Search

Background/Aim. The incidence of postoperative delirium (POD) after non-cardiac surgery is a problem not often recognized by many anesthesiologists. The objective of our study was to detect POD and its possible cause, in patients undergoing radical retropubic prostatectomy (RRP) under general anesthesia. Methods. After Ethical Committee approval, we enrolled 80 patients, ASA (the American Society of Anestesiology) status II, scheduled to undergo RRP un-der general anesthesia, in a prospective study. All patients completed MMSE tests (the Folstein Mini Mental State Ex-am) the evening before, and 48 hours after the surgery. Assessment for the presence and severity of delirium was per-formed using CAM (the Confusion Assessment Method), and an assessment of the degree of agitation and sedation using RASS (the Richmond Agitation and Sedation Scale). Results. The average preoperative MMSE score (28.59 ± 1.04) significantly decreased following the surgery (27.74 ± 1.52) (p < 0.0001). The average postoperative MMSE score trend descended in correlation to intraoperative bleeding (p = 0.036). The patients with higher pain scores had significant decline in MMSE after the surgery (28.75 vs. 26.25; p < 0.001). Five patients were considered positive for delirium, and four of them reported regular alcoholic drinks intake (> 1 drink per day) preoperatively (p < 0.0001). Based on RASS score, 13 patients (16.3%) were agitated or sedated, and they had statistically significantly higher intraoperative bleeding (p < 0.001). Conclusion. Results of this study emphasize the importance of proper preoperative evaluation; especially regarding the alcohol consumption since all the patients that developed POD reported moderate alcohol consumption. Further-more, greater intraoperative bleeding and postoperative pain scores did not influence the occurrence of delirium, but resulted in lower postoperative MMSE scores, which high-lights the importance of adequate intraoperative treatment of patients during surgery and anesthesia in order to reduce the risk of developing POD.

Regenerative medicine is broadly based on the body’s essential ability to heal itself, by supplementing the innate repair mechanisms with homologous or autologous biologic agents. Regenerative therapy shows a great amount of promise in improving musculoskeletal conditions and providing patients with an effective treatment option for their chronic pain. One such biologic agent is platelet-rich plasma (PRP), a concentrate made from whole blood centrifuged to remove red blood cells, which contains a variety of growth factors. Four types of PRP can be formulated, depending on the white blood cell counts and fibrin architecture. PRP has demonstrated the most efficacy in treating inflammatory states, such as arthritic conditions. Mesenchymal stem cells (MSCs) are another currently available biologic agent. MSCs are unspecialized progenitor cells, capable of division and self-renewal for long period of time, and can give rise to specialized cell lines. Their medicinal potential is based on their ability to secrete bioactive factors that promote tissue healing, and ability to induce endogenous stem cell activity. The differentiation of MSCs is susceptible to local paracrine influence, and low levels of inflammation are necessary to achieve desired anabolic regenerative effects. As a result, MSCs are most effective in degenerative diseases, such as repair of bone and cartilage in discogenic disease and osteoarthritis. Current literature establishes biologic agents as a cost-effective approach, more beneficial than standard, non-interventional care, and guidelines suggest they be considered upon initial failure of conservative therapy. Several contraindications are known, and must be acknowledged, including blood dyscrasias, infections and malignancy. Potential adverse events include infection, tissue rejection, and transient worsening of the pain. Interventional pain guidelines specifically have recommended that it be used independently or in conjunction with other treatment modalities, following diagnostic evidence of a need for biologic therapy. [ABSTRACT FROM AUTHOR]