Precursors of Postoperative Delirium in Elderly Patients and Therapeutic Approaches
According to the World Health Organization, the number of elderly and senile patients in Europe by 2030 will amount to 30 % of the total population, and by 2050 will increase by 2–3 times. Risk factors of postoperative delirium in patients in the surgical clinic include: age 65 years and over, cognitive dysfunction or a history of dementia, severe concomitant somatic pathology. Preventive measures are: ensuring adequate oxygen delivery, correction of fluid and electrolyte balance, elimination of pain syndrome, normalization of gastrointestinal functions and urination, and exclusion of drugs with anticholinergic or dopaminergic properties. Non-pharmacological methods to prevent postoperative delirium include the provision and maintenance of patient’s temporal and spatial orientation that seems very important and significant. Maintenance of the minimum level of physical activity is achieved by performing therapeutic exercises 15 minutes three times a day under the control of the medical staff. It is important to ensure the cycle of day/night with the light off at night and constant lighting during the day, maximum limit of procedures and manipulations at night. Modern methods of prevention and treatment of delirium have a limited evidence base. Inclusion of 900 mg of gabapentin in premedication seems promising in patients at high risk of postoperative delirium. The authors suggested paying attention to some options of the ABCDE rule. The main directions in the prevention of postoperative delirium are attempts to modify risk factors for its development. Further researches are needed to develop correct and scientifically based methods of prevention and treatment of postoperative delirium.
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