Postoperative Delirium in Elderly Patients

O.O. Pavlov, S.O. Lutsyk

Abstract


The literature review provides information on prevention of delirium in elderly patients undergoing surgery. Poor quantity of quality researches on the delirium prevention was found. The etiology of postoperative cognitive impairment remains unclear until now. We considered several mechanisms of postoperative delirium. They include perioperative hypoxemia and ischemia. However, it should be noted that those parameters were determined by blood pressure measuring and pulse oximetry that could have an error. Cerebral oximetry may presumably add some accuracy and clinical significance. The clinical forms of postoperative delirium, the mechanisms and prevalence of this complication are described. The study presents the results of the analysis of several studies of preventive measures and comparison of drug and non-drug treatment regimens and prevention. It is important to emphasize that pharmacological treatment is not the first line. Current objectives include the evaluation of preoperative risk index, a decision on the most appropriate intervention and prevention of various postoperative complications, including postoperative delirium in elderly patients. Thought disorder and confusion are typical clinical features of postoperative delirium, starting from 1–3 day after surgery. Delirium may last more than one week and is associated with various complications, prolongation of hospitalization and low functional status at discharge from the hospital. However, pharmacological treatment is necessary in case of patient agitation or lack of adequate post-operative care. Physical limitations are undesirable, except for the most severe cases, and then only as a temporary measure until pharmacological and other interventions failed for calming result. The data may direct clinicians to moderate approach regarding criteria for surgical indications in elderly patients.

Keywords


delirium; age; post-operative period; review

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DOI: https://doi.org/10.22141/2224-0586.7.78.2016.86104

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