Incidences of Post Coronary Artery Bypass Surgery Delirium

By

ACKNOWLEDGEMENTS

My thanks go out to all who have helped me complete this study and with whom this project may have not been possible. In particular, my gratitude goes out to friends, facilitator and family for extensive and helpful comments on early drafts. I am also deeply indebted to the authors who have shared my interest and preceded me. Their works provided me with a host of information to learn from and build upon, also served as examples to emulate.

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DECLARATION

I, (Your name), would like to declare that all contents included in this thesis/dissertation stand for my individual work without any aid, & this thesis/dissertation has not been submitted for any examination at academic as well as professional level previously. It is also representing my very own views & not essentially which are associated with university.

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TABLE OF CONTENTS

ACKNOWLEDGEMENTSII

DECLARATIONIII

CHAPTER 1: INTRODUCTION1

Introduction1

Background2

Theoretical criteria3

Post CABG delirium4

Studies6

Comparing the incidences7

DSM8

Summary9

Study Aims10

CHAPTER 2: METHODS11

Study Selection Criteria11

Search strategy11

Selection procedure12

Studies used14

CHAPTER 3: RESULTS15

CHAPTER 4: DISCUSSION17

Delirium incidences17

Variations in the 1970s to now19

Relationship between CABG and other surgeries20

CHAPTER 5: CONCLUSION23

Delirium after CABG23

Analyzing incidences from 1970 to now23

Relationship and incidence23

REFERENCES25

CHAPTER 1: INTRODUCTION

Introduction

While overall diffuse neuro cognitive outcomes of patients undergoing OPCAB versus CCAB have recently received considerable investigative attention, little attention has been directed at the problem of delirium after CCAB and OPCAB. Delirium is disturbance of cognition, attention, or consciousness characterized by sudden onset of symptoms that may fluctuate unpredictably and may last for a few days [11]. Patients with delirium may be much disoriented, hallucinating, restless, and agitated; or they can be very quiet and drowsy.

Although the determination of specific drugs that contribute to delirium may be difficult because of the complexity of drug kinetics and bio-physiological conditions of patients receiving drugs, it is reasonable to believe that the risk of delirium can be diminished by avoiding or reducing these types of drugs. However, a definitive answer to this question in relation to post CABG and OPCAB patients awaits further study. Patients with delirium tend to have lower tolerance levels for physiological, psychosocial, and environmental changes relative to age-matched, cognitively intact counterparts [47]. Patients with delirium require immediate attention so as to identify and treat underlying causes of delirium and to control impinging environmental stimuli in order to keep them within their limited tolerance levels [14]. In addition, aggressive and hyperactive behaviors among patients with delirium or confusion may create more of a demand on the already compromised heart muscle (potentially increasing myocardial ischemia), resulting in dysrhythmias or heart failure [20].

Most patients with delirium do not remember their experience of delirium because of their lowered attention or shortened memory. Many patients, however, remember their emotionally upsetting experience, fear they are losing their minds, have frightening nightmares [100], or employ defense mechanisms to deny their experience of delirium. The experience of delirium may be upsetting to family members who may feel embarrassed or shocked by the patients' unusual behaviors [20]. Despite the importance of risk assessment and prediction of possible development ...