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07-10-2024 | Delirium | Review Free for a limited time

Pharmacological Prevention of Postoperative Delirium in Adults: A Review of Recent Literature

Authors: Nathan C. White, Christopher R. Cowart, Theodore J. Cios

Published in: Current Neurology and Neuroscience Reports | Issue 12/2024

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Abstract

Purpose of Review

Postoperative delirium (POD) is a common complication that has important implications for surgical patients, often leading to both short- and long-term cognitive deficits, worse outcomes, and increased healthcare costs. Given these implications, there may be a benefit in reducing the incidence of POD. Pharmacologic interventions may have the potential to reduce the risk of a patient developing POD.

Recent Findings

Recently studied therapies include dexmedetomidine, propofol, haloperidol, ketamine, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, acetaminophen, melatonin/ramelteon, corticosteroids, midazolam, physostigmine, and neostigmine. In addition, the implementation of regional anesthesia and reduction of overall anesthetic depth have been examined. Of these therapies, dexmedetomidine has been studied the most and has the most supporting evidence for prevention of POD, but current studies lack clarity on optimal dosing and timing of dexmedetomidine administration. Acetaminophen, corticosteroids, and melatonin/ramelteon are other plausible medications that have potential for reducing POD incidence, but they all require further investigation. Reduction of anesthetic depth and regional anesthetics are options for anesthetic management that show promise but still lack enough supporting evidence in recent literature to receive a strong recommendation.

Summary

Future research should focus on identifying optimal strategies for the implementation of the pharmacological options listed, including doses and timing of administration. Attention should be given to dexmedetomidine given its promise demonstrated by recent literature.
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Metadata
Title
Pharmacological Prevention of Postoperative Delirium in Adults: A Review of Recent Literature
Authors
Nathan C. White
Christopher R. Cowart
Theodore J. Cios
Publication date
07-10-2024
Publisher
Springer US
Published in
Current Neurology and Neuroscience Reports / Issue 12/2024
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-024-01385-4

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