Implementation of strategies to prevent and treat postoperative delirium in the post-anesthesia caring unit

Abstract

Background Postoperative delirium is associated with worse outcome. The aim of this study is to understand present strategies for delirium screening and therapy in German Post Anesthesia Caring Units (PACU) in hospitals and ambulatory anesthesia facilities. Methods We designed German-wide web-based survey of 922 leading anesthesiologists in hospitals and 726 in ambulatory surgery. Results The response rate was 30% for hospital anesthesiologists. 10% (95%-confidence interval: 8-12) of the anesthesiologists applied a standardised screening for delirium. Even though not on a regular basis, in 44% (41-47) of the hospitals, a recommended and validated screening was used, the Nursing Delirium Screening Scale (NuDesc) or the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). If delirium is likely to occur, 46% (43-50) of the patients were examined using a delirium tool and 20% (17-23) screened in intensive care units. For the treatment of delirium, alpha-2-agonists (83%, 80-85) were used most frequently for vegetative symptoms, benzodiazepines in anxiety in 71% (68-74), typical neuroleptics in 77% (71-82%) of patients with psychotic symptoms and in 20% (15-25) of patients with hypoactive delirium. 45% (39-51) of the respondents suggested no therapy for this entity. One third of the respondents indicated an age limit for pre-anesthetic medication with a mean age (SD) of 74.2 (±6.4) years and avoid benzodiazepines. Conclusions Monitoring of delirium was not established as a standard procedure in German PACUs. However, symptom-oriented therapy for postoperative delirium corresponded with the current guidelines.

Effect of sedative premedication with oral midazolam on postanesthesia care unit delirium in older adults: a secondary analysis following an uncontrolled before-after design

“…Studies on the incidence of PACU delirium vary substantially with regard to screening instruments used and time points of assessment (Card et al 2015 ; Hernandez et al 2017 ; Hesse et al 2019 ; Saller et al 2020 ). Methodological heterogeneity among trials on PACU delirium may limit the comparability of study results.…”

“…However, delirium screening in our study was limited to the postopeorative recovery period in the PACU and we cannot generalize our results to POD beyond the PACU stay. We used the CAM-ICU, which is a validated and widely used tool for the assessment of POD (Card et al 2015 ; Hesse et al 2019 ; Saller et al 2020 ). Despite high specificity, sensitivity for delirium signs in the PACU may be limited (Neufeld et al 2013b ).…”

Nursing Delirium Screening Scale, a Tool for Early Detection of Delirium: Integrative Review

“…The Nu-DESC, CAM-ICU, and DSM tools were the most used by nurses for detecting delirium in critical care units, post-operative units, especially older adults (51,52). However, because of the lack of education in delirium recognition, nurses are not prepared to identify delirium in the unit.…”

Bedeutung der Desorientierung bei der Delireinschätzung

“…Für die Überwachung eines Delirs empfiehlt die deutschsprachige S3-Leitlinie „Delirmanagement, Analgesie und Sedierung“ [ 7 ] neben der „Intensive Care Delirium Screening Checklist“ (ICDSC) [ 3 ] die „Confusion Assessment Method for Intensive Care Unit“ (CAM-ICU) [ 9 ]. Die CAM-ICU ist im deutschsprachigen Raum der am weitesten verbreitete Delir-Test [ 20 , 31 ]. Da intubierte Intensivpatienten sich nicht verbal äußern können, wurde die CAM-ICU so konzipiert, dass Patienten sich auf einer „Ja/Nein-Basis“ (z.…”