Ulf Guenther1, Linda Riedel, Finn M Radtke. 1. aPD Dr med. Ulf Guenther DESA, EDIC, Linda Riedel, Klinik für Anästhesiologie & Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Germany bPD Dr med. Finn M. Radtke, Anæstesiafdelingen, Næstved Sygehus, Næstved, Denmark.
Abstract
PURPOSE OF REVIEW: The aim of this study was to review current literature on identification of patients at risk for postoperative delirium (POD) and to summarize recent findings on prophylaxis and treatment. RECENT FINDINGS: Age and preoperative cognitive impairment are among the most important risk factors of POD. POD is the result of a complex interplay of predisposing and precipitating factors. Thus, both prophylaxis and treatment require multicomponent intervention programs. No single medication to prevent or treat POD is available. Avoiding too deep anesthesia, avoiding additional psychoactive substances including benzodiazepines and intravenous opioids, and effective pain management as well as early mobilization are essential. SUMMARY: An increase of the proportion of elderly patients undergoing surgery will lead to a higher incidence of POD. Preoperative assessment should facilitate identification of patients at high risk. Perioperative management should include monitoring depth of anesthesia, preference for nonopioid pain therapy, early regular delirium monitoring starting in the recovery room, avoiding ICU-sedation, early mobilization and exercise, and cognitive training.
PURPOSE OF REVIEW: The aim of this study was to review current literature on identification of patients at risk for postoperative delirium (POD) and to summarize recent findings on prophylaxis and treatment. RECENT FINDINGS: Age and preoperative cognitive impairment are among the most important risk factors of POD. POD is the result of a complex interplay of predisposing and precipitating factors. Thus, both prophylaxis and treatment require multicomponent intervention programs. No single medication to prevent or treat POD is available. Avoiding too deep anesthesia, avoiding additional psychoactive substances including benzodiazepines and intravenous opioids, and effective pain management as well as early mobilization are essential. SUMMARY: An increase of the proportion of elderly patients undergoing surgery will lead to a higher incidence of POD. Preoperative assessment should facilitate identification of patients at high risk. Perioperative management should include monitoring depth of anesthesia, preference for nonopioid pain therapy, early regular delirium monitoring starting in the recovery room, avoiding ICU-sedation, early mobilization and exercise, and cognitive training.
Authors: Matthias L Herrmann; Cindy Boden; Christoph Maurer; Felix Kentischer; Eva Mennig; Sören Wagner; Lars O Conzelmann; Bernd R Förstner; Michael A Rapp; Christine A F von Arnim; Michael Denkinger; Gerhard W Eschweiler; Christine Thomas Journal: Front Med (Lausanne) Date: 2022-05-06
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Authors: Christian Mychajliw; Matthias L Herrmann; Ulrike Suenkel; Katharina Brand; Anna-Katharina von Thaler; Isabel Wurster; Rezzak Yilmaz; Gerhard W Eschweiler; Florian G Metzger Journal: Front Aging Neurosci Date: 2021-06-07 Impact factor: 5.750