Postoperative delirium

Abstract

Delirium can be defined as "Acute Brain Dysfunction". Compared to dementia which is a disease that deteriorates the brain function in chronic course, delirium shows very similar symptoms but mostly ameliorates when the causative factors are normalized. Due to its heterogeneity of etiologies and symptoms, people including health care workers often mistake delirium for dementia or other psychiatric disorders. Delirium has attracted the global interest increasingly enough to gather vast amount of research on its management in various ways. Experts on the field have consistently suggested that systematic interventions should be implemented through a team-based multicomponent approach aimed to reduce the incidence and duration of delirium. Surgery involves many health care workers with different expertise who are not familiar with delirium. For the team-based approach on the management, it is vital that all medical personnel concerned have common understanding and consistent communication of delirium. Postoperative delirium is a common complication and exerts enormous burden on patients, their families, hospitals, and public resources. To alleviate this burden, this article is aimed to review general features and latest evidence-based knowledge of delirium with the focus on postoperative delirium.

The correlation of intraoperative hypotension and postoperative cognitive impairment: a meta-analysis of randomized controlled trials

“…Postoperative cognitive impairment (POD and POCD) is associated with high mortality and increased societal costs, which received increasing attention [1,[6][7][8]. Common concepts on the etiology are anesthesia-, surgery-, and patient-related factors [2,3,5].…”

“…Common concepts on the etiology are anesthesia-, surgery-, and patient-related factors [ 2 , 3 , 5 ]. Previous studies have reported that inflammation, neurotransmitter imbalance and sleep deprivation play an essential role in the pathogenesis of cognitive impairment [ 4 , 6 , 7 , 32 ]. Moreover, some studies indicated that intraoperative hypotension was linked to the development of POD or POCD [ 9 , 12 , 17 ].…”

“…POD is an acute change of patient's attention, consciousness, perception or cognition, which occurs in several hours or days after the operation and its duration is usually short (a few days) [3,4]; POCD is characterized by short-term disturbances in patients' memory, executive functioning, personality or sleep, which usually appears in weeks or months after surgery and can last for months or even longer [5]. POD and POCD are leading to adverse results, including prolonged length of hospital stay, increased mortality and unexpected complications, which results in increased medical costs and decreased the quality of patient's life [3,[6][7][8].…”

“…The underlying pathophysiology of POD or POCD is multifactor and complicated. Immutable risk factors, such as surgery types, age and baseline cognitive function have been identified [ 5 , 7 ]. Although the definitive preventive or therapeutic measure of POD or POCD is still unknown, there are increasing studies shows that hypoperfusion of the brain caused by hypotension during the surgery may be one pathogenic mechanism [ 9 – 12 ].…”

The correlation of intraoperative hypotension and postoperative cognitive impairment: a meta-analysis of randomized controlled trials

“…Common concepts on the etiology are anesthesia-, surgery-, and patient-related factors [2,3,5]. Previous studies have reported that in ammation, neurotransmitter imbalance and sleep deprivation play an essential role in the pathogenesis of cognitive impairment [4,6,7,32]. Moreover, some studies indicated that intraoperative hypotension was linked to the development of POD or POCD [9,12,17].…”