Development Of Postoperative Delirium Research Articles

Postoperative Delirium In The Elderly Patients.

DOI: 10.18535/ijmsci/v3i4.2 International Journal Of Medical Science And Clinical Inventions Volume 3 issue 4 2016 page no. 1751-1757 e-ISSN: 2348-991X p-ISSN: 2454-9576 Available Online At: http://valleyinternational.net/index.php/our-jou/ijmsci Postoperative Delirium In The Elderly Patients. Haxhire Gani 1 ,Vjollca Beqiri 2 ,Majlinda Naco 3 ,Aurel Janko 4 ,Bilbil Hoxha 5 ,Rudin Domi 6 . UHC. ―Mother Teresa‖,Dept. of Surgery, Tirana, Albania. Summary. Age-related changes in physiology and pharmacology can affect every aspect of perioperative care. The purpose of this study was to describe the natural history, identify risk factors, and determine outcomes for the development of postoperative delirium in the elderly. Pathogenesis :The underlying mechanisms contributing to delirium are poorly understood. Risk factors for delirium:The following are risk factors which are associated with an increased risk of delirium:Age ≥65 years.Male sex.Pre-existing cognitive deficit, e.g. dementia, stroke.Severity of dementia. Co-existing medical problems etc.The recognition and identification of appropriate interventions for patients with acute postoperative delirium continues to challenge perianesthesia nurses, anesthesia care providers,and other health care providers.

MP08-16 LOSS OF RENAL FUNCTION AND SLOW GAIT SPEED ARE RISK FACTORS FOR POSTOPERATIVE DELIRIUM AFTER UROLOGICAL SURGERY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety II1 Apr 2016MP08-16 LOSS OF RENAL FUNCTION AND SLOW GAIT SPEED ARE RISK FACTORS FOR POSTOPERATIVE DELIRIUM AFTER UROLOGICAL SURGERY Shingo Hatakeyama, Tendo Sato, Teppei Okamoto, Hayato Yamamoto, Atsushi Imai, Takahiro Yoneyama, Yasuhiro Hashimoto, Takuya Koie, and Chikara Ohyama Shingo HatakeyamaShingo Hatakeyama More articles by this author , Tendo SatoTendo Sato More articles by this author , Teppei OkamotoTeppei Okamoto More articles by this author , Hayato YamamotoHayato Yamamoto More articles by this author , Atsushi ImaiAtsushi Imai More articles by this author , Takahiro YoneyamaTakahiro Yoneyama More articles by this author , Yasuhiro HashimotoYasuhiro Hashimoto More articles by this author , Takuya KoieTakuya Koie More articles by this author , and Chikara OhyamaChikara Ohyama More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2261AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study was to identify risk factors associated with postoperative delirium in patients undergoing urological surgery. METHODS We prospectively evaluated pre- and postoperative risk factors for postoperative delirium in consecutive 215 patients who received urological surgery between August 2013 and February 2015. Preoperative factors included patient demographics, comorbidities, and frailty assessment. Frailty was measured by hand-grip strength, fatigue scale of depression, fall risk assessment, and gait speed (the timed Get-up and Go test). Postoperative factors included types of anesthesia, surgical procedure, renal function and serum albumin decline, blood loss, surgery time, highest body temperature, and complications. Uni- and multivariate logistic regression analyses were performed to assess pre- and postoperative predictors for the development of postoperative delirium. RESULTS Median age of this cohort was 67 years. Ten patients (4.7%) experienced postoperative delirium. These patients were significantly older, had weak handgrip strength, a higher fall risk assessment score, slow gait speed, and greater renal function decline compared with patients without delirium. Multivariate analysis revealed slow gait speed (>13.0 s) and rapid renal function decline (>30%) were independent risk factors for postoperative delirium. CONCLUSIONS Slow gait speed and rapid renal function decline after urological surgery significant factors for postoperative delirium. These data will be helpful for perioperative patient management. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e91 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Shingo Hatakeyama More articles by this author Tendo Sato More articles by this author Teppei Okamoto More articles by this author Hayato Yamamoto More articles by this author Atsushi Imai More articles by this author Takahiro Yoneyama More articles by this author Yasuhiro Hashimoto More articles by this author Takuya Koie More articles by this author Chikara Ohyama More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Serum protein S100 as marker of postoperative delirium after off-pump coronary artery bypass surgery: secondary analysis of two prospective randomized controlled trials.

To investigate the predictive value of S100 (biochemical marker of neuroglial injury) for the occurrence of postoperative delirium (POD) in patients undergoing off-pump coronary artery bypass (OPCAB)-surgery. We enrolled 92 patients older than 18 years undergoing elective OPCAB-surgery. Serum-levels of S100 were determined at baseline (BL), end of surgery (EOS) and on the first postoperative day (PD1). Postoperatively, all-patients were evaluated daily until PD5 for the presence of POD using the confusion assessment method (CAM) or the confusion assessment method for the intensive care unit (CAM-ICU) for patients in the intensive care unit (ICU). The overall incidence of POD was 21%. S100-values on PD1 significantly predicted the occurrence of POD during the later hospital stay [area under the curve (AUC)=0.724 (95% confidence interval (CI): 0.619-0.814); p=0.0001] with an optimal cut-off level of 123 pg mL-1 (sensitivity 100%, specificity 44%). Below this value, the absence of POD was predicted correctly in 43.66% of patients without POD [negative predictive value (NPV) of 100% (95%CI: 88.8%-100.0%) - positive predictive value of 29.8% (95%CI: 18.4%-43.4%) and likelihood ratio (LR) of the negative result of 0.0]. S100-levels <123 pg mL-1 measured on PD1 reliably rule out the development of POD after elective OPCAB-surgery. This finding warrants testing whether S100-levels could be used for a risk stratification of cardiac surgical patients and for the initiation of preventive measures against POD in patients with high postoperative S100-levels.

Depression and postoperative complications: an overview.

BackgroundThe interaction of depression and anesthesia and surgery may result in significant increases in morbidity and mortality of patients. Major depressive disorder is a frequent complication of surgery, which may lead to further morbidity and mortality.Literature searchSeveral electronic data bases, including PubMed, were searched pairing “depression” with surgery, postoperative complications, postoperative cognitive impairment, cognition disorder, intensive care unit, mild cognitive impairment and Alzheimer’s disease.Review of the literatureThe suppression of the immune system in depressive disorders may expose the patients to increased rates of postoperative infections and increased mortality from cancer. Depression is commonly associated with cognitive impairment, which may be exacerbated postoperatively. There is evidence that acute postoperative pain causes depression and depression lowers the threshold for pain. Depression is also a strong predictor and correlate of chronic post-surgical pain. Many studies have identified depression as an independent risk factor for development of postoperative delirium, which may be a cause for a long and incomplete recovery after surgery. Depression is also frequent in intensive care unit patients and is associated with a lower health-related quality of life and increased mortality. Depression and anxiety have been widely reported soon after coronary artery bypass surgery and remain evident one year after surgery. They may increase the likelihood for new coronary artery events, further hospitalizations and increased mortality. Morbidly obese patients who undergo bariatric surgery have an increased risk of depression. Postoperative depression may also be associated with less weight loss at one year and longer. The extent of preoperative depression in patients scheduled for lumbar discectomy is a predictor of functional outcome and patient’s dissatisfaction, especially after revision surgery. General postoperative mortality is increased.ConclusionsDepression is a frequent cause of morbidity in surgery patients suffering from a wide range of conditions. Depression may be identified through the use of Patient Health Questionnaire-9 or similar instruments. Counseling interventions may be useful in ameliorating depression, but should be subject to clinical trials.

The Association of Brain MRI Characteristics and Postoperative Delirium in Cardiac Surgery Patients

PurposeDelirium is common after cardiac surgery and is associated with adverse consequences, including cognitive decline. Identification of vulnerable older adults might allow for early implementation of delirium-prevention strategies. Brain MRI findings provide insight into structural brain changes that may identify vulnerable patients. The purpose of this study was to examine the association between brain MRI characteristics potentially associated with delirium vulnerability and the development of postoperative delirium in a nested cohort of patients undergoing cardiac surgery. MethodsWe identified 79 cardiac surgery patients who had brain MRI imaging after cardiac surgery, as part of an ongoing randomized trial evaluating the efficacy of blood pressure management based on cerebral autoregulation monitoring versus standard management for improving neurological outcomes. Cerebral lateral ventricular size, cortical sulcal width, and white matter hyperintensities (WMH) on brain MRI scans were graded on a validated 0 to 9 scale, and categorized into tertiles. New ischemic lesions were characterized as present or absent. Delirium was assessed using a validated chart-review. Neuropsychological testing performed before surgery was used to establish preoperative cognitive baseline. Multivariable logistic regression was used to assess the independent association between MRI characteristics and postoperative delirium. FindingsThe average age of patients was 70.1 ± 7.8 years old, and 72% were male. Twenty-eight of 79 (35.4%) patients developed postoperative delirium. Patients with delirium had higher unadjusted ventricular size (median 4 vs. 3, P = 0.003), and there was a trend towards higher sulcal sizes and WMH grades. Increasing tertiles of ventricular size (Odds Ratio [OR] 3.59; 95% Confidence Interval [CI] 1.59-8.12; P = 0.002) and sulcal size (OR 2.15; 95%CI 1.13-4.12; P = 0.02) were associated with postoperative delirium, with a trend for tertiles of WMH grade (OR 1.91; 95%CI 0.99-3.68; P = 0.05). In multivariable models adjusted for logistic EuroSCORE, baseline cognitive status, bypass time, and any postoperative complication, each tertile of ventricular size was associated with increased odds of postoperative delirium (OR 3.23 per tertile increase in ventricular size; 95%CI 1.21-8.60; P = 0.02). There were no differences in odds of delirium by tertiles of sulcal grade, tertiles of white matter grade, or presence of new ischemic lesions, in adjusted models. ImplicationsIncreased brain ventricular size was independently associated with delirium after cardiac surgery. These results suggest that cerebral atrophy may contribute to increased vulnerability for postoperative delirium. Baseline brain MRIs may be useful in identifying cardiac surgery patients at high risk for postoperative delirium, who might benefit from targeted perioperative approaches to prevent delirium. ClinicalTrials.gov identifier: NCT00981474.

Postoperative delirium: age and low functional reserve as independent risk factors

Study ObjectiveThe aim of this study was to determine the incidence of postoperative delirium (POD) and the presence of previous conditions related to its development. DesignProspective observational study. SettingsThe study was performed in adult patients (n=221) scheduled for elective surgery and admitted to the postanesthesia care unit (PACU). MeasurementsThe presence of POD was assessed by the Nursing Delirium Screening Scale at discharge from the PACU and 24hours after surgery. Descriptive analyses were carried out, and statistical comparisons were performed with Mann-Whitney U, χ2, or Fisher exact test. Logistic regression analysis was used for evaluation of independent determinants of POD. Main resultsPOD was found in 25 patients (11%). Patients who developed POD were older (median age, 69 vs 57years; P<.001); had a higher American Society of Anesthesiologists physical status score (≥3) (60% vs 19%, respectively, had American Society of Anesthesiologists physical status III/IV; P<.001); and showed higher incidences of ischemic heart disease (24% vs 6%; P=.001), chronic kidney disease (20% vs 5%; P=.005), hypertension (80% vs 45%; P=.001), chronic obstructive pulmonary disease (20% vs 6%; P=.009), and low functional reserve (LFR) (24% vs 2%; P<.001). Age (odds ratio, 1.06; 95% confidence interval, 1.02-1.10; P=.003) and LFR (odds ratio, 8.04; 95% confidence interval, 3.95-32.27; P=.003) were considered independent risk factors for POD. ConclusionsThe incidence of POD in the study population (11%) is consistent with that described in the literature (5%-15%). The comorbidities associated with its development were ischemic heart disease, hypertension, chronic kidney disease, LFR, and chronic obstructive pulmonary disease. Age ≥65years and LFR were independent risk factors for POD development.

Short-Form Mini Nutritional Assessment as a useful method of predicting the development of postoperative delirium in elderly patients undergoing orthopedic surgery.

Postoperative delirium (POD) is a major cause for concern among elderly patients undergoing surgery, often resulting in poor outcome. It is therefore important to predict and prevent POD. The aim of this study was to evaluate the Mini Nutritional Assessment Short-Form (MNA-SF) as a predictor of POD after orthopedic surgery. Elderly patients undergoing orthopedic surgery between April 2011 and March 2013 were included in the study (n=544; mean age, 74.24 ± 7.92 years). The MNA-SF was used to evaluate preoperative nutritional status. Delirium was assessed daily after surgery using the confusion assessment method. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria were used to confirm delirium diagnosis. Univariate and multivariate logistic regression analyses were performed to identify key factors associated with POD. POD occurred in 52 patients (9.6%). According to the MNA-SF, 17.5% of subjects were at risk of undernutrition. Adjusting for all potential factors in the final model, age, male gender and lower Mini-Mental State Examination and higher Charlson Comorbidity Index scores were associated with significantly increased likelihood of POD. Subjects who were identified preoperatively as at risk of undernutrition were 2.85 times more likely to develop POD compared to normally nourished subjects (odds ratio: 2.85, 95% confidence interval: 1.19-6.87). These results suggest that the MNA-SF is a simple and effective tool that can be used to predict incident delirium in elderly patients after orthopedic surgery.

Risk factors contributing to postoperative delirium in geriatric patients postorthopedic surgery.

Postoperative delirium is a common clinical manifestation in geriatric patients, resulting in prolonged hospitalization and increased economic burden, in addition to higher morbidity and mortality rates. Therefore, identifying non-obvious risk factors that contribute to the development of postoperative delirium in geriatric patients is crucial. From January 2011 to June 2013, 200 geriatric patients of over 65 years of age scheduled for orthopedic surgery were randomly selected and statistically analyzed with respect to the effects of the following 12 factors on postoperative delirium: sex, age, anesthesia type, surgical type (i.e. spine, hip replacement, and pelvic or femoral fracture repair), operative duration, intraoperative hypoxia, intraoperative hypercapnia, intraoperative hypotension, intraoperative blood loss, preoperative affective state, postoperative sleep disorders, and underlying disease (i.e. hypertension, coronary heart disease, diabetes, hyperlipidemia, and chronic bronchitis). Seven factors--age, anesthesia type, duration of operation, intraoperative hypercapnia, intraoperative hypotension, preoperative affective state, and postoperative sleep disorders--were found to be significantly differentiated, suggesting that these factors have an impact on the development of postoperative delirium. Sex, surgical type, intraoperative hypoxia, intraoperative blood loss (with 300 ml as a cutoff value), and underlying disease were not directly related to the development of postoperative delirium. Advanced age (>70 years), the use of general anesthesia, longer surgical duration (>3 hours), the presence of intraoperative hypercapnia and hypotension, the presence of preoperative affective dysfunction, and the presence of postoperative sleep disorders appear to be associated with the development of postoperative delirium in geriatric patients after orthopedic surgery.

PACIENTE ADULTO MAYOR Y CIRUGÍA NO CARDÍACA: ¿QUÉ DEBEMOS SABER?

elderly patient and non cardiac surgery: What should we know? The surgical procedures in elderly patients are and will be more common. They are characterized by greater morbidity and mortality than those in younger patients, so it is essential an appropriate preoperative evaluation, a diligent intraoperative monitoring and a proper management of the postoperative period. The old age has a number of physiological changes and an increased incidence of chronic diseases and together determine a decline in physiological reserve and functional capacity. In the preoperative evaluation is important a systematic assessment of comorbidities and drugs routinely prescribed, “fragility” of these patients due to the surgical procedure and the risk of developing postoperative cognitive deficit. Type of surgery, degree of urgency and patient conditions are the main factors to consider at time to choose type of anesthesia. Common complications include the development of postoperative delirium and postoperative cognitive decline, where efforts should be directed at prevention rather than treatment, because it significantly increases perioperative morbidity.

Impact of malnutrition on postoperative delirium development after on pump coronary artery bypass grafting.

Background & aimsEven though malnutrition is frequently observed in cardiac population outcome data after cardiac surgery in malnourished patients is very rare. No thorough research was done concerning the impact of malnutrition on neuropsychological outcomes after cardiac surgery. The aim of our study was to analyze the incidence of postoperative delirium development in malnourished patients undergoing on pump bypass grafting.MethodsWe performed a cohort study of adults admitted to Vilnius University Hospital Santariskiu Clinics for elective coronary artery bypass grafting. The nutritional status of the patients was assessed by Nutritional Risk Screening 2002 (NRS-2002) questionnaire the day before surgery. Patients were considered as having no risk of malnutrition when NRS-2002 score was less than 3 and at risk of malnutrition when NRS-2002 score was ≥3. During ICU stay patients were screened for postoperative delirium development using the CAM-ICU method. and divided into two groups: delirium and non delirium. The statistical analysis was preformed to evaluate the differences between the two independent groups. The logistic regression model was used to evaluate the potential preoperative and intraoperative risk factors of postoperative delirium.ResultsNinety-nine patients were enrolled in the study. Preoperative risk of malnutrition was detected in 24 % (n = 24) of the patients. The incidence of early postoperative delirium in overall study population was 8.0 % (n = 8). The incidence of the patients at risk of malnutrition was significantly higher in the delirium group (5 (62.5 %) vs 19 (20.9 %), p <0.0191). In multivariate logistic regression analysis risk of malnutrition defined by NRS 2002 was an independent preoperative and intraoperative risk factor of postoperative delirium after coronary artery bypass grafting (OR: 6.316, 95 % CI: 1.384-28.819 p = 0.0173).ConclusionsPreoperative malnutrition is common in patients undergoing elective coronary artery bypass grafting. Nutrition deprivation is associated with early postoperative delirium after on pump coronary artery bypass grafting.

Effect of intraperitoneal hyperthermic chemotherapy on postoperative delirium in patients undergoing cytoreductive surgery

Objective To evaluate the effect of intraperitoneal hyperthermic chemotherapy (IPHC) on postoperative delirium in the patients undergoing cytoreductive surgery (CS) . Methods One hundred twenty patients of both sexes, aged 18-64 yr, weighing 40-70 kg, of ASA physical status Ⅰ-Ⅲ, scheduled for elective CS under general anesthesia, were enrolled in the study.According to whether or not the patients underwent IPHC, they were divided into 3 groups (n=40 each) : CS group, IPHC 1 h group (group IPHC1) and IPHC 2 h group (group IPHC2) . IPHC1 and IPHC2 groups were perfused with chemotherapeutics for 1 and 2 h, respectively, after CS.Postoperative delirium was evaluated using the Confusion Assessment Method for the Intensive Care Unit at 1-3 days after surgery. Results The incidence of postoperative delirium was 15%, 28% and 38% in CS, IPHC1 and IPHC2 groups, respectively.The incidence of postoperative delirium was significantly higher in IPHC1 and IPHC2 groups than in group CS, and in group IPHC2 than in group IPHC1. Conclusion IPHC may increase the development of postoperative delirium in the patients undergoing CS. Key words: Delirium; Postoperative complications; Cytoreductive surgery; Chemotherapy, cancer, regional perfusion

EARLY DETECTION AND TREATMENT: AN EXAMINATION OF PRODROMAL SYMPTOMS OF POST OPERATIVE DELIRIUMIN ELDERLY PATIENTS

Introduction: The development of postoperative delirium is a mental disorder common among those aged 70 and over in the wake of the surgery. The impact of postoperative delirium can be severe and result in withdrawal and deterioration in patients quality of life. The purpose of this study was to identity the prodromal symptoms perceived by veteran nurses to reflect onset of postoperative delirium among elderly patients in Japan. Methods: Participants A total of 300 nurses, each with over five years of nursing experience and over three years of clinical nursing experience on surgical wards, participated in this research. Consent and investigative cooperation was obtained from the nursing director of each hospital who was then sent copies of the questionnaire. Each director was requested to distribute the questionnaires among nurses in the surgical wards Participants. That met the inclusion criteria of this study. Questionnaires were returned by post in accordance with a three-week deadline. Results: The following items were to be most characteristic of postoperative delirium onset: Has been refrain, patient's mood is dark, complains of wound pain, refuses to roll over, complains of urgency, patient experiences a constant urge to have a bowel movement, the wrong time, patient refuses to adhere to their diet, and patient is unable to effectively use the nurses call. Conclusions: The results of this research revealed that prodromal symptoms identified by clinical nurses can be categorized into six distinct areas: behavior, confusion, negative symptoms, sleep, delusion, and excretion.KEYWORDS: Postoperative Delirium; Prodromal Symptoms; Early Detection; Questionnaires; Japan.

Incidence and risk factors of delirium in patients after cardiac surgery: Modifiable and non-modifiable factors

BackgroundPost cardiac surgery delirium is a severe complication. This study tried to evaluate the early postoperative delirium risk factors and to identify which of them can be modified in order to optimize perioperative management. MethodsIt is a prospective observational study. 250 consecutive cardiac surgery patients took part in the study. Cardiac surgery, the anesthetic regiment and the postoperative management were standardized. The incidence and the risk factors of the postoperative delirium were analyzed by univariate and multivariate analysis. Delirium was assessed with screening scale – The Confusion Assessment Method for the intensive care unit every 12h postoperatively. ResultsDelirium developed in 52 patients (20.8%). Univariate analysis of the variables confirmed that older age (p=0.0001), the higher EuroSCORE II value (p=0.0001), longer CPB time (p=0.0001), longer ACC time (p=0.0001), and the sufentanil dose (p=0.010) were strongly independently associated with postoperative delirium. The benzodiazepine administration was shown to be an intermediate predictor for developing postoperative delirium (p=0.055). ConclusionsAdvanced age, higher EuroSCORE II value, longer CPB and ACC times, and higher sufentanil doses during anesthesia were all predictors for the development of postoperative delirium. The only modifiable risk factor was the use of larger doses of sufentanil which is related with the duration of the operation. New preventive strategies and use of reduced dose of sufentanil intraoperatively, or the use of different opioid should be studied and applied in order to reduce the incidence of the postoperative delirium.

Sleep apnea – another piece of the postoperative delirium puzzle?

AbstractCardiac surgery is associated with high rates of postoperative delirium. The development of postoperative delirium increases morbidity, mortality and healthcare costs. Sleep disordered breathing is highly prevalent in patients undergoing cardiac surgery, and now appears likely to be an independent risk factor for postoperative delirium. If confirmed in larger controlled trials, sleep apnea may represent a risk factor for targeted intervention to reduce the rate of postoperative delirium.

General anesthetic and the risk of dementia in elderly patients: current insights.

In this review, we aim to provide clinical insights into the relationship between surgery, general anesthesia (GA), and dementia, particularly Alzheimer’s disease (AD). The pathogenesis of AD is complex, involving specific disease-linked proteins (amyloid-beta [Aβ] and tau), inflammation, and neurotransmitter dysregulation. Many points in this complex pathogenesis can potentially be influenced by both surgery and anesthetics. It has been demonstrated in some in vitro, animal, and human studies that some anesthetics are associated with increased aggregation and oligomerization of Aβ peptide and enhanced accumulation and hyperphosphorylation of tau protein. Two neurocognitive syndromes that have been studied in relation to surgery and anesthesia are postoperative delirium and postoperative cognitive dysfunction, both of which occur more commonly in older adults after surgery and anesthesia. Neither the route of anesthesia nor the type of anesthetic appears to be significantly associated with the development of postoperative delirium or postoperative cognitive dysfunction. A meta-analysis of case-control studies found no association between prior exposure to surgery utilizing GA and incident AD (pooled odds ratio =1.05, P=0.43). The few cohort studies on this topic have shown varying associations between surgery, GA, and AD, with one showing an increased risk, and another demonstrating a decreased risk. A recent randomized trial has shown that patients who received sevoflurane during spinal surgery were more likely to have progression of preexisting mild cognitive impairment compared to controls and to patients who received propofol or epidural anesthesia. Given the inconsistent evidence on the association between surgery, anesthetic type, and AD, well-designed and adequately powered studies with longer follow-up periods are required to establish a clear causal association between surgery, GA, and AD.

Use of Benzodiazepines and Haloperidol Among Orthopedic Patients in Postoperative Delirium. A Systematic Review

Postoperative delirium may occur as a serious complication after orthopedic surgery. In addition, risk factors such as age, mental and organic illnesses may increase the incidence of the aforementioned complication. Delirium has a negative impact on postoperative mobilization and recovery. Furthermore, it may result in longer hospital treatment. This study is a systematic literature review of articles that was conducted through a key word search of PubMed. The review includes: 1) pathogenesis, 2) risk factors in the development of postoperative delirium, and 3) the effective methods and strategies of treatment, especially in relation to patients hospitalized in orthopedics. This systematic review will discuss benzodiazepines and haloperidol, which are used to treat delirium in the prevention and treatment of postoperative delirium. The findings suggest that prevention of postoperative delirium with drugs can be an effective strategy. Keywords: Benzodiazepines, haloperidol, hip fracture, olanzapine, orthopedic, postoperative delirium.

The assessment of the T102C polymorphism of the 5HT2a receptor gene, 3723G/A polymorphism of the NMDA receptor 3A subunit gene (GRIN3A) and 421C/A polymorphism of the NMDA receptor 2B subunit gene (GRIN2B) among cardiac surgery patients with and without delirium

ObjectiveThe studies regarding the role of genes polymorphism in development of postoperative delirium are extremely rare. Therefore, we investigated the potential association of polymorphism in 5HT2a receptor gene and N-methyl-d-aspartate (NMDA) receptor 3A and 2B subunits genes with postoperative delirium. MethodWe conducted a prospective, nested, case–control study. For analysis, 3723G/A (rs3739722) polymorphism in the GRIN3A gene, 421C/A (rs3764028) polymorphism in the GRIN2B gene and T102C (rs6313) polymorphism in the 5HT2A gene were selected. ResultsGenetic analysis confirmed that there were significant differences in genotype frequencies for 3723G/A between delirium patients and controls. No other significant associations were observed. Moreover, according to the multivariate conditional logistic regression analysis the presence of AG haplotype of GRIN3A gene was independently associated with postoperative delirium. ConclusionsThese findings suggest that the genetic variations of NR3A subunit of NMDA receptor may be a predisposing factor to delirium among the Polish population of cardiac surgery patients.

Type of Anesthesia and Postoperative Delirium After Vascular Surgery

The purpose of this study was to investigate the association between general (GA), regional (RA), and local (LA) anesthetic techniques with respect to the development of delirium after vascular surgery. The authors hypothesized that patients undergoing GA for vascular surgery would have a higher incidence of postoperative delirium. The role of LA with respect to postoperative delirium in vascular surgery patients previously has not been reported. Retrospective review. Tertiary referral center, university hospital. 500 patients undergoing vascular surgical procedures. Based on the chosen anesthetic technique, all patients were divided into GA, RA, and LA groups, respectively. Exclusion criteria were patients with preoperative dementia or abnormal level of consciousness, patients undergoing open abdominal aneurysm repair surgery, and patients undergoing carotid endarterectomy. All anesthetic techniques were conducted according to routine institutional practices. Patients in both the RA and LA groups received intravenous sedation. Three hundred ninety-six (79%) patients received GA, 73 (15%) RA, and 31 (6%) LA. The overall incidence of delirium was 19.4% and rates were similar among the 3 groups, with 73 (18.4%) patients in the GA group, 17 (23.2%) in the RA group, and 7 (22.5%) in the LA group (p = 0.56). Patients in the LA group were more likely to have emergency surgery and also had a higher incidence of previous cerebrovascular accidents or transient ischemic attacks. There was no significant difference with respect to either onset or duration of delirium among the 3 groups. Median length of hospital stay and in-hospital mortality were similar among the 3 groups. Delirium rates after vascular surgery were similar with local, regional, or general anesthesia techniques. The presence of risk factors for the development of postoperative delirium should not influence the type of anesthesia provided.

Interventions to prevent postoperative delirium in elderly cancer patients should be targeted at those undergoing nonsuperficial surgery with special attention to the cognitive impaired patients

AimsThe aim of this study was to determine risk factors for postoperative delirium (POD) in elderly cancer patients. MethodsThis study was an observational multicentre retrospective study performed in the University Medical Center Groningen and Medical Center Leeuwarden, the Netherlands. Patients over 65 years of age undergoing elective surgery for a solid tumour were included. The main outcome was POD. Medical records were screened for POD using a standardized instrument. The risk factors considered were: age, gender, severity of the surgical procedure, comorbidity, American Society of Anaesthesiologists (ASA) score and 15 items suggestive for frailty as measured with the Groningen Frailty Indicator (GFI). To examine an association between the risk factors and the development of POD, univariate and multivariate logistic regression analysis was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). ResultsWe reviewed 251 medical records. Forty-six patients developed POD (18.3%). Preoperative cognitive functioning (as measured by the item cognition of the GFI) (OR: 23.36; 95% CI: 5.33–102.36) and severity of the surgical procedure were identified as independent risk factors for POD; intermediate (OR: 15.44, 95% CI: 1.70–140.18) and major surgical procedures (OR: 45.01, 95% CI: 5.22–387.87) significantly increased the risk for POD as compared to minor surgery. ConclusionsPreoperative cognitive functioning and the severity of the surgical procedure are independent risk factors for POD in elderly undergoing elective surgery for a solid tumour.

Mild Cognitive Impairment with Associated Inflammatory and Cortisol Alterations as Independent Risk Factor for Postoperative Delirium

Aims: The present study aimed to determine the impact of mild cognitive impairment (MCI) on the development of postoperative delirium and, secondly, to assess the association between MCI and raised perioperative cortisol, cytokine, cobalamin and homocysteine levels. Methods: The study recruited 113 consecutive adult patients scheduled for cardiac surgery with cardiopulmonary bypass. The patients were examined preoperatively with the Montreal Cognitive Assessment and Trail Making Test. A diagnosis of MCI was established based upon the criteria of the National Institute on Aging and Alzheimer's Association. Patients were screened for delirium within the first 5 days postoperatively. Results: MCI was diagnosed in 24.8% of the patients, whereas the frequency of delirium was 36%. A multivariate analysis demonstrated that individuals with MCI were at a significantly higher risk of postoperative delirium (OR = 6.33, p = 0.002). Preoperative cortisol, postoperative cortisol and IL-2 plasma levels were higher in the MCI group as compared to non-MCI subjects. Conclusion: MCI is associated with a higher risk of postoperative delirium. Perioperative cortisol and inflammatory alterations observed in MCI may provide a physiological explanation for this increased risk.