Questions · Preventing Postoperative Delirium
9 questions, 0 approved. Approve them one at a time — a quiz shows nothing you have not.
Recall — derived from a kept point
The American Geriatrics Society published a clinical practice guideline on postoperative delirium in older adults. In one sentence, state which category of intervention that guideline places first for preventing delirium in at-risk older surgical patients, and where pharmacologic measures sit relative to it.
Answer: The guideline puts multicomponent non-pharmacologic intervention first for preventing delirium in at-risk older surgical patients, with pharmacologic measures secondary.
When a family asks what you will do to prevent delirium, the guideline-concordant first answer is the multicomponent non-pharmacologic bundle, with drugs as a secondary measure.
Source claim: The American Geriatrics Society guideline puts multicomponent non-pharmacologic intervention first for preventing delirium in at-risk older surgical patients, with pharmacologic measures secondary.
American Geriatrics Society Abstracted Clinical Practice Guideline for Postoperative Delirium in Older Adults, Journal of the American Geriatrics Society 2015
recall · CA-1 · phrased by llm
A randomised, double-blind, placebo-controlled trial gave a low-dose dexmedetomidine infusion to patients over 65 admitted to intensive care after non-cardiac surgery. State the effect on delirium over the first seven days, giving both rates.
Answer: Low-dose dexmedetomidine infusion reduced delirium over the first seven days from 23% to 9%.
That trial is the strongest single-trial signal for dexmedetomidine and delirium, but note the setting it was done in: patients over 65 admitted to intensive care after non-cardiac surgery.
Source claim: In patients over 65 admitted to intensive care after non-cardiac surgery, a low-dose dexmedetomidine infusion reduced delirium over the first seven days from 23% to 9%.
Dexmedetomidine for Prevention of Delirium in Elderly Patients After Non-Cardiac Surgery: A Randomised, Double-Blind, Placebo-Controlled Trial, Lancet (London, England) 2016
recall · CA-2 · phrased by llm
A meta-analysis pooled six randomized trials of dexmedetomidine in older patients undergoing noncardiac surgery. Name the outcomes that were reduced in that pooled analysis and the one adverse outcome that increased.
Answer: Pooled across the six trials, dexmedetomidine reduced delirium and lowered tachycardia, hypertension, stroke and hypoxaemia, but increased bradycardia.
Dexmedetomidine buys you less delirium plus fewer haemodynamic and hypoxaemic events in this pooled analysis, and the price you pay for it is bradycardia.
Source claim: Pooled across six trials in older non-cardiac surgical patients, dexmedetomidine reduced delirium and lowered tachycardia, hypertension, stroke and hypoxaemia — but increased bradycardia.
Dexmedetomidine for the Prevention of Postoperative Delirium in Elderly Patients Undergoing Noncardiac Surgery: A Meta-Analysis of Randomized Controlled Trials, PloS one 2019
recall · CA-2 · phrased by llm
A resident states that deep anaesthesia causes postoperative delirium and cites the delirium substudy of the BALANCED trial. According to published commentary on anaesthetic depth and delirium, what is the status of that question, and what feature of the BALANCED delirium substudy result is the reason for caution?
Answer: The commentary holds that whether deep anaesthesia is deliriogenic remains unsettled, because the effect seen in the BALANCED delirium substudy appeared to rest on outcomes in patients from East Asia.
You cannot yet tell a resident that depth causes delirium: the substudy effect appeared to hinge on outcomes in patients from East Asia, which is why the question is still open.
Source claim: Whether deep anaesthesia is deliriogenic remains unsettled: the effect in the BALANCED delirium substudy appeared to rest on outcomes in patients from East Asia.
Anaesthetic Depth and Delirium: A Challenging Balancing Act, British journal of anaesthesia 2021
recall · CA-3 · phrased by llm
Dexmedetomidine's effect on delirium is dose-dependent: cumulative doses at or below ___ micrograms per kilogram were associated with less delirium, while higher doses were not, with the lowest risk between 0.25 and 0.35.
Answer: 0.49
Dexmedetomidine's effect on delirium is dose-dependent: cumulative doses at or below 0.49 micrograms per kilogram were associated with less delirium, while higher doses were not, with the lowest risk between 0.25 and 0.35.
Dose-Dependent Relationship Between Intra-Operative Dexmedetomidine and Delirium After Non-Cardiac Surgery: A Retrospective Cohort Study · PMID 41717663
recall · CA-2 · phrased by derived
The point with one number taken out. No model wrote any of this: the stem is the sentence you reviewed, minus a digit, and the paper it came from is named beneath it.
Open prompts
How does your plan change if the patient is not optimised?
open · CA-2 · phrased by derived
What is the physiology behind what we just did?
open · CA-2 · phrased by derived
Talk me through the trade-off you made there.
open · CA-2 · phrased by derived
What would make you abandon this plan and do something else?
open · CA-2 · phrased by derived
Questions only — nothing here asserts anything, which is why a model is allowed to phrase them. Where no model was reachable these are the level defaults.