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Current Anesthesiology Reports

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01-12-2019 | Ketamine | Geriatric Anesthesia (S Akhtar, Section Editor)

Perioperative Management of Delirium in Geriatric Patients

Authors: Elisabeth Beck Powelson, May J. Reed, Itay Bentov

Published in: Current Anesthesiology Reports | Issue 4/2019

Abstract

Purpose of Review

We review the current literature on predictors, pathophysiology, and prevention of delirium in surgical patients. The focus is on the role of the anesthesiologist in the prevention and management of delirium in the perioperative setting.

Recent Findings

Recent literature has examined how surgery and anesthetic management can affect the incidence of delirium. Anesthesiologists play a critical role in identifying those at risk of developing delirium and adjusting their anesthetic management and perioperative course to minimize this risk.

Summary

Delirium research is evolving rapidly. Current evidence suggests that environmental interventions, pre-operative optimization, and choice of anesthetic plan, such as the use of regional anesthesia and specific medications, can reduce the incidence of delirium in surgical patients.

• Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol. 2009;5(4):210–20 Excellent review and summary.CrossRef

Avidan MS, Fritz BA, Maybrier HR, Muench MR, Escallier KE, Chen Y, et al. The Prevention of Delirium and Complications Associated with Surgical Treatments (PODCAST) study: protocol for an international multicentre randomised controlled trial. BMJ Open. 2014;4(9):e005651. https://doi.org/10.1136/bmjopen-2014-005651.CrossRefPubMedPubMedCentral

Rudolph JL, Inouye SK, Jones RN, Yang FM, Fong TG, Levkoff SE, et al. Delirium: an independent predictor of functional decline after cardiac surgery. J Am Geriatr Soc. 2010;58(4):643–9. https://doi.org/10.1111/j.1532-5415.2010.02762.x.CrossRefPubMedPubMedCentral

Prielipp RC, Morell RC, Coursin DB, Brull SJ, Barker SJ, Rice MJ, et al. The future of anesthesiology: should the perioperative surgical home redefine us? Anesth Analg. 2015;120(5):1142–8. https://doi.org/10.1213/ane.0000000000000711.CrossRefPubMed

Prielipp RC, Cohen NH. The future of anesthesiology: implications of the changing healthcare environment. Curr Opin Anaesthesiol. 2016;29(2):198–205. https://doi.org/10.1097/aco.0000000000000301.CrossRefPubMed

•• Evered L, Silbert B, Knopman DS, Scott DA, DeKosky ST, Rasmussen LS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Br J Anaesth. 2018;121(5):1005–12. https://doi.org/10.1016/j.bja.2017.11.087Definitions of perioperative cognitive change nomenclature. CrossRefPubMedPubMedCentral

Marcantonio ER. Delirium in hospitalized older adults. N Engl J Med. 2017;377(15):1456–66.CrossRef

Morandi A, Di Santo SG, Cherubini A, Mossello E, Meagher D, Mazzone A, et al. Clinical features associated with delirium motor subtypes in older inpatients: results of a multicenter study. Am J Geriatr Psychiatry. 2017;25(10):1064–71. https://doi.org/10.1016/j.jagp.2017.05.003.CrossRefPubMed

Collins N, Blanchard MR, Tookman A, Sampson EL. Detection of delirium in the acute hospital. Age Ageing. 2009;39(1):131–5. https://doi.org/10.1093/ageing/afp201.CrossRefPubMed

10.

O’Regan NA, Fitzgerald J, Timmons S, O’Connell H, Meagher D. Delirium: a key challenge for perioperative care. Int J Surg (London, England). 2013;11(2):136–44. https://doi.org/10.1016/j.ijsu.2012.12.015.CrossRef

11.

•• Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22. https://doi.org/10.1016/s0140-6736(13)60688-1Excellent review.CrossRefPubMed

12.

Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008;168(1):27–32. https://doi.org/10.1001/archinternmed.2007.4.CrossRefPubMedPubMedCentral

13.

Schenning KJ, Deiner SG. Postoperative delirium in the geriatric patient. Anesthesiol Clin. 2015;33(3):505–16. https://doi.org/10.1016/j.anclin.2015.05.007.CrossRefPubMedPubMedCentral

14.

Inouye SK, Robinson T, Blaum C, Busby-Whitehead J, Boustani M, Chalian A, et al. Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. J Am Coll Surg. 2015;220(2):136–48.e1. https://doi.org/10.1016/j.jamcollsurg.2014.10.019.CrossRef

15.

Moskowitz EE, Overbey DM, Jones TS, Jones EL, Arcomano TR, Moore JT, et al. Post-operative delirium is associated with increased 5-year mortality. Am J Surg. 2017;214(6):1036–8. https://doi.org/10.1016/j.amjsurg.2017.08.034.CrossRefPubMed

16.

• Berger M, Terrando N, Smith SK, Browndyke JN, Newman MF, Mathew JP. Neurocognitive function after cardiac surgery: from phenotypes to mechanisms. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2018;129(4):829–51. https://doi.org/10.1097/ALN.0000000000002194 %J Anesthesiology: The Journal of the American Society of Anesthesiologists. Detailed discussion of neuroinflammation. CrossRef

17.

Berger M, Oyeyemi D, Olurinde MO, Whitson HE, Weinhold KJ, Woldorff MG, et al. The INTUIT Study: investigating neuroinflammation underlying postoperative cognitive dysfunction. J Am Geriatr Soc. 2019. https://doi.org/10.1111/jgs.15770.

18.

Subramaniyan S, Terrando N. Neuroinflammation and perioperative neurocognitive disorders. Anesth Analg. 2019;128(4):781–8. https://doi.org/10.1213/ane.0000000000004053.CrossRefPubMedPubMedCentral

19.

Cerejeira J, Firmino H, Vaz-Serra A, Mukaetova-Ladinska EB. The neuroinflammatory hypothesis of delirium. Acta Neuropathol. 2010;119(6):737–54. https://doi.org/10.1007/s00401-010-0674-1.CrossRefPubMed

20.

Maldonado JR. Acute brain failure: pathophysiology, diagnosis, management, and sequelae of delirium. Crit Care Clin. 2017;33(3):461–519. https://doi.org/10.1016/j.ccc.2017.03.013.CrossRefPubMed

21.

•• Maldonado JR. Neuropathogenesis of delirium: review of current etiologic theories and common pathways. Am J Geriatr Psychiatry. 2013;21(12):1190–222 Review of mechanisms of delirium. CrossRef

22.

•• Wei LA, Fearing MA, Sternberg EJ, Inouye SK. The confusion assessment method: a systematic review of current usage. J Am Geriatr Soc. 2008;56(5):823–30. https://doi.org/10.1111/j.1532-5415.2008.01674.xSummary of the data for CAM and the variations. CrossRefPubMedPubMedCentral

23.

• Grover S, Kate N. Assessment scales for delirium: a review. World J Psychiatry. 2012;2(4):58–70. https://doi.org/10.5498/wjp.v2.i4.58Review of other delirium assessments. CrossRefPubMedPubMedCentral

24.

van Velthuijsen EL, Zwakhalen SM, Warnier RM, Mulder WJ, Verhey FR, Kempen GI. Psychometric properties and feasibility of instruments for the detection of delirium in older hospitalized patients: a systematic review. Int J Geriatric Psychiatry. 2016;31(9):974–89. https://doi.org/10.1002/gps.4441.CrossRef

25.

Inouye SK, Kosar CM, Tommet D, Schmitt EM, Puelle MR, Saczynski JS, et al. The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts. Ann Intern Med. 2014;160(8):526–33. https://doi.org/10.7326/m13-1927.CrossRefPubMedPubMedCentral

26.

Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338–44. https://doi.org/10.1164/rccm.2107138.CrossRefPubMed

27.

Neelon VJ, Champagne MT, Carlson JR, Funk SG. The NEECHAM Confusion Scale: construction, validation, and clinical testing. Nurs Res. 1996;45(6):324–30.CrossRef

28.

• Halladay CW, Sillner AY, Rudolph JL. Performance of electronic prediction rules for prevalent delirium at hospital admission. JAMA Netw Open. 2018;1(4):e181405. https://doi.org/10.1001/jamanetworkopen.2018.1405Cutting edge electronic predicition of patients at risk. CrossRefPubMedPubMedCentral

29.

Rudolph JL, Doherty K, Kelly B, Driver JA, Archambault E. Validation of a delirium risk assessment using electronic medical record information. J Am Med Dir Assoc. 2016;17(3):244–8. https://doi.org/10.1016/j.jamda.2015.10.020.CrossRefPubMed

30.

Whitlock EL, Vannucci A, Avidan MS. Postoperative delirium. Minerva Anestesiol. 2011;77(4):448–56.PubMedPubMedCentral

31.

Leung JM, Tsai TL, Sands LP. Preoperative frailty in older surgical patients is associated with early postoperative delirium. Anesth Analg. 2011;112(5):1199–201. https://doi.org/10.1213/ane.0b013e31820c7c06.CrossRefPubMedPubMedCentral

32.

Inouye SK. Delirium in hospitalized older patients: recognition and risk factors. J Geriatr Psychiatry Neurol. 1998;11(3):118–25; discussion 57-8. https://doi.org/10.1177/089198879801100302.CrossRefPubMed

33.

Adogwa O, Elsamadicy AA, Vuong VD, Fialkoff J, Cheng J, Karikari IO, et al. Association between baseline cognitive impairment and postoperative delirium in elderly patients undergoing surgery for adult spinal deformity. J Neurosurg Spine. 2018;28(1):103–8. https://doi.org/10.3171/2017.5.Spine161244.CrossRefPubMed

34.

Heng M, Eagen CE, Javedan H, Kodela J, Weaver MJ, Harris MB. Abnormal Mini-Cog is associated with higher risk of complications and delirium in geriatric patients with fracture. J Bone Joint Surg Am. 2016;98(9):742–50. https://doi.org/10.2106/jbjs.15.00859.CrossRefPubMed

35.

Culley DJ, Flaherty D, Fahey MC, Rudolph JL, Javedan H, Huang CC, et al. Poor performance on a preoperative cognitive screening test predicts postoperative complications in older orthopedic surgical patients. Anesthesiology. 2017;127(5):765–74. https://doi.org/10.1097/aln.0000000000001859.CrossRefPubMedPubMedCentral

36.

Rockwood K, Hogan DB, MacKnight C. Conceptualisation and measurement of frailty in elderly people. Drugs Aging. 2000;17(4):295–302. https://doi.org/10.2165/00002512-200017040-00005.CrossRefPubMed

37.

• Bentov I, Kaplan SJ, Pham TN, Reed MJ. Frailty assessment: from clinical to radiological tools. Br J Anaesth. 2019. https://doi.org/10.1016/j.bja.2019.03.034Review of frailty assessments.

38.

Berian JR, Rosenthal RA, Baker TL, Coleman J, Finlayson E, Katlic MR, et al. Hospital standards to promote optimal surgical care of the older adult: a report from the coalition for quality in geriatric surgery. Ann Surg. 2017;Publish Ahead of Print. https://doi.org/10.1097/sla.0000000000002185.

39.

Maldonado JR. Delirium in the acute care setting: characteristics, diagnosis and treatment. Crit Care Clin. 2008;24(4):657–722, vii. https://doi.org/10.1016/j.ccc.2008.05.008.CrossRefPubMed

40.

• Inouye SK, Bogardus ST Jr, Baker DI, Leo-Summers L, Cooney LM Jr. The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. J Am Geriatr Soc. 2000;48(12):1697–706 A model of environmental interventions. CrossRef

41.

Harari D, Hopper A, Dhesi J, Babic-Illman G, Lockwood L, Martin F. Proactive care of older people undergoing surgery (‘POPS’): designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients. Age Ageing. 2007;36(2):190–6. https://doi.org/10.1093/ageing/afl163.CrossRefPubMed

42.

Kassie GM, Nguyen TA, Kalisch Ellett LM, Pratt NL, Roughead EE. Preoperative medication use and postoperative delirium: a systematic review. BMC Geriatr. 2017;17(1):298. https://doi.org/10.1186/s12877-017-0695-x.CrossRefPubMedPubMedCentral

43.

•• American Geriatrics Society updated. Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31. https://doi.org/10.1111/j.1532-5415.2012.03923.xBeers criteria medications. CrossRef

44.

Leung JM, Sands LP, Chen N, Ames C, Berven S, Bozic K, et al. Perioperative gabapentin does not reduce postoperative delirium in older surgical patients: a randomized clinical trial. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2017;127(4):633–44. https://doi.org/10.1097/ALN.0000000000001804 %J Anesthesiology: The Journal of the American Society of Anesthesiologists.CrossRef

45.

Valentin LS, Pereira VF, Pietrobon RS, Schmidt AP, Oses JP, Portela LV, et al. Effects of single low dose of dexamethasone before noncardiac and nonneurologic surgery and general anesthesia on postoperative cognitive dysfunction-a phase III double blind, randomized clinical trial. PLoS One. 2016;11(5):e0152308. https://doi.org/10.1371/journal.pone.0152308.CrossRefPubMedPubMedCentral

46.

Schrader SL, Wellik KE, Demaerschalk BM, Caselli RJ, Woodruff BK, Wingerchuk DM. Adjunctive haloperidol prophylaxis reduces postoperative delirium severity and duration in at-risk elderly patients. Neurologist. 2008;14(2):134–7. https://doi.org/10.1097/NRL.0b013e318166b88c.CrossRefPubMed

47.

Kalisvaart KJ, de Jonghe JF, Bogaards MJ, Vreeswijk R, Egberts TC, Burger BJ, et al. Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc. 2005;53(10):1658–66. https://doi.org/10.1111/j.1532-5415.2005.53503.x.CrossRefPubMed

48.

Nandi S, Harvey WF, Saillant J, Kazakin A, Talmo C, Bono J. Pharmacologic risk factors for post-operative delirium in total joint arthroplasty patients: a case-control study. J Arthroplast. 2014;29(2):268–71. https://doi.org/10.1016/j.arth.2013.06.004.CrossRef

49.

Wang W, Li H-L, Wang D-X, Zhu X, Li S-L, Yao G-Q, et al. Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial. Crit Care Med. 2012;40(3):731–9.CrossRef

50.

Larsen KA, Kelly SE, Stern TA, Bode RH Jr, Price LL, Hunter DJ, et al. Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial. Psychosomatics. 2010;51(5):409–18. https://doi.org/10.1176/appi.psy.51.5.409.CrossRefPubMed

51.

Vaurio LE, Sands LP, Wang Y, Mullen EA, Leung JM. Postoperative delirium: the importance of pain and pain management. Anesth Analg. 2006;102(4):1267–73. https://doi.org/10.1213/01.ane.0000199156.59226.af.CrossRefPubMed

52.

Morrison RS, Magaziner J, Gilbert M, Koval KJ, McLaughlin MA, Orosz G, et al. Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci. 2003;58(1):76–81.CrossRef

53.

•• Mason SE, Noel-Storr A, Ritchie CW. The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. J Alzheimers Dis. 2010;22(s3):S67–79 Systematic review and meta-analysis of regional vs. general anesthesia. CrossRef

54.

Neuman MD, Rosenbaum PR, Ludwig JM, Zubizarreta JR, Silber JH. Anesthesia technique, mortality, and length of stay after hip fracture surgery. Jama. 2014;311(24):2508–17. https://doi.org/10.1001/jama.2014.6499.CrossRefPubMedPubMedCentral

55.

Neuman MD, Silber JH, Elkassabany NM, Ludwig JM, Fleisher LA. Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology. 2012;117(1):72–92. https://doi.org/10.1097/ALN.0b013e3182545e7c.CrossRefPubMed

56.

Patorno E, Neuman MD, Schneeweiss S, Mogun H, Bateman BT. Comparative safety of anesthetic type for hip fracture surgery in adults: retrospective cohort study. Bmj. 2014;348:g4022. https://doi.org/10.1136/bmj.g4022.CrossRefPubMedPubMedCentral

57.

•• Weinstein SM, Poultsides L, Baaklini LR, Mörwald EE, Cozowicz C, Saleh JN, et al. Postoperative delirium in total knee and hip arthroplasty patients: a study of perioperative modifiable risk factors. Br J Anaesth. 2018;120(5):999–1008. https://doi.org/10.1016/j.bja.2017.12.046Good examination of this patient population and modifiable risk factors. CrossRefPubMed

58.

•• Panel AGSBCUE, Fick DM, Semla TP, Steinman M, Beizer J, Brandt N et al. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatrics Soc. Updated BEERs list.

59.

Clegg A, Young JB. Which medications to avoid in people at risk of delirium: a systematic review. Age Ageing. 2011;40(1):23–9. https://doi.org/10.1093/ageing/afq140.CrossRefPubMed

60.

Pandharipande P, Shintani A, Peterson J, Pun BT, Wilkinson GR, Dittus RS, et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006;104(1):21–6.CrossRef

61.

Dale O, Somogyi AA, Li Y, Sullivan T, Shavit Y. Does intraoperative ketamine attenuate inflammatory reactivity following surgery? A systematic review and meta-analysis. Anesth Analg. 2012;115(4):934–43. https://doi.org/10.1213/ANE.0b013e3182662e30.CrossRefPubMed

62.

Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. The journal of pain : official journal of the American Pain Society. 2016;17(2):131–57. https://doi.org/10.1016/j.jpain.2015.12.008.CrossRef

63.

Bowdle TA, Radant AD, Cowley DS, Kharasch ED, Strassman RJ, Roy-Byrne PP. Psychedelic effects of ketamine in healthy volunteers: relationship to steady-state plasma concentrations. Anesthesiology. 1998;88(1):82–8.CrossRef

64.

Hudetz JA, Patterson KM, Iqbal Z, Gandhi SD, Byrne AJ, Hudetz AG, et al. Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2009;23(5):651–7. https://doi.org/10.1053/j.jvca.2008.12.021.CrossRefPubMed

65.

Hudetz JA, Iqbal Z, Gandhi SD, Patterson KM, Byrne AJ, Hudetz AG, et al. Ketamine attenuates post-operative cognitive dysfunction after cardiac surgery. Acta Anaesthesiol Scand. 2009;53(7):864–72. https://doi.org/10.1111/j.1399-6576.2009.01978.x.CrossRefPubMed

66.

•• Avidan MS, Maybrier HR, Abdallah AB, Jacobsohn E, Vlisides PE, Pryor KO, et al. Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults: an international, multicentre, double-blind, randomised clinical trial. Lancet. 2017. https://doi.org/10.1016/S0140-6736(17)31467-8Very important RCT of ketamine.

67.

Liu MM, Reidy AB, Saatee S, Collard CD. Perioperative steroid management: approaches based on current evidence. Anesthesiology. 2017;127(1):166–72. https://doi.org/10.1097/aln.0000000000001659.CrossRefPubMed

68.

Clemmesen CG, Lunn TH, Kristensen MT, Palm H, Foss NB. 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):1353–60. https://doi.org/10.1111/anae.14406.CrossRefPubMed

69.

Mo Y, Zimmermann AE. Role of dexmedetomidine for the prevention and treatment of delirium in intensive care unit patients. Ann Pharmacother. 2013;47(6):869–76. https://doi.org/10.1345/aph.1AR708.CrossRefPubMed

70.

Bathula M, Gonzales JP. The pharmacologic treatment of intensive care unit delirium: a systematic review. Ann Pharmacother. 2013;47(9):1168–74. https://doi.org/10.1177/1060028013500466.CrossRefPubMed

71.

• Deiner S, Luo X, Lin HM, Sessler DI, Saager L, Sieber FE, et al. Intraoperative infusion of dexmedetomidine for prevention of postoperative delirium and cognitive dysfunction in elderly patients undergoing major elective noncardiac surgery: a randomized clinical trial. JAMA Surg. 2017;152(8):e171505. https://doi.org/10.1001/jamasurg.2017.1505Important RCT of dexmedetomidine for prevention.CrossRefPubMedPubMedCentral

72.

• Su X, Meng ZT, Wu XH, Cui F, Li HL, Wang DX, et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial. Lancet. 2016;388(10054):1893–902. https://doi.org/10.1016/s0140-6736(16)30580-3. Important trial of dexmedetomidine for prevention of delirium. CrossRefPubMed

73.

Coburn M, Sanders RD, Maze M, Nguyen-Pascal ML, Rex S, Garrigues B, et al. The hip fracture surgery in elderly patients (HIPELD) study to evaluate xenon anaesthesia for the prevention of postoperative delirium: a multicentre, randomized clinical trial. Br J Anaesth. 2018;120(1):127–37. https://doi.org/10.1016/j.bja.2017.11.015.CrossRefPubMed

74.

Ye X, Lian Q, Eckenhoff MF, Eckenhoff RG, Pan JZ. Differential general anesthetic effects on microglial cytokine expression. PLoS One. 2013;8(1):e52887. https://doi.org/10.1371/journal.pone.0052887.CrossRefPubMedPubMedCentral

75.

Wu X, Lu Y, Dong Y, Zhang G, Zhang Y, Xu Z, et al. The inhalation anesthetic isoflurane increases levels of proinflammatory TNF-alpha, IL-6, and IL-1beta. Neurobiol Aging. 2012;33(7):1364–78. https://doi.org/10.1016/j.neurobiolaging.2010.11.002.

76.

•• Hirsch J, DePalma G, Tsai T, Sands L, Leung J. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery. Br J Anaesth. 2015;115(3):418–26 Blood pressure fluctuations effect on delirium. CrossRef

77.

Bjorkelund KB, Hommel A, Thorngren KG, Gustafson L, Larsson S, Lundberg D. Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study. Acta Anaesthesiol Scand. 2010;54(6):678–88. https://doi.org/10.1111/j.1399-6576.2010.02232.x.CrossRefPubMed

78.

Smith PJ, Blumenthal JA, Hoffman BM, Rivelli SK, Palmer SM, Davis RD, et al. reduced cerebral perfusion pressure during lung transplant surgery is associated with risk, duration, and severity of postoperative delirium. Annals of the American Thoracic Society. 2016;13(2):180–7. https://doi.org/10.1513/AnnalsATS.201507-454OC.CrossRefPubMedPubMedCentral

79.

Hori D, Brown C, Ono M, Rappold T, Sieber F, Gottschalk A, et al. Arterial pressure above the upper cerebral autoregulation limit during cardiopulmonary bypass is associated with postoperative delirium. Br J Anaesth. 2014;113(6):1009–17. https://doi.org/10.1093/bja/aeu319.CrossRefPubMedPubMedCentral

80.

Soehle M, Dittmann A, Ellerkmann RK, Baumgarten G, Putensen C, Guenther U. Intraoperative burst suppression is associated with postoperative delirium following cardiac surgery: a prospective, observational study. BMC Anesthesiol. 2015;15:61. https://doi.org/10.1186/s12871-015-0051-7.CrossRefPubMedPubMedCentral

81.

Sieber FE, Neufeld KJ, Gottschalk A, Bigelow GE, Oh ES, Rosenberg PB, 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):987–95. https://doi.org/10.1001/jamasurg.2018.2602.CrossRefPubMedPubMedCentral

82.

•• MacKenzie KK, Britt-Spells AM, Sands LP, Leung JM. Processed electroencephalogram monitoring and postoperative delirium: a systematic review and meta-analysis. Anesthesiology. 2018;129(3):417–27. https://doi.org/10.1097/aln.0000000000002323Excellent systematic review of EEG. CrossRefPubMedPubMedCentral

83.

Wildes TS, Mickle AM, Ben Abdallah A, Maybrier HR, Oberhaus J, Budelier TP, 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):473–83. https://doi.org/10.1001/jama.2018.22005.CrossRefPubMedPubMedCentral

84.

Buffum MD, Hutt E, Chang VT, Craine MH, Snow AL. Cognitive impairment and pain management: review of issues and challenges. J Rehabil Res Dev. 2007;44(2):315–30.CrossRef

Title: Perioperative Management of Delirium in Geriatric Patients
Authors: Elisabeth Beck Powelson
May J. Reed
Itay Bentov
Publication date: 01-12-2019
Publisher: Springer US
Keyword: Ketamine
Published in: Current Anesthesiology Reports / Issue 4/2019
Electronic ISSN: 2167-6275
DOI: https://doi.org/10.1007/s40140-019-00353-w

At a glance: The STEP trials

Springer Medicine

Perioperative Management of Delirium in Geriatric Patients

Abstract

Purpose of Review

Recent Findings

Summary

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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