Postoperative delirium: perioperative assessment, risk reduction, and management
Zhaosheng Jin,Jie Hu,Daqing Ma +2 more
TLDR
It is proposed that risk assessment and perioperative risk reduction may be the most effective approaches in managing postoperative delirium.Abstract:
Summary Postoperative delirium is a relatively common and serious complication. It increases hospital stay by 2–3 days and is associated with a 30-day mortality of 7–10%. It is most prevalent in older patients, those with existing neurocognitive disorders, and those undergoing complex or emergency procedures. Preclinical and clinical research in recent years has uncovered more about the pathophysiology of postoperative delirium and may yield more potential therapeutic options. Using the enhanced recovery pathway framework of risk stratification, risk reduction, and rescue treatment, we have reviewed the current clinical evidence on the validity of delirium prediction scores for the surgical population, the effectiveness of perioperative delirium risk reduction interventions, and management options for established delirium. Effective perioperative interventions include depth of anaesthesia monitoring, intraoperative dexmedetomidine infusion, and multimodal analgesia. Choice of general anaesthetic agent may not be associated with significant difference in delirium risk. Several other factors, such as preoperative fasting, temperature control, and blood pressure management have some association with the risk of postoperative delirium; these will require further studies. Because of the limited treatment options available for established delirium, we propose that risk assessment and perioperative risk reduction may be the most effective approaches in managing postoperative delirium.read more
Citations
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Antipsychotic Therapy and Short-term Serious Events in Older Adults With Dementia.
Rochon,Normand,Gomes (Tara),Gill +3 more
TL;DR: Serious events, as indicated by a hospital admission or death, are frequent following the short-term use of antipsychotic drugs in older adults with dementia and should be used with caution even when short- term therapy is being prescribed.
Efficacy and safety of haloperidol versus atypical antipsychotic medications in the treatment of delirium
Hyung-Jun Yoon,Kyoungmin Park,Won Jung Choi,Soo Hee Choi,Jin Young Park,Jae Jin Kim,Jeong-Ho Seok +6 more
TL;DR: Haloperidol, risperidone, olanzapine, and quetiapine were equally efficacious and safe in the treatment of delirium, however, age is a factor that needs to be considered when making a choice of antipsychotic medication for the Treatment of Delirium.
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Association Between Intraoperative Arterial Hypotension and Postoperative Delirium After Noncardiac Surgery: A Retrospective Multicenter Cohort Study.
Luca J Wachtendorf,Luca J Wachtendorf,Omid Azimaraghi,Omid Azimaraghi,Peter Santer,Felix C. Linhardt,Felix C. Linhardt,Michael Blank,Michael Blank,Aiman Suleiman,Aiman Suleiman,Curie Ahn,Ying H. Low,Bijan Teja,Bijan Teja,Samir Kendale,Maximilian S. Schaefer,Timothy T. Houle,Richard J. Pollard,Balachundhar Subramaniam,Matthias Eikermann,Matthias Eikermann,Karuna Wongtangman,Karuna Wongtangman +23 more
TL;DR: In this article, the authors hypothesized that intraoperative arterial hypotension within a range frequently observed in clinical practice is associated with increased odds of delirium after surgery, and they used multivariable logistic regression adjusted for patient and procedure-related factors, including demographics, comorbidities, and markers of procedural severity.
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Perioperative neurocognitive disorders: A narrative review focusing on diagnosis, prevention, and treatment
TL;DR:
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Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery: A prospective cohort clinical trial.
Yanan Song,Yajie Liu,Yi Yuan,Xixi Jia,Wenchao Zhang,Geng Wang,Yunyang Jia,Xiaoxiao Wang,Lei Liu,Weitian Li,Xinping Li,Cai Nan,Chang Liu,Yue Li,Yongzheng Han,Yang Zhou,Xinning Mi,Chengmei Shi,John Q. Wang,Alain Vuylsteke,Xiangyang Guo,Zhengqian Li +21 more
TL;DR: Wang et al. as discussed by the authors compared the impact of subarachnoid anaesthesia and general anaesthesia on the peak of melatonin secretion and postoperative delirium (POD) in older patients undergoing hip fracture surgery.
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