Clinical advances on prevention of postoperative delirium during peri-anesthetic period_West China Medical Journal

Authors：

WANG Rui , TANG Yidan ,  YANG Jing

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

YANG Jing, Email: hxyangjing@qq.com

Keywords：

Postoperative delirium; Prevention; Peri-anesthetic period

DOI：

10.7507/1002-0179.202101164

Video：

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Postoperative delirium (POD) is a serious postoperative complication, which is significantly correlated with poor prognosis such as prolonged hospital stay and increased rate of readmission. POD is the result of multiple factors, and intervention targeting at its risk factors can significantly reduce the incidence of POD. At present, POD prevention tends to be multidisciplinary and cluster-oriented, aiming at forming a process-oriented, whole-perioperative assessment and intervention path. However, at present, there are few studies on POD peri-anesthetic period intervention, and there are many controversies. All guidelines and expert consensus are also blank in this part, and further studies are needed to fill the gaps. This paper discusses the current prevention strategies for POD during peri-anesthetic period, guiding future studies and further improving the intervention strategies for POD during peri- anesthetic period, so as to reduce the occurrence of POD.

Citation： WANG Rui, TANG Yidan, YANG Jing. Clinical advances on prevention of postoperative delirium during peri-anesthetic period. West China Medical Journal, 2021, 36(10): 1450-1455. doi: 10.7507/1002-0179.202101164 Copy

1.	Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol, 2017, 34(4): 192-214.
2.	Evered L, Silbert B, Knopman DS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Anesthesiology, 2018, 129(5): 872-879.
3.	Jin L, Yao R, Heng L, et al. Ultrasound-guided continuous thoracic paravertebral block alleviates postoperative delirium in elderly patients undergoing esophagectomy: a randomized controlled trial. Medicine (Baltimore), 2020, 99(17): e19896.
4.	Hughes CG, Boncyk CS, Culley DJ, et al. American society for enhanced recovery and perioperative quality initiative joint consensus statement on postoperative delirium prevention. Anesth Analg, 2020, 130(6): 1572-1590.
5.	Kratz T, Heinrich M, Schlauß E, et al. Preventing postoperative delirium. Dtsch Arztebl Int, 2015, 112(17): 289-296.
6.	Memtsoudis S, Cozowicz C, Zubizarreta N, et al. Risk factors for postoperative delirium in patients undergoing lower extremity joint arthroplasty: a retrospective population-based cohort study. Reg Anesth Pain Med, 2019.
7.	Miller D, Lewis SR, Pritchard MW, et al. Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery. Cochrane Database Syst Rev, 2018, 8(8): CD012317.
8.	Li CJ, Wang BJ, Mu DL, et al. Randomized clinical trial of intraoperative dexmedetomidine to prevent delirium in the elderly undergoing major non-cardiac surgery. Br J Surg, 2020, 107(2): e123-e132.
9.	Clemmesen CG, Lunn TH, Kristensen MT, et al. Effect of a single pre-operative 125 mg dose of methylprednisolone on postoperative delirium in hip fracture patients; a randomised, double‐blind, placebo‐controlled trial. Anaesthesia, 2018, 73(11): 1353-1360.
10.	Punjasawadwong Y, Chau-In W, Laopaiboon M, et al. Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults. Cochrane Database Syst Rev, 2018, 5(5): CD011283.
11.	Sieber FE, Neufeld KJ, Gottschalk A, et al. Effect of depth of sedation in older patients undergoing hip fracture repair on postoperative delirium: the STRIDE randomized clinical trial. JAMA Surg, 2018, 153(11): 987-995.
12.	Wang J, Zhu L, Li Y, et al. The potential role of lung-protective ventilation in preventing postoperative delirium in elderly patients undergoing prone spinal surgery: a preliminary study. Med Sci Monit, 2020, 26: e926526.
13.	Xu X, Hu X, Wu Y, et al. Effects of different BP management strategies on postoperative delirium in elderly patients undergoing hip replacement: a single center randomized controlled trial. J Clin Anesth, 2020, 62: 109730.
14.	Mu DL, Zhang DZ, Wang DX, et al. Parecoxib supplementation to morphine analgesia decreases incidence of delirium in elderly patients after hip or knee replacement surgery: a randomized controlled trial. Anesth Analg, 2017, 124(6): 1992-2000.
15.	Wang X, Wang Y, Hu Y, et al. Effect of flurbiprofen axetil on postoperative delirium for elderly patients. Brain Behav, 2019, 9(6): e01290.
16.	Wildes TS, Mickle AM, Ben Abdallah A, et al. Effect of electroencephalography-guided anesthetic administration on postoperative delirium among older adults undergoing major surgery: the ENGAGES randomized clinical trial. JAMA, 2019, 321(5): 473-483.
17.	Bocskai T, Kovács M, Szakács Z, et al. Is the bispectral index monitoring protective against postoperative cognitive decline? A systematic review with meta-analysis. PLoS One, 2020, 15(2): e0229018.
18.	Tian Y, Zhao P, Li L, et al. Pre-emptive parecoxib and post-operative cognitive function in elderly patients. Int Psychogeriatr, 2014: 1-8.
19.	中华医学会麻醉学分会. 成人术后谵妄防治的专家共识//(2014)中国麻醉学指南与专家共识. (2014-07-15)[2021-01-05]. http://www.csahq.cn/guide/detail_214.html.
20.	American geriatrics society expert panel on postoperative delirium in older adults. Postoperative delirium in older adults: best practice statement from the American geriatrics society. J Am Coll Surg, 2015, 220(2): 136-148.
21.	中华医学会麻醉学分会. 中国老年患者围术期麻醉管理指导意见//中国麻醉学指南与专家共识(2017版). (2017-08-01)[2021-01-05]. http://www.csahq.cn/guide/detail_372.html.
22.	中华医学会麻醉学分会老年人麻醉学组, 国家老年疾病临床医学研究中心中华医学会精神病学分会, 国家睡眠研究中心, 等. 中国老年患者围术期脑健康多学科专家共识(二). 中华医学杂志, 2019, 99(29): 2252-2269.

1. Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol, 2017, 34(4): 192-214.
2. Evered L, Silbert B, Knopman DS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Anesthesiology, 2018, 129(5): 872-879.
3. Jin L, Yao R, Heng L, et al. Ultrasound-guided continuous thoracic paravertebral block alleviates postoperative delirium in elderly patients undergoing esophagectomy: a randomized controlled trial. Medicine (Baltimore), 2020, 99(17): e19896.
4. Hughes CG, Boncyk CS, Culley DJ, et al. American society for enhanced recovery and perioperative quality initiative joint consensus statement on postoperative delirium prevention. Anesth Analg, 2020, 130(6): 1572-1590.
5. Kratz T, Heinrich M, Schlauß E, et al. Preventing postoperative delirium. Dtsch Arztebl Int, 2015, 112(17): 289-296.
6. Memtsoudis S, Cozowicz C, Zubizarreta N, et al. Risk factors for postoperative delirium in patients undergoing lower extremity joint arthroplasty: a retrospective population-based cohort study. Reg Anesth Pain Med, 2019.
7. Miller D, Lewis SR, Pritchard MW, et al. Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery. Cochrane Database Syst Rev, 2018, 8(8): CD012317.
8. Li CJ, Wang BJ, Mu DL, et al. Randomized clinical trial of intraoperative dexmedetomidine to prevent delirium in the elderly undergoing major non-cardiac surgery. Br J Surg, 2020, 107(2): e123-e132.
9. Clemmesen CG, Lunn TH, Kristensen MT, et al. Effect of a single pre-operative 125 mg dose of methylprednisolone on postoperative delirium in hip fracture patients; a randomised, double‐blind, placebo‐controlled trial. Anaesthesia, 2018, 73(11): 1353-1360.
10. Punjasawadwong Y, Chau-In W, Laopaiboon M, et al. Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults. Cochrane Database Syst Rev, 2018, 5(5): CD011283.
11. Sieber FE, Neufeld KJ, Gottschalk A, et al. Effect of depth of sedation in older patients undergoing hip fracture repair on postoperative delirium: the STRIDE randomized clinical trial. JAMA Surg, 2018, 153(11): 987-995.
12. Wang J, Zhu L, Li Y, et al. The potential role of lung-protective ventilation in preventing postoperative delirium in elderly patients undergoing prone spinal surgery: a preliminary study. Med Sci Monit, 2020, 26: e926526.
13. Xu X, Hu X, Wu Y, et al. Effects of different BP management strategies on postoperative delirium in elderly patients undergoing hip replacement: a single center randomized controlled trial. J Clin Anesth, 2020, 62: 109730.
14. Mu DL, Zhang DZ, Wang DX, et al. Parecoxib supplementation to morphine analgesia decreases incidence of delirium in elderly patients after hip or knee replacement surgery: a randomized controlled trial. Anesth Analg, 2017, 124(6): 1992-2000.
15. Wang X, Wang Y, Hu Y, et al. Effect of flurbiprofen axetil on postoperative delirium for elderly patients. Brain Behav, 2019, 9(6): e01290.
16. Wildes TS, Mickle AM, Ben Abdallah A, et al. Effect of electroencephalography-guided anesthetic administration on postoperative delirium among older adults undergoing major surgery: the ENGAGES randomized clinical trial. JAMA, 2019, 321(5): 473-483.
17. Bocskai T, Kovács M, Szakács Z, et al. Is the bispectral index monitoring protective against postoperative cognitive decline? A systematic review with meta-analysis. PLoS One, 2020, 15(2): e0229018.
18. Tian Y, Zhao P, Li L, et al. Pre-emptive parecoxib and post-operative cognitive function in elderly patients. Int Psychogeriatr, 2014: 1-8.
19. 中华医学会麻醉学分会. 成人术后谵妄防治的专家共识//(2014)中国麻醉学指南与专家共识. (2014-07-15)[2021-01-05]. http://www.csahq.cn/guide/detail_214.html.
20. American geriatrics society expert panel on postoperative delirium in older adults. Postoperative delirium in older adults: best practice statement from the American geriatrics society. J Am Coll Surg, 2015, 220(2): 136-148.
21. 中华医学会麻醉学分会. 中国老年患者围术期麻醉管理指导意见//中国麻醉学指南与专家共识(2017版). (2017-08-01)[2021-01-05]. http://www.csahq.cn/guide/detail_372.html.
22. 中华医学会麻醉学分会老年人麻醉学组, 国家老年疾病临床医学研究中心中华医学会精神病学分会, 国家睡眠研究中心, 等. 中国老年患者围术期脑健康多学科专家共识(二). 中华医学杂志, 2019, 99(29): 2252-2269.

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