European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium

Aldecoa, César; Bettelli, Gabriella; Bilotta, Federico; Sanders, Robert D.; Audisio, Riccardo A.; Borozdina, Anastasia; Cherubini, Antonio; Jones, Christina; Kehlet, Henrik; MacLullich, Alasdair M.J.; Radtke, Frank‐Olaf; Riese, Florian; Slooter, Arjen J. C.; Veyckemans, Francis; Krämer, Sarah; Neuner, Bruno; Weiß, Björn; Spies, Claudia

doi:10.1097/eja.0000000000000594

Cited by 833 publications

(967 citation statements)

References 381 publications

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“…The ESA guideline on the prevention of POD [10] lists predisposing factors such as age, comorbidities including alcohol use disorders, frailty and pre-operative pain as well as precipitating factors such as preoperative fasting and dehydration, Natrium imbalances, anticholinergics, severe blood loss and cavity surgery.…”

Section: Risk Factorsmentioning

confidence: 99%

Postoperative delirium: A preventable complication in the elderly surgical patient

Bettelli

Neuner

2017

Monaldi Arch Chest Dis

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Postoperative delirium (POD) is an acute organic cerebral disturbance of consciousness and attention in combination with additional cognitive symptoms. It usually develops shortly after surgery and lasts for some hours up to some days. It worsens clinical outcomes, prolongs the hospital stay and leads to negative trajectories of cognitive, emotional and functional outcomes up to month if not years after surgery. There are several known predisposing and precipitating factors. Several of them are influenceable. Offering optimal and safe care for an elderly surgery patient requires a team based approach. Strategies for reducing POD incidence include early detection of risk factors, adaptation of surgical and anaesthesiologic techniques, avoiding certain drugs, optimisation of haemostasis, continuously monitoring of the patients' cognitive status as well as early mobilization and careful management of eventual early signs of POD. If POD is prevented, it's negative trajectories may be likewise anticipated.

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Section: Risk Factorsmentioning

confidence: 99%

Postoperative delirium: A preventable complication in the elderly surgical patient

Bettelli

Neuner

2017

Monaldi Arch Chest Dis

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“…It is important, however, not to deny premedication to patients with severe anxiety, as untreated patients are also at higher risk for complications [44]. In such cases, dosage adjustments should be considered.…”

Section: Preparation For Surgerymentioning

confidence: 99%

Perioperative Management of Elderly Patients with Gastrointestinal Malignancies: The Contribution of Anesthesia

et al. 2017

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Introduction: Elderly patients suffering from gastrointestinal malignancies are particularly prone to perioperative complications. Elderly patients often present with reduced physiological reserves, and comorbidities can limit treatment options and promote complications. Surgeons and anesthesiologists must be aware of strategies required to deal with this vulnerable subgroup. Methods: We provide a brief review of current and emerging perioperative strategies for the treatment of elderly patients with gastrointestinal malignancies and frequent comorbidities. Results: Especially in combination with advanced age, the effects of malignancies can be devastating, bringing new health challenges, exacerbating preexisting conditions, and exerting severe psychological strain. An interdisciplinary assessment and process planning provide an ideal setting to identify and prevent potential complications, especially in regards to frailty and cardiovascular risk. In addition, important perioperative considerations are presented, such as malnutrition, fasting, intraoperative neuromonitoring, and hemodynamic control, as well as postoperative early mobilization, pain, and delirium management. Conclusion: The decisions and interventions made in the perioperative stage can positively influence many intra- and postoperative factors, significantly improving the chances of successful treatment of elderly cancer patients. Appropriate management can help prevent or mitigate complications, secure a quick recovery, and improve short- and long-term outcomes.

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“…El delirium puede ser reversible hasta en el 50% de los (1) casos, y su tratamiento de fondo consiste en tratar su etiología de base . (27,28,29) Entre las intervenciones no farmacológicas se incluyen las siguientes : (6,28,29) Recomendaciones generales · Revisar medicación del paciente a fin de minimizar la exposición a fármacos asociados a delirium (véase tabla 1). Asegurar que todas las dosis son apropiadas.…”

Section: Tratamientounclassified

“…A continuación se describe, en general, el tratamiento farmacológico del delirium. (1,6,25,(28)(29)(30)(31)(32)(33) Delirium hiperactivo…”

Section: Tratamientounclassified

Delirium: an update for internists and psychiatrists

Torales

Barrios

Armoa

2017

Rev. virtual Soc. Parag. Med. Int

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RESUMENA lo largo del tiempo, al delirium se lo ha conocido por diversos nombres: falla cerebral aguda, síndrome cerebral orgánico agudo, síndrome confusional o psicosis postquirúrgica. No obstante, el término preferido en la actualidad es delirium (de latín delirare, que significa "arar fuera del surco"). El delirium, como síndrome, es un conjunto de signos y síntomas de inicio agudo caracterizado por deterioro cognitivo fluctuante, con enturbiamiento de la conciencia y capacidad disminuida de mantener y cambiar la atención de un punto a otro.Numerosos estudios han demostrado que los pacientes que desarrollan delirium tienen un riesgo aumentado de resultados adversos tanto durante la hospitalización como tras el alta. Este riesgo es independiente de cualquier comorbilidad existente, de la severidad de la enfermedad, la edad u otras variables asociadas. Asimismo, el delirium está asociado a un incremento en la mortalidad, aumento del tiempo de hospitalización y desarrollo de disfunciones cognitivas posteriores al alta.Este artículo de revisión presenta una actualización acerca de la fisiopatología del delirium, de las herramientas de reconocimiento del cuadro y de su tratamiento. Todas estas informaciones resultan útiles en el manejo diario de este tipo de pacientes, tanto por médicos internistas como por médicos psiquiatras. Palabras claves:ABSTRACT Over time, delirium has been known by several names: acute brain failure, acute organic brain syndrome, confusional syndrome, or post-surgical psychosis. However, the currently preferred term is delirium (from the Latin term delirare, which means "to go out of the furrow"). Delirium, as a syndrome, is a set of signs and symptoms of acute onset characterized by fluctuating cognitive impairment, clouding of consciousness and diminished ability to maintain and shift attention from one point to another. Numerous studies have shown that patients who develop delirium have an increased risk of adverse outcomes both during hospitalization and after discharge. This risk is independent of any existing comorbidity, severity of disease, age or other associated variables. Likewise, delirium is associated with an increase in mortality, delirio, trastornos neurocognitivos, síndrome confusional, delirio -fisiopatología, delirio -tratamiento farmacológico

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European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium

Cited by 833 publications

References 381 publications

Postoperative delirium: A preventable complication in the elderly surgical patient

Postoperative delirium: A preventable complication in the elderly surgical patient

Perioperative Management of Elderly Patients with Gastrointestinal Malignancies: The Contribution of Anesthesia

Delirium: an update for internists and psychiatrists

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