[Updated ESAIC guidelines on postoperative delirium in adults]

Area of Science:

• Anesthesiology
• Geriatrics
• Critical Care Medicine

Context:

• Postoperative delirium (POD) is a common complication in surgical patients, particularly the elderly.
• Existing guidelines require updates to reflect current evidence and best practices.
• The European Society of Anaesthesiology and Intensive Care (ESAIC) has revised its recommendations.

Purpose:

• To provide updated, evidence-based recommendations for the prevention, diagnosis, and management of POD.
• To guide clinicians in optimizing patient care and reducing the incidence and severity of POD.
• To address specific areas of uncertainty, such as the use of dexmedetomidine and EEG monitoring.

Summary:

• The guideline includes 13 recommendations, with five designated as 'strong'.
• Key strong recommendations focus on preoperative risk assessment, patient optimization, prevention strategies, multicomponent non-pharmacological interventions for at-risk patients, and risk-benefit assessment of prophylactic dexmedetomidine.
• Index-based EEG monitoring is recommended, alongside other parameters like burst suppression and density spectral array. Haloperidol is recommended for treatment if non-pharmacological measures fail, while benzodiazepines are not advised.

Impact:

• Aims to improve patient outcomes by reducing the incidence and impact of POD.
• Provides a clear framework for clinicians to implement evidence-based practices.
• Highlights the importance of a multimodal approach to POD management, emphasizing non-pharmacological strategies.