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Postoperative confusion at ICU – an important perioperative complication in older patients


Authors: J. Bruthans 1;  D. Bruthansová 2;  M. Svítek 1
Authors‘ workplace: KARIM, 1. LF UK a VFN 1;  VÚPSV v. v. i. 2
Published in: Čes Ger Rev 2009; 7(2): 68-74

Overview

Postoperative delirium is a complication in the perioperative period that affects usually patients aged 65 and older. Multiple negative events usually occure in deliri ous pati ent –  e. g. inadvert extracti on of catheters or endotracheal tube, lenghtening of hospitalizati on and increse of costs, mortality growth and potenti onally even long‑term worsening of cognitive functi ons. Due to multifactori al re asons of such a state, a complex approach to preventi on and therapy of postoperative deliri um is required. Basically, the burden of the operati on, disturbati on of soci al settings and disturbati on of pati ent’s bi orythms sho ud be diminished and drugs (especi ally ne uroleptic drugs) sho uld be administred with cauti on. In case of development of postoperative deliri um first signs sho uld be recognised and tre ated, possibly with suitable psychological appro ach. An appropri ate behavi o ur of staff is of the utmost importance. Also relatives might be helpful and a sensitive appro ach to them is necessary. Further tre atment includes antipsychotic drugs, controversi al movement restricti on by harnesses and sedating of the pati ent, even to the extent of general anesthesi a.

Keywords

postoperative deliri um –  delirant syndrom –  older paci ent –  complicati on postoperative –  restrictive me asures


Sources

1. Thomas RI, Cameron DJ, Fahs MC. A prospective study of deliri um and prolonged hospital stay. Exploratoty study. Arch Gen Psychol 1988; 45: 937– 940.

2. Brown TM, Boyle MF. Deliri um. BMJ 2002; 325: 644– 647.

3. Trzepacz PT. The ne uropathogenesis of deliri um: a need to focus o ur rese arch. Psychosomatics 1994; 35: 374– 391.

4. Tune L, Carr S, Ho ag E et al. Anticholinergic effects of drugs commonly prescribed for the elderly: potenti al me ans for assessing risk of deliri um. Am J Psychi atry 1992; 149: 1393– 1394.

5. Mach JR, Dysken MW, Kuskowski M et al. Serum anticholinergic activity in hospitalized older persons with deliri um: a preliminary study. J Am Geri atr Soc 1995; 43: 491– 495.

6. Murray GB. Excess endogeno us dopamine and decre ased endogeno us acetylcholine responsible for acute deliri um: an hypothesis. J Ne uropsychi at 1993; 5: 456.

7. Marcantoni o E, Ta T, Duthi e E et al. Deliri um severity and psychomotor types: their relati onship with o utcomes after hip fracture repair. J Am Geri atr Soc 2002; 50: 850– 857.

8. Milstein A, Pollack A, Kleinman G et al. Confusi on/ deliri um following cataract surgery: an incidence study of 1- ye ar durati on. Int Psychogeri atr 2002; 14: 301– 306.

9. Gustafson Y, Brannstrom B, Berggren D et al. A geri atric anesthesi ologic program to reduce acute confusi onal states in elderly pati ents tre ated for femoral neck fractures. J Am Geri atr Soc 1991; 39: 655– 662.

10. American Psychi atric Associ ati on. Practic Guideline for the Tre atment of Pati ents with Deliri um. Washington, DC: American Psychi atric Associ ati on 1999.

11. Ino uye SK, Bogardus ST, Charpenti er PA et al. A multicomponent interventi on to prevent deliri um in hospitalized older pati ents. N Engl J Med 1999; 340: 669– 676.

12. Me agher DJ. Deliri um: Optimising management. BMJ 2001; 322: 144– 149.

13. Breitbart W, Tremblay A, Gibson C. An open tri al of olanzapine for the tre atment of deliri um in hospitalized cancer pati ents. Psychosomatics 2002; 43: 175– 182.

14. Burns A, Gallagley A, Byrne J. Deliri um. J Ne urol Ne urosurg Psychi atry 2004; 75: 362– 367.

15. Cremer OL, Mo ons KG, Bo uman EA et al. Long‑term propofol infusi on and cardi ac failure in adult he ad- injured pati ents. Lancet 2001; 357: 117– 118.

16. Holmerová I, Jurašková B, Rokosová M et al. Po užívání omezovacích prostředků a kvalita péče o paci enty s demencí. Čes Ger Rev 2008; 4: 235– 237.

17. Bruthansová D, Červenková A, Jeřábková V. Odpovědnost za škodu vzniklo u kli entovi v pobytových zařízeních soci álních služeb. Fórum soci ální politiky 2009; 1: 2– 4.

Labels
Geriatrics General practitioner for adults
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