Postoperative Delirium
Background
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Def'n: acute, fluctuating alteration in awareness and disturbance of attention
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Timeline: PACU to POD5
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Associated with: ↓ surgical outcomes, ↑ LOS, functional decline, ↑ cost, ↑ mortality
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Two forms:
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Hyperactive - classic well-known type
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Hypoactive - may go unnoticed
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Considerations
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Risk factors:
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Age > 65, pre-existing cognitive impairment, severe illness, multiple comorbid conditions, hearing/visual impairment, active infection
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Major surgery, longer surgery
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Need for pre-operative risk assessment
Prevention
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Screen for delirium before PACU discharge
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Avoid deliriogenic medications post-op: anticholinergics, benzos, meperidine
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Frequent reorientation and reassurance, having familiar objects in the room
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Ensure glasses/hearing aids are on as soon as possible
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Good pain control via multi-modal analgesia
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Ensuring circadian rhythm
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Eliminate restraint use
Management
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Employ prevention measures as above
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Evaluate and address precipitating factors:
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Pain, hypoxia, pneumonia, infection, electrolyte abn, hypoglycemia, medications
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Haldol 0.5mg-1mg IV/IM when all other measures have failed
References
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Miller, R. D. (2020). Chapter 80: The Post-Anesthesia Care Unit. In Miller's Anesthesia. Elsevier Churchill Livingstone.