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The Effects of the Infusion of Hypertonic Sodium Chloride on the Prevention of Delirium After Surgery: Randomized Controlled

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Abstract

This research was performed to determine the effects of hypertonic sodium chloride on the prevention of delirium in surgical patients. This randomized, controlled, double-blind study was conducted between September 2018 and April 2019 in a training and research hospital, and orthopedic and cardiovascular surgery clinics. All patients who were hospitalized for orthopedic and cardiovascular surgery during this period formed the universe of the study. The study group consisted of 50 patients’ ≥ 65 years of age who were administered 3% hypertonic sodium chloride. The control group consisted of 50 patients’ ≥ 65 years of age who were administered 0.9% sodium chloride. A total of 100 patients formed the research sample. The Nursing Delirium Screening Scale and Mini-Mental State Examination were used as data collection tools. SPSS 25.0 statistical package was used to evaluate the data. For statistical significance, p < 0.05 was accepted as sufficient. The incidence of delirium after surgery was 40% in patients with 0.9% sodium chloride and 3% in patients with 3% hypertonic sodium chloride, and the difference was statistically significant (p < 0.05). Relative activity 6, attributed efficacy 30, and efficacy ratio 85 were calculated. Hypertonic sodium chloride is effective in reducing the incidence and severity of delirium after surgery.

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References

  1. Registered Nurses’ Association of Ontario (2016) Delirium, dementia, and depression in older adults: assessment and care. Toronto, Registered Nurses’ Association of Ontario. Best Practıce Guıdelınes, p 29. Website: www.RNAO.ca/bpg. ISBN 978–1–926944–67–8. Accessed 2 Apr 2019

  2. Şimşek T, Şimşek HU, Cantürk NZ (2014) Response to trauma and metabolic changes: posttraumatic metabolism (Orj:Travmaya cevap ve metabolik değişiklikler: posttravmatik metabolizma). Turk J Surg/Ulusal Cerrahi Dergisi 30(3). https://doi.org/10.5152/UCD.2014.2653

  3. Cortese GP, Burger C (2017) Neuroinflammatory challenges compromise neuronal function in the aging brain: postoperative cognitive delirium and Alzheimer’s disease. Behav Brain Res 322:269–279. https://doi.org/10.1016/j.bbr.2016.08.027

    Article  CAS  PubMed  Google Scholar 

  4. Xin X, Xin F, Chen X, Zhang Q, Li Y, Huo S, Chang C, Wang Q (2017) Hypertonic saline for prevention of delirium in geriatric patients who underwent hip surgery. J Neuroinflamm 14(1):221. https://doi.org/10.1186/s12974-017-0999-y

    Article  CAS  Google Scholar 

  5. Mazandarani M, Yousefshahi F, Abdollahi M, Hamishehkar H, Barkhordari K, Boroomand MA, Jalali A, Ahmadi A, Moharani RS, Mojtahedzadeh M (2012) Comparison of hypertonic saline versus normal saline on cytokine profile during CABG. DARU J Pharm Sci 20(1):49. https://doi.org/10.1186/2008-2231-20-49

    Article  CAS  Google Scholar 

  6. Rizoli SB, Rhind SG, Shek PN, Inaba K, Filips D, Tien H, Brenneman F, Rotstein O (2006) The immunomodulatory effects of hypertonic saline resuscitation in patients sustaining traumatic hemorrhagic shock: a randomized, controlled, double-blinded trial. Ann Surg 243(1):47. https://doi.org/10.1097/01.sla.0000193608.93127.b1

    Article  PubMed  PubMed Central  Google Scholar 

  7. Motaharinia J, Etezadi F, Moghaddas A, Mojtahedzadeh M (2015) Immunomodulatory effect of hypertonic saline in hemorrhagic shock. DARU J Pharm Sci 23(1):1–8. https://doi.org/10.1186/s40199-015-0130-9

    Article  CAS  Google Scholar 

  8. Kim JY, Choi SH, Yoon YH, Moon SW, Cho YD (2013) Effects of hypertonic saline on macrophage migration inhibitory factor in traumatic conditions. Exp Ther Med 5(1):362–366. https://doi.org/10.3892/etm.2012.800

    Article  CAS  PubMed  Google Scholar 

  9. Zeng WX, Han YL, Zhu GF, Huang LQ, Deng YY, Wang QS, … , Zeng HK (2017) Hypertonic saline attenuates expression of Notch signaling and proinflammatory mediators in activated microglia in experimentally induced cerebral ischemia and hypoxic BV-2 microglia. BMC Neurosci 18(1):1–14. https://doi.org/10.1186/s12868-017-0351-6

  10. Kanık EA (ed) (2009) MedCalc Step by Step. Ümit Ofset, Ankara

    Google Scholar 

  11. Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA (2005) Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manag 29(4):368–375. https://doi.org/10.1016/j.jpainsymman.2004.07.009

    Article  Google Scholar 

  12. Güngen C, Ertan T, Eker E, Yaşar R, Engin F (2002) Reliability and validity of the standardized mini mental state examination in The Diagnosis of Mild Dementia in Turkish Population(Orj: Standardize mini mental test’in Türk toplumunda hafif demans tanısında geçerlik ve güvenilirliği. Turk J Psychiatry 13(4):273–281

    Google Scholar 

  13. Deiner S, Silverstein JH (2009) Postoperative delirium and cognitive dysfunction. Br J Anaesth 103(suppl_1):41–46. https://doi.org/10.1093/bja/aep291

    Article  Google Scholar 

  14. Sanders RD, Pandharipande PP, Davidson AJ, Ma D, Maze M (2011) Anticipating and managing postoperative delirium and cognitive decline in adults. BMJ 343. https://doi.org/10.1136/bmj.d4331

  15. Tuttolomondo A, Pinto A, Di Raimondo D, Corrao S, Di Sciacca R, Scaglione R, ... , Licata G (2011) Changes in natriuretic peptide and cytokine plasma levels in patients with heart failure, after treatment with high dose of furosemide plus hypertonic saline solution (HSS) and after a saline loading. Nutr Metab Cardiovasc Dis 21(5):372−379. https://doi.org/10.1016/j.numecd.2009.10.014

  16. Liu Z, Li Y, Liu B et al (2013) Synergistic effects of hypertonic saline and valproic acid in a lethal rat two-hit model. Trauma Acute Care Surg 74(4):991–997. https://doi.org/10.1097/TA.0b013e31828583e3

    Article  CAS  Google Scholar 

  17. Cerejeira J, Firmino H, Vaz-Serra A, Mukaetova-Ladinska EB (2010) The neuroinflammatory hypothesis of delirium. Acta Neuropathol 119(6):737–754. https://doi.org/10.1007/s00401-010-0674-1

    Article  PubMed  Google Scholar 

  18. Capri M, Yani SL, Chattat R, Fortuna D, Bucci L, Lanzarini C, …, Franceschi C (2014) Pre-operative, high-IL-6 blood level is a risk factor of post-operative delirium onset in old patients. Front Endocrinol 5:173. https://doi.org/10.3389/fendo.2014.00173

  19. De Vecchis R, Noutsias M, Ariano C, Cesaro A, Cioppa C, Giasi A, Maurea N (2017) Does accidental overcorrection of symptomatic hyponatremia in chronic heart failure require specific therapeutic adjustments for preventing central pontine myelinolysis? J Clin Med Res 9(4):266. https://doi.org/10.14740/jocmr2933w

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. van den Boogaard M, Slooter AJ, Brüggemann RJ, Schoonhoven L, Kuiper MA, van der Voort PH, Hoogendoorn ME, Beishuizen A, Schouten JA, Spronk PE, Houterman S, van der Hoeven JG, Pickkers P (2013) Prevention of ICU delirium and delirium-related outcome with haloperidol: a study protocol for a multicenter randomized controlled trial. Trials 14(400):1–9. https://doi.org/10.1186/1745-6215-15-327

    Article  CAS  Google Scholar 

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Correspondence to Fadime Çınar.

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Çınar, F., Aslan, F.E., Saraçoğlu, K.T. et al. The Effects of the Infusion of Hypertonic Sodium Chloride on the Prevention of Delirium After Surgery: Randomized Controlled. Indian J Surg 84, 482–490 (2022). https://doi.org/10.1007/s12262-021-02986-w

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