Other bulletins in this series include:

Breast Surgery

Thursday, 28 July 2011

The evaluation and management of delirium among older persons

The evaluation and management of delirium among older persons. Med Clin North Am. 2011 May;95(3):555-77.

Flaherty, JH.


This article reviews the pathophysiology, prevalence, incidence, and consequences of delirium, focusing on the evaluation of delirium, the published models of care for prevention in patients at risk of delirium, and management of patients for whom delirium is not preventable.

Computer protocol facilitates evidence-based care of sepsis in the surgical intenstive care unit

Computer protocol facilitates evidence-based care of sepsis in the surgical ICU. Journal of Trauma. 2011 May;70(5):1153-66; discussion 1166-7.

McKinley, BA, et al.


Care of sepsis has been the focus of intense research and guideline development for more than two decades. With ongoing success of computer protocol (CP) technology and with publication of Surviving Sepsis Campaign (SSC) guidelines, we undertook protocol development for management of sepsis of surgical intensive care unit patients in mid-2006.

Treatment of cancer pain

Treatment of cancer pain. The Lancet, Volume 377, Issue 9784, Pages 2236 - 2247, 25 June 2011.

Portenoy, RK.



In patients with active cancer, the management of chronic pain is an essential element in a comprehensive strategy for palliative care. This strategy emphasises multidimensional assessment and the coordinated use of treatments that together mitigate suffering and provide support to the patient and family.

Treatment of chronic non-cancer pain

Treatment of chronic non-cancer pain. The Lancet, Volume 377, Issue 9784, Pages 2226 - 2235, 25 June 2011.

Turk, DC, et al.



Chronic pain is a pervasive problem that affects the patient, their significant others, and society in many ways. The past decade has seen advances in our understanding of the mechanisms underlying pain and in the availability of technically advanced diagnostic procedures; however, the most notable therapeutic changes have not been the development of novel evidenced-based methods, but rather changing trends in applications and practices within the available clinical armamentarium.

Treatment of acute postoperative pain

Treatment of acute postoperative pain. The Lancet, Volume 377, Issue 9784, Pages 2215 - 2225, 25 June 2011.

Wu, CL and Raja, SN.



Although postoperative pain remains incompletely controlled in some settings, increased understanding of its mechanisms and the development of several therapeutic approaches have substantially improved pain control in past years.

Managing pain effectively

Managing pain effectively. The Lancet, Volume 377, Issue 9784, Page 2151, 25 June 2011



Over the past decade, our understanding of the underlying pathophysiological process of pain and its management has advanced, leading to new analgesic drugs and techniques, and offering new avenues to alleviate suffering. In The Lancet today, we publish a clinical Series focusing on treatments for postoperative, chronic non-cancer, and chronic cancer pain to give an overview of these developments.

Anticipating and managing postoperative delirium and cognitive decline in adults

Anticipating and managing postoperative delirium and cognitive decline in adults. BMJ 2011; 343:d4331.

Sanders, RD, et al.


The brain is vulnerable during the perioperative period in people of all ages. Neurobehavioural disturbances are common complications of perioperative care, manifesting in three distinct forms: emergence delirium, postoperative delirium, and postoperative cognitive decline. Delirium is defined by the presence of disturbed consciousness (reduced clarity of awareness of the environment with reduced ability to focus, sustain, or shift attention) and a change in cognition (such as memory deficit, disorientation, or language disturbance) or the development of a perceptual disturbance that is not better accounted for by a pre-existing, established, or evolving dementia. Emergence delirium occurs on emergence from anaesthesia and sedation, with no lucid interval, and lasts approximately 30 minutes. Postoperative delirium lasts hours or longer, with or without lucid intervals. Postoperative cognitive decline refers to a more subtle cognitive impairment noted on neuropsychological tests that typically assess attention and memory.