. 2011;114(6):1289–96.CrossRef Mashour GA, Shanks AM, Kheterpal S. Perioperative stroke and associated mortality after noncardiac, nonneurologic surgery. J Am Soc Anesthesiol. 2011;114(6):1289–96.CrossRef
20.
Zurück zum Zitat Group PS. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371(9627):1839–47.CrossRef Group PS. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371(9627):1839–47.CrossRef
21.
Zurück zum Zitat Wang H, Li S-L, Bai J, Wang D-X. Perioperative acute ischemic stroke increases mortality after noncardiac, nonvascular, and non-neurologic surgery: a retrospective case series. J Cardiothorac Vasc Anesth. 2019;33(8):2231–6.PubMedCrossRef Wang H, Li S-L, Bai J, Wang D-X. Perioperative acute ischemic stroke increases mortality after noncardiac, nonvascular, and non-neurologic surgery: a retrospective case series. J Cardiothorac Vasc Anesth. 2019;33(8):2231–6.PubMedCrossRef
22.
Zurück zum Zitat Tarakji KG, Sabik JF, Bhudia SK, Batizy LH, Blackstone EH. Temporal onset, risk factors, and outcomes associated with stroke after coronary artery bypass grafting. JAMA. 2011;305(4):381–90.PubMedCrossRef Tarakji KG, Sabik JF, Bhudia SK, Batizy LH, Blackstone EH. Temporal onset, risk factors, and outcomes associated with stroke after coronary artery bypass grafting. JAMA. 2011;305(4):381–90.PubMedCrossRef
23.
Zurück zum Zitat Ng JL, Chan MT, Gelb AW, Warner DS. Perioperative stroke in noncardiac, nonneurosurgical surgery. J Am Soc Anesthesiol. 2011;115(4):879–90.CrossRef Ng JL, Chan MT, Gelb AW, Warner DS. Perioperative stroke in noncardiac, nonneurosurgical surgery. J Am Soc Anesthesiol. 2011;115(4):879–90.CrossRef
24.
Zurück zum Zitat Caplan LR. Clinical diagnosis of stroke subtypes. EE UU: UpToDate. 2014. Caplan LR. Clinical diagnosis of stroke subtypes. EE UU: UpToDate. 2014.
25.
Zurück zum Zitat Mrkobrada M, Chan MT, Cowan D, Campbell D, Wang CY, Torres D, et al. Perioperative covert stroke in patients undergoing non-cardiac surgery (NeuroVISION): a prospective cohort study. Lancet. 2019;394(10203):1022–9.CrossRef Mrkobrada M, Chan MT, Cowan D, Campbell D, Wang CY, Torres D, et al. Perioperative covert stroke in patients undergoing non-cardiac surgery (NeuroVISION): a prospective cohort study. Lancet. 2019;394(10203):1022–9.CrossRef
26.
Zurück zum Zitat •• Benesch C, Glance LG, Derdeyn CP, Fleisher LA, Holloway RG, Messé SR, et al. Perioperative neurological evaluation and management to lower the risk of acute stroke in patients undergoing noncardiac, nonneurological surgery: a scientific statement from the American Heart Association/American Stroke Association. Circulation. 2021;143(19):e923–46. This consensus article provides a comphrensive review of the AHA and ASA’s updated recommendations regarding the initial evaluation, risk mitigation, and further management of perioperative stroke.PubMedCrossRef •• Benesch C, Glance LG, Derdeyn CP, Fleisher LA, Holloway RG, Messé SR, et al. Perioperative neurological evaluation and management to lower the risk of acute stroke in patients undergoing noncardiac, nonneurological surgery: a scientific statement from the American Heart Association/American Stroke Association. Circulation. 2021;143(19):e923–46. This consensus article provides a comphrensive review of the AHA and ASA’s updated recommendations regarding the initial evaluation, risk mitigation, and further management of perioperative stroke.PubMedCrossRef
27.
Zurück zum Zitat Investigators VPS. An international prospective cohort study evaluating major vascular complications among patients undergoing noncardiac surgery: the VISION Pilot Study. Open Med. 2011;5(4): e193. Investigators VPS. An international prospective cohort study evaluating major vascular complications among patients undergoing noncardiac surgery: the VISION Pilot Study. Open Med. 2011;5(4): e193.
28.
Zurück zum Zitat Kikura M, Oikawa F, Yamamoto K, Iwamoto T, Tanaka K, Sato S, Landesberg G. Myocardial infarction and cerebrovascular accident following non-cardiac surgery: differences in postoperative temporal distribution and risk factors. J Thromb Haemost. 2008;6(5):742–8.PubMedCrossRef Kikura M, Oikawa F, Yamamoto K, Iwamoto T, Tanaka K, Sato S, Landesberg G. Myocardial infarction and cerebrovascular accident following non-cardiac surgery: differences in postoperative temporal distribution and risk factors. J Thromb Haemost. 2008;6(5):742–8.PubMedCrossRef
29.
Zurück zum Zitat Platzbecker K, Grabitz SD, Raub D, Rudolph MI, Friedrich S, Vinzant N, et al. Development and external validation of a prognostic model for ischaemic stroke after surgery. Br J Anaesth. 2021;127(5):713–21.PubMedCrossRef Platzbecker K, Grabitz SD, Raub D, Rudolph MI, Friedrich S, Vinzant N, et al. Development and external validation of a prognostic model for ischaemic stroke after surgery. Br J Anaesth. 2021;127(5):713–21.PubMedCrossRef
30.
Zurück zum Zitat Wardlaw JM, Mielke O. Early signs of brain infarction at CT: observer reliability and outcome after thrombolytic treatment—systematic review. Radiology. 2005;235(2):444–53.PubMedCrossRef Wardlaw JM, Mielke O. Early signs of brain infarction at CT: observer reliability and outcome after thrombolytic treatment—systematic review. Radiology. 2005;235(2):444–53.PubMedCrossRef
31.
Zurück zum Zitat Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344–418.PubMedCrossRef Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344–418.PubMedCrossRef
32.
Zurück zum Zitat Cronin CA, Shah N, Morovati T, Hermann LD, Sheth KN. No increased risk of symptomatic intracerebral hemorrhage after thrombolysis in patients with European Cooperative Acute Stroke Study (ECASS) exclusion criteria. Stroke. 2012;43(6):1684–6.PubMedCrossRef Cronin CA, Shah N, Morovati T, Hermann LD, Sheth KN. No increased risk of symptomatic intracerebral hemorrhage after thrombolysis in patients with European Cooperative Acute Stroke Study (ECASS) exclusion criteria. Stroke. 2012;43(6):1684–6.PubMedCrossRef
33.
Zurück zum Zitat Menon BK, Buck BH, Singh N, Deschaintre Y, Almekhlafi MA, Coutts SB, et al. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial. Lancet. 2022;400(10347):161–9.PubMedCrossRef Menon BK, Buck BH, Singh N, Deschaintre Y, Almekhlafi MA, Coutts SB, et al. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial. Lancet. 2022;400(10347):161–9.PubMedCrossRef
34.
Zurück zum Zitat Fayad P. Improved prospects for thrombectomy in large ischemic stroke. N Engl J Med. 2023;388:1326–8.PubMedCrossRef Fayad P. Improved prospects for thrombectomy in large ischemic stroke. N Engl J Med. 2023;388:1326–8.PubMedCrossRef
35.
Zurück zum Zitat Sabben C, Charbonneau F, Delvoye F, Strambo D, Heldner MR, Ong E, et al. Endovascular therapy or medical management alone for isolated posterior cerebral artery occlusion: a multicenter study. Stroke. 2023;54(4):928–37.PubMedCrossRef Sabben C, Charbonneau F, Delvoye F, Strambo D, Heldner MR, Ong E, et al. Endovascular therapy or medical management alone for isolated posterior cerebral artery occlusion: a multicenter study. Stroke. 2023;54(4):928–37.PubMedCrossRef
36.
Zurück zum Zitat • Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, et al. 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2022;53(7):e282–361. This consensus article by the AHA and ASA provides updtated management guidelines for spontaneous (non-traumatic) intracerebral hemorrhage.PubMedCrossRef • Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, et al. 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2022;53(7):e282–361. This consensus article by the AHA and ASA provides updtated management guidelines for spontaneous (non-traumatic) intracerebral hemorrhage.PubMedCrossRef
37.
Zurück zum Zitat Sander J, Hart Y, Shorvon S, Johnson A. Medical science: National General Practice Study of Epilepsy: newly diagnosed epileptic seizures in a general population. The Lancet. 1990;336(8726):1267–71.CrossRef Sander J, Hart Y, Shorvon S, Johnson A. Medical science: National General Practice Study of Epilepsy: newly diagnosed epileptic seizures in a general population. The Lancet. 1990;336(8726):1267–71.CrossRef
38.
Zurück zum Zitat Ramsay RE, Rowan AJ, Pryor FM. Special considerations in treating the elderly patient with epilepsy. Neurology. 2004;62(5 suppl 2):S24–9.PubMed Ramsay RE, Rowan AJ, Pryor FM. Special considerations in treating the elderly patient with epilepsy. Neurology. 2004;62(5 suppl 2):S24–9.PubMed
39.
Zurück zum Zitat Faught E, Richman J, Martin R, Funkhouser E, Foushee R, Kratt P, et al. Incidence and prevalence of epilepsy among older US Medicare beneficiaries. Neurology. 2012;78(7):448–53.PubMedPubMedCentralCrossRef Faught E, Richman J, Martin R, Funkhouser E, Foushee R, Kratt P, et al. Incidence and prevalence of epilepsy among older US Medicare beneficiaries. Neurology. 2012;78(7):448–53.PubMedPubMedCentralCrossRef
40.
Zurück zum Zitat Choi H, Pack A, Elkind MS, Longstreth W, Ton TG, Onchiri F. Predictors of incident epilepsy in older adults: the Cardiovascular Health Study. Neurology. 2017;88(9):870–7.PubMedPubMedCentralCrossRef Choi H, Pack A, Elkind MS, Longstreth W, Ton TG, Onchiri F. Predictors of incident epilepsy in older adults: the Cardiovascular Health Study. Neurology. 2017;88(9):870–7.PubMedPubMedCentralCrossRef
41.
Zurück zum Zitat Thurman DJ, Logroscino G, Beghi E, Hauser WA, Hesdorffer DC, Newton CR, et al. The burden of premature mortality of epilepsy in high-income countries: a systematic review from the Mortality Task Force of the International League Against Epilepsy. Epilepsia. 2017;58(1):17–26.PubMedCrossRef Thurman DJ, Logroscino G, Beghi E, Hauser WA, Hesdorffer DC, Newton CR, et al. The burden of premature mortality of epilepsy in high-income countries: a systematic review from the Mortality Task Force of the International League Against Epilepsy. Epilepsia. 2017;58(1):17–26.PubMedCrossRef
42.
Zurück zum Zitat Lekoubou A, Bishu KG, Ovbiagele B. Health care expenditures among elderly patients with epilepsy in the United States. Epilepsia. 2018;59(7):1433–43.PubMedCrossRef Lekoubou A, Bishu KG, Ovbiagele B. Health care expenditures among elderly patients with epilepsy in the United States. Epilepsia. 2018;59(7):1433–43.PubMedCrossRef
43.
Zurück zum Zitat Shih T, Schmader KE. Seizures and epilepsy in older adults: Etiology, clinical presentation, and diagnosis. Waltham, MA: UpToDate. 2022. Shih T, Schmader KE. Seizures and epilepsy in older adults: Etiology, clinical presentation, and diagnosis. Waltham, MA: UpToDate. 2022.
44.
Zurück zum Zitat Sung CY, Chu NS. Status epilepticus in the elderly: etiology, seizure type and outcome. Acta Neurol Scand. 1989;80(1):51–6.PubMedCrossRef Sung CY, Chu NS. Status epilepticus in the elderly: etiology, seizure type and outcome. Acta Neurol Scand. 1989;80(1):51–6.PubMedCrossRef
45.
Zurück zum Zitat Loiseau J, Loiseau P, Duché B, Guyot M, Dartigues JF, Aublet B. A survey of epileptic disorders in southwest France: seizures in elderly patients. Ann Neurol. 1990;27(3):232–7.PubMedCrossRef Loiseau J, Loiseau P, Duché B, Guyot M, Dartigues JF, Aublet B. A survey of epileptic disorders in southwest France: seizures in elderly patients. Ann Neurol. 1990;27(3):232–7.PubMedCrossRef
46.
Zurück zum Zitat Bladin CF, Alexandrov AV, Bellavance A, Bornstein N, Chambers B, Coté R, et al. Seizures after stroke: a prospective multicenter study. Arch Neurol. 2000;57(11):1617–22.PubMedCrossRef Bladin CF, Alexandrov AV, Bellavance A, Bornstein N, Chambers B, Coté R, et al. Seizures after stroke: a prospective multicenter study. Arch Neurol. 2000;57(11):1617–22.PubMedCrossRef
47.
Zurück zum Zitat Niesen AD, Jacob AK, Aho LE, Botten EJ, Nase KE, Nelson JM, Kopp SL. Perioperative seizures in patients with a history of a seizure disorder. Anesth Analg. 2010;111(3):729–35.PubMedCrossRef Niesen AD, Jacob AK, Aho LE, Botten EJ, Nase KE, Nelson JM, Kopp SL. Perioperative seizures in patients with a history of a seizure disorder. Anesth Analg. 2010;111(3):729–35.PubMedCrossRef
48.
Zurück zum Zitat Merkler AE, Gialdini G, Lerario MP, Parikh NS, Morris NA, Kummer B, et al. Population-based assessment of the long-term risk of seizures in survivors of stroke. Stroke. 2018;49(6):1319–24.PubMedPubMedCentralCrossRef Merkler AE, Gialdini G, Lerario MP, Parikh NS, Morris NA, Kummer B, et al. Population-based assessment of the long-term risk of seizures in survivors of stroke. Stroke. 2018;49(6):1319–24.PubMedPubMedCentralCrossRef
49.
Zurück zum Zitat Zehtabchi S, Silbergleit R, Chamberlain JM, Shinnar S, Elm JJ, Underwood E, et al. Electroencephalographic seizures in emergency department patients after treatment for convulsive status epilepticus. J Clin Neurophysiol. 2022;39(6):441–5.PubMedCrossRef Zehtabchi S, Silbergleit R, Chamberlain JM, Shinnar S, Elm JJ, Underwood E, et al. Electroencephalographic seizures in emergency department patients after treatment for convulsive status epilepticus. J Clin Neurophysiol. 2022;39(6):441–5.PubMedCrossRef
50.
Zurück zum Zitat Cock H, Schapira A. A comparison of lorazepam and diazepam as initial therapy in convulsive status epilepticus. QJM. 2002;95(4):225–31.PubMedCrossRef Cock H, Schapira A. A comparison of lorazepam and diazepam as initial therapy in convulsive status epilepticus. QJM. 2002;95(4):225–31.PubMedCrossRef
51.
Zurück zum Zitat Silbergleit R, Lowenstein D, Durkalski V, Conwit R, Investigators NETT. RAMPART (Rapid Anticonvulsant Medication Prior to Arrival Trial): a double-blind randomized clinical trial of the efficacy of intramuscular midazolam versus intravenous lorazepam in the prehospital treatment of status epilepticus by paramedics. Epilepsia. 2011;52:45–7.PubMedPubMedCentralCrossRef Silbergleit R, Lowenstein D, Durkalski V, Conwit R, Investigators NETT. RAMPART (Rapid Anticonvulsant Medication Prior to Arrival Trial): a double-blind randomized clinical trial of the efficacy of intramuscular midazolam versus intravenous lorazepam in the prehospital treatment of status epilepticus by paramedics. Epilepsia. 2011;52:45–7.PubMedPubMedCentralCrossRef
52.
Zurück zum Zitat Hoffman RS, Weinhouse GL, Traub SJ, Grayzel J. Management of moderate and severe alcohol withdrawal syndromes. UpToDate Waltham (MA): UpToDate. 2011. Hoffman RS, Weinhouse GL, Traub SJ, Grayzel J. Management of moderate and severe alcohol withdrawal syndromes. UpToDate Waltham (MA): UpToDate. 2011.
53.
Zurück zum Zitat Schuckit MA. Management of withdrawal delirium (delirium tremens). N Engl J Med. 2015;372(6):580–1.PubMed Schuckit MA. Management of withdrawal delirium (delirium tremens). N Engl J Med. 2015;372(6):580–1.PubMed
54.
Zurück zum Zitat Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989;84(11):1353–7.PubMedCrossRef Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989;84(11):1353–7.PubMedCrossRef
55.
Zurück zum Zitat DeCarolis DD, Rice KL, Ho L, Willenbring ML, Cassaro S. Symptom-driven lorazepam protocol for treatment of severe alcohol withdrawal delirium in the intensive care unit. Pharmacotherapy: J Hum Pharmacol Drug Ther. 2007;27(4):510–8.CrossRef DeCarolis DD, Rice KL, Ho L, Willenbring ML, Cassaro S. Symptom-driven lorazepam protocol for treatment of severe alcohol withdrawal delirium in the intensive care unit. Pharmacotherapy: J Hum Pharmacol Drug Ther. 2007;27(4):510–8.CrossRef
56.
Zurück zum Zitat McClelland S III, Hall WA. Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis. 2007;45(1):55–9.PubMedCrossRef McClelland S III, Hall WA. Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis. 2007;45(1):55–9.PubMedCrossRef
57.
Zurück zum Zitat Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Scheld WM, et al. 2017 Infectious Diseases Society of America’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis. 2017;64(6):e34–65.PubMedPubMedCentralCrossRef Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Scheld WM, et al. 2017 Infectious Diseases Society of America’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis. 2017;64(6):e34–65.PubMedPubMedCentralCrossRef
58.
Zurück zum Zitat Lozier AP, Sciacca RR, Romagnoli MF, Connolly Jr ES. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery. 2008;62:SHC-688-SHC-700. Lozier AP, Sciacca RR, Romagnoli MF, Connolly Jr ES. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery. 2008;62:SHC-688-SHC-700.
59.
Zurück zum Zitat Reynolds F. Neurological infections after neuraxial anesthesia. Anesthesiol Clin. 2008;26(1):23–52.PubMedCrossRef Reynolds F. Neurological infections after neuraxial anesthesia. Anesthesiol Clin. 2008;26(1):23–52.PubMedCrossRef
60.
Zurück zum Zitat Fritz BA, King CR, Mehta D, Somerville E, Kronzer A, Abdallah AB, et al. Association of a perioperative multicomponent fall prevention intervention with falls and quality of life after elective inpatient surgical procedures. JAMA Netw Open. 2022;5(3):e221938-e.CrossRef Fritz BA, King CR, Mehta D, Somerville E, Kronzer A, Abdallah AB, et al. Association of a perioperative multicomponent fall prevention intervention with falls and quality of life after elective inpatient surgical procedures. JAMA Netw Open. 2022;5(3):e221938-e.CrossRef
61.
Zurück zum Zitat Church S, Robinson TN, Angles EM, Tran ZV, Wallace JI. Postoperative falls in the acute hospital setting: characteristics, risk factors, and outcomes in males. Am J Surg. 2011;201(2):197–202.PubMedCrossRef Church S, Robinson TN, Angles EM, Tran ZV, Wallace JI. Postoperative falls in the acute hospital setting: characteristics, risk factors, and outcomes in males. Am J Surg. 2011;201(2):197–202.PubMedCrossRef
62.
Zurück zum Zitat Gardner RC, Dams-O’Connor K, Morrissey MR, Manley GT. Geriatric traumatic brain injury: epidemiology, outcomes, knowledge gaps, and future directions. J Neurotrauma. 2018;35(7):889–906.PubMedPubMedCentralCrossRef Gardner RC, Dams-O’Connor K, Morrissey MR, Manley GT. Geriatric traumatic brain injury: epidemiology, outcomes, knowledge gaps, and future directions. J Neurotrauma. 2018;35(7):889–906.PubMedPubMedCentralCrossRef
63.
Zurück zum Zitat Kehoe A, Rennie S, Smith J. Glasgow Coma Scale is unreliable for the prediction of severe head injury in elderly trauma patients. Emerg Med J. 2015;32(8):613–5.PubMedCrossRef Kehoe A, Rennie S, Smith J. Glasgow Coma Scale is unreliable for the prediction of severe head injury in elderly trauma patients. Emerg Med J. 2015;32(8):613–5.PubMedCrossRef
64.
Zurück zum Zitat Goode T, Young A, Wilson SP, Katzen J, Wolfe LG, Duane TM. Evaluation of cervical spine fracture in the elderly: can we trust our physical examination? Am Surg. 2014;80(2):182–4.PubMedCrossRef Goode T, Young A, Wilson SP, Katzen J, Wolfe LG, Duane TM. Evaluation of cervical spine fracture in the elderly: can we trust our physical examination? Am Surg. 2014;80(2):182–4.PubMedCrossRef
65.
Zurück zum Zitat Stiell IG, Clement CM, McKnight RD, Brison R, Schull MJ, Rowe BH, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349(26):2510–8.PubMedCrossRef Stiell IG, Clement CM, McKnight RD, Brison R, Schull MJ, Rowe BH, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349(26):2510–8.PubMedCrossRef
66.
Zurück zum Zitat Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury. Neurosurgery. 2017;80(1):6–15.PubMedCrossRef Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury. Neurosurgery. 2017;80(1):6–15.PubMedCrossRef
67.
Zurück zum Zitat TQIP A. Best practices in the management of traumatic brain injury. ACS Committee on Trauma. 2015:3–23. TQIP A. Best practices in the management of traumatic brain injury. ACS Committee on Trauma. 2015:3–23.
68.
Zurück zum Zitat Joseph B, Friese RS, Sadoun M, Aziz H, Kulvatunyou N, Pandit V, et al. The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. J Trauma Acute Care Surg. 2014;76(4):965–9.PubMedCrossRef Joseph B, Friese RS, Sadoun M, Aziz H, Kulvatunyou N, Pandit V, et al. The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. J Trauma Acute Care Surg. 2014;76(4):965–9.PubMedCrossRef
69.
Zurück zum Zitat Hoh BL, Ko NU, Amin-Hanjani S, Chou SH-Y, Cruz-Flores S, Dangayach NS, et al. 2023 Guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2023;54(7):e314-e70. Hoh BL, Ko NU, Amin-Hanjani S, Chou SH-Y, Cruz-Flores S, Dangayach NS, et al. 2023 Guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2023;54(7):e314-e70.
70.
Zurück zum Zitat Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28(1):14–20.PubMedCrossRef Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28(1):14–20.PubMedCrossRef
Metadaten
Titel
Postoperative Neurologic Complications in the Older Adult
Surgical Care for Current Geriatric Reports (https://www.springer.com/journal/13670)
verfasst von
Sriharsha Gummadi
Jose L. Pascual L.
Publikationsdatum
23.02.2024
Verlag
Springer US
Erschienen in
Current Geriatrics Reports / Ausgabe 2/2024
Elektronische ISSN: 2196-7865
DOI
https://doi.org/10.1007/s13670-024-00409-8

Weitere Artikel der Ausgabe 2/2024

Current Geriatrics Reports 2/2024 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

„Jeder Fall von plötzlichem Tod muss obduziert werden!“

17.05.2024 Plötzlicher Herztod Nachrichten

Ein signifikanter Anteil der Fälle von plötzlichem Herztod ist genetisch bedingt. Um ihre Verwandten vor diesem Schicksal zu bewahren, sollten jüngere Personen, die plötzlich unerwartet versterben, ausnahmslos einer Autopsie unterzogen werden.

Hirnblutung unter DOAK und VKA ähnlich bedrohlich

17.05.2024 Direkte orale Antikoagulanzien Nachrichten

Kommt es zu einer nichttraumatischen Hirnblutung, spielt es keine große Rolle, ob die Betroffenen zuvor direkt wirksame orale Antikoagulanzien oder Marcumar bekommen haben: Die Prognose ist ähnlich schlecht.

Schlechtere Vorhofflimmern-Prognose bei kleinem linken Ventrikel

17.05.2024 Vorhofflimmern Nachrichten

Nicht nur ein vergrößerter, sondern auch ein kleiner linker Ventrikel ist bei Vorhofflimmern mit einer erhöhten Komplikationsrate assoziiert. Der Zusammenhang besteht nach Daten aus China unabhängig von anderen Risikofaktoren.

Semaglutid bei Herzinsuffizienz: Wie erklärt sich die Wirksamkeit?

17.05.2024 Herzinsuffizienz Nachrichten

Bei adipösen Patienten mit Herzinsuffizienz des HFpEF-Phänotyps ist Semaglutid von symptomatischem Nutzen. Resultiert dieser Benefit allein aus der Gewichtsreduktion oder auch aus spezifischen Effekten auf die Herzinsuffizienz-Pathogenese? Eine neue Analyse gibt Aufschluss.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.