TY  - JOUR
A1  - Herrmann, Matthias L.
A1  - Boden, Cindy
A1  - Maurer, Christoph
A1  - Kentischer, Felix
A1  - Mennig, Eva
A1  - Wagner, Sören
A1  - Conzelmann, Lars O.
A1  - Förstner, Bernd R.
A1  - Rapp, Michael A.
A1  - von Arnim, Christine A. F.
A1  - Denkinger, Michael
A1  - Eschweiler, Gerhard W.
A1  - Thomas, Christine
T1  - Anticholinergic drug exposure increases the risk of delirium in older patients undergoing elective surgery
JF  - Frontiers in medicine
N2  - IntroductionPostoperative delirium (POD) is a common and serious adverse event of surgery in older people. Because of its great impact on patients' safety and quality of life, identification of modifiable risk factors could be useful. Although preoperative medication intake is assumed to be an important modifiable risk factor, the impact of anticholinergic drugs on the occurrence of POD seems underestimated in elective surgery. The aim of this study was to investigate the association between preoperative anticholinergic burden and POD. We hypothesized that a high preoperative anticholinergic burden is an independent, potentially modifiable predisposing and precipitating factor of POD in older people. MethodsBetween November 2017 and April 2019, 1,470 patients of 70 years and older undergoing elective orthopedic, general, cardiac, or vascular surgery were recruited in the randomized, prospective, multicenter PAWEL trial. Anticholinergic burden of a sub-cohort of 899 patients, who did not receive a multimodal intervention for preventing POD, was assessed by two different tools at hospital admission: The established Anticholinergic Risk Scale (ARS) and the recently developed Anticholinergic Burden Score (ABS). POD was detected by confusion assessment method (CAM) and a validated post discharge medical record review. Logistic regression analyses were performed to evaluate the association between anticholinergic burden and POD. ResultsPOD was observed in 210 of 899 patients (23.4%). Both ARS and ABS were independently associated with POD. The association persisted after adjustment for relevant confounding factors such as age, sex, comorbidities, preoperative cognitive and physical status, number of prescribed drugs, surgery time, type of surgery and anesthesia, usage of heart-lung-machine, and treatment in intensive care unit. If a patient was taking one of the 56 drugs listed in the ABS, risk for POD was 2.7-fold higher (OR = 2.74, 95% CI = 1.55-4.94) and 1.5-fold higher per additional point on the ARS (OR = 1.54, 95% CI = 1.15-2.02). ConclusionPreoperative anticholinergic drug exposure measured by ARS or ABS was independently associated with POD in older patients undergoing elective surgery. Therefore, identification, discontinuation or substitution of anticholinergic medication prior to surgery may be a promising approach to reduce the risk of POD in older patients.
KW  - delirium
KW  - acute encephalopathy
KW  - surgery
KW  - anticholinergic
KW  - geriatric
KW  - postoperative
Y1  - 2022
U6  - https://doi.org/10.3389/fmed.2022.871229
SN  - 2296-858X
VL  - 9
PB  - Frontiers Media
CY  - Lausanne
ER  - 
TY  - JOUR
A1  - Hermann, Andreas
A1  - Humbert, Emmanuel
T1  - Mass functions of a compact manifold
JF  - Journal of geometry and physics : JGP
N2  - Let M be a compact manifold of dimension n. In this paper, we introduce the Mass Function a >= 0 bar right arrow X-+(M)(a) (resp. a >= 0 bar right arrow X--(M)(a)) which is defined as the supremum (resp. infimum) of the masses of all metrics on M whose Yamabe constant is larger than a and which are flat on a ball of radius 1 and centered at a point p is an element of M. Here, the mass of a metric flat around p is the constant term in the expansion of the Green function of the conformal Laplacian at p. We show that these functions are well defined and have many properties which allow to obtain applications to the Yamabe invariant (i.e. the supremum of Yamabe constants over the set of all metrics on M).
KW  - Yamabe operator
KW  - Yamabe invariant
KW  - surgery
KW  - positive mass theorem
Y1  - 2020
U6  - https://doi.org/10.1016/j.geomphys.2020.103650
SN  - 0393-0440
SN  - 1879-1662
VL  - 154
PB  - Elsevier
CY  - Amsterdam [u.a.]
ER  - 
TY  - JOUR
A1  - Boujemaa, Hajar
A1  - Yilmaz, Alaaddin
A1  - Robic, Boris
A1  - Koppo, Katrien
A1  - Claessen, Guido
A1  - Frederix, Ines
A1  - Dendale, Paul
A1  - Völler, Heinz
A1  - van Loon, Luc J. C.
A1  - Hansen, Dominique
T1  - The effect of minimally invasive surgical aortic valve replacement on postoperative pulmonary and skeletal muscle function
JF  - Experimental physiology
N2  - Suboptimal post-operative improvements in functional capacity are often observed after minimally invasive aortic valve replacement (mini-AVR). It remains to be studied how AVR affects the cardiopulmonary and skeletal muscle function during exercise to explain these clinical observations and to provide a basis for improved/tailored post-operative rehabilitation. Twenty two patients with severe aortic stenosis (AS) (aortic valve area (AVA) < 1.0 cm(2)) were preoperatively compared to 22 healthy controls during submaximal constant-workload endurance-type exercise for oxygen uptake (V-O2), carbon dioxide output (V-CO2), respiratory gas exchange ratio, expiratory volume (V-E), ventilatory equivalents for O-2 (V-E/V-O2) and CO2 (V-E/V-CO2), respiratory rate (RR), tidal volume (V-t), heart rate (HR), oxygen pulse (V-O2/HR), blood lactate, Borg ratings of perceived exertion (RPE) and exercise-onset V-O2 kinetics. These exercise tests were repeated at 5 and 21 days after AVR surgery (n = 14), along with echocardiographic examinations. Respiratory exchange ratio and ventilatory equivalents (V-E/V-O2 and V-E/V-CO2) were significantly elevated, V-O2 and V-O2/HR were significantly lowered, and exercise-onset V-O2 kinetics were significantly slower in AS patients vs. healthy controls (P < 0.05). Although the AVA was restored by mini-AVR in AS patients, V-E/V-O2 and V-E/V-CO2 further worsened significantly within 5 days after surgery, accompanied by elevations in Borg RPE, V-E and RR, and lowered V-t. At 21 days after mini-AVR, exercise-onset V-O2 kinetics further slowed significantly (P < 0.05). A decline in pulmonary function was observed early aftermini-AVRsurgery, which was followed by a decline in skeletal muscle function in the subsequent weeks of recovery. Therefore, a tailored rehabilitation programmeshould include training modalities for the respiratory and peripheral muscular system.
KW  - aortic valve stenosis
KW  - exercise tolerance
KW  - surgery
Y1  - 2019
U6  - https://doi.org/10.1113/EP087407
SN  - 0958-0670
SN  - 1469-445X
VL  - 104
IS  - 6
SP  - 855
EP  - 865
PB  - Wiley
CY  - Hoboken
ER  -