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Postoperative delirium - treatment and prevention
Thomas Duning1, Katharina Ilting-Reuke1, Mara Beckhuis1
1Department of Neurology, University Hospital of Münster, Münster.
Current Opinion in Anaesthesiology
|December 14, 2020
Summary
Postoperative delirium (POD) management requires a multidisciplinary approach. Early detection of high-risk patients and standardized nonpharmacological strategies are crucial for improving outcomes and preventing cognitive deficits.
Area of Science:
- Geriatric Medicine
- Anesthesiology
- Neuroscience
Background:
- Postoperative delirium (POD) is a severe complication with significant consequences, including increased mortality and long-term cognitive impairment.
- Current management lacks standardized global guidelines, necessitating advances in prevention, diagnosis, and treatment.
- Subtle, permanent cognitive deficits after POD impact daily life, highlighting the need for effective interventions.
Purpose of the Study:
- To review current strategies for the prevention, diagnosis, and treatment of postoperative delirium (POD).
- To emphasize the importance of risk stratification and standardized management concepts for POD.
- To highlight the need for improved recognition and management of delirium and its consequences.
Main Methods:
- Multiprofessional approach to POD management.
- Detection of high-risk patients using validated tools.
- Individualized intraoperative anesthetic management plans for older patients.
Main Results:
- Preventive nonpharmacological concepts are essential.
- Intraoperative management should focus on maintaining physiological stability (blood pressure, normothermia, adequate analgesia, anesthetic depth).
- Both pharmaceutical and nonpharmacological treatment and diagnostic concepts are necessary.
Conclusions:
- Not all POD cases are preventable; early detection of high-risk individuals is key.
- Predisposing factors include advanced age, cognitive deficits, multimorbidity, and polypharmacy.
- Multidisciplinary, evidence-based approaches to POD management are highly recommended due to demographic changes.
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