Pharmacological strategies to prevent postoperative delirium: a systematic review and network meta-analysis

Lee, Jun Mo; Cho, Ye Jin; Ahn, Eun Jin; Choi, Geun Joo; Kang, Hyun

doi:10.17085/apm.20079

Cited by 11 publications

(9 citation statements)

References 80 publications

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“…There is a retrospective study of 123 geriatric hip fracture patients ( Connolly et al, 2020 ), which showed that intravenous acetaminophen had reduced the incidence of POD from 32.8 to 15.4% ( p = 0.024). In a 2021 network meta-analysis ( Lee et al, 2021 ), the combination of propofol and acetaminophen was the most successful pharmaceutical strategy with a minimal incidence of POD.…”

Section: Prevention and Treatmentmentioning

confidence: 99%

Postoperative delirium in geriatric patients with hip fractures

Chen

Liang

et al. 2022

Front. Aging Neurosci.

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Postoperative delirium (POD) is a frequent complication in geriatric patients with hip fractures, which is linked to poorer functional recovery, longer hospital stays, and higher short-and long-term mortality. Patients with increased age, preoperative cognitive impairment, comorbidities, perioperative polypharmacy, and delayed surgery are more prone to develop POD after hip fracture surgery. In this narrative review, we outlined the latest findings on postoperative delirium in geriatric patients with hip fractures, focusing on its pathophysiology, diagnosis, prevention, and treatment. Perioperative risk prediction, avoidance of certain medications, and orthogeriatric comprehensive care are all examples of effective interventions. Choices of anesthesia technique may not be associated with a significant difference in the incidence of postoperative delirium in geriatric patients with hip fractures. There are few pharmaceutical measures available for POD treatment. Dexmedetomidine and multimodal analgesia may be effective for managing postoperative delirium, and adverse complications should be considered when using antipsychotics. In conclusion, perioperative risk intervention based on orthogeriatric comprehensive care is the most effective strategy for preventing postoperative delirium in geriatric patients with hip fractures.

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Section: Prevention and Treatmentmentioning

confidence: 99%

Postoperative delirium in geriatric patients with hip fractures

Chen

Liang

et al. 2022

Front. Aging Neurosci.

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“…These include reducing the number of sedatives and algesia used while surgical procedures, attenuating the immune cascade and inflammatory mediators, and dexmedetomidine making a natural sleep-like sedative stress, which might support to decrease the risk of postoperative delirium. 27 Level 1a…”

Section: Discussionmentioning

confidence: 99%

“…Drug-based treatment for POD does not consider for all clients and is used only for patients who do not respond to non-pharmacological treatments. 27 Level 1a…”

Section: Discussionmentioning

confidence: 99%

Evidence-Based Guideline on Management of Postoperative Delirium in Older People for Low Resource Setting: Systematic Review Article

Mossie¹,

Regasa²,

Neme³

et al. 2022

IJGM

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Background Postoperative delirium is the highest prevalence and life-threatening complication following geriatric surgery. The overall incidence rate varies from 5% to 52% of hospitalized surgical patients based on the type of surgery that often began in the postanesthesia care unit and continues up to 5 days post-surgery. Postoperative delirium manifests as a hypoactive, hyperactive and mixed subtype. The mechanism of delirium development is not clear, but it is accepted that delirium is a result of the patient’s underlying vulnerabilities or risk factors combined with an outside stressor such as infection or surgery. Objective To develop evidence-based recommendations for the prevention, diagnosis, and treatment of postoperative delirium. Methods Literature was searched from PubMed, CINAH, Google Scholar, and Cochrane databases that are published from 2010 to 2021 by formulating inclusion and exclusion criteria. Filtering was made depending on methodological quality, outcome, and data on population. Finally, 11 meta-analysis, 11 systematic reviews, 7 interventional studies, 11 observational studies, and recommendations of the previous clinical practice guideline developed by the American and European are included in this review. Results A total of 43 studies were considered in this evaluation. The development of this guideline was based on nine studies on risk stratification for postoperative delirium, eighteen studies on risk minimization and prevention for postoperative delirium, five studies on diagnosis for postoperative delirium, and eleven studies on treatments for postoperative delirium. Conclusion Postoperative delirium management can be categorized into risk assessment, risk minimization, early diagnosis, and treatment. Early diagnosis is critical to trigger focused and effective treatment. Non-pharmacological interventions are the first-line management for both hypoactive and hyperactive postoperative with considering contributory factors and underlying causes. Antipsychotics should only be used for hyperactive delirium individuals who try to harm themselves. Current evidence suggested that dexmedetomidine can be used as a treatment option for postoperative delirium.

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“…In this paper, we pursue the idea that anesthetics used in humans may also have an impact on learning in single-celled organisms. Postoperative delirium is a common condition after the administration of anesthetics which is characterized by altered consciousness, disorientation, impaired memory, perceptual disturbance, altered psychomotor activity, and altered sleep–wake cycles [ 12 ]. Our results, although preliminary, indicate that propofol—which is known as the “milk of amnesia” [ 13 ]—also depresses learning and memory in Physarum .…”

Section: Introductionmentioning

confidence: 99%

Learning in the Single-Cell Organism Physarum polycephalum: Effect of Propofol

Kippenberger

Pipa

Steinhorst

et al. 2023

IJMS

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Propofol belongs to a class of molecules that are known to block learning and memory in mammals, including rodents and humans. Interestingly, learning and memory are not tied to the presence of a nervous system. There are several lines of evidence indicating that single-celled organisms also have the capacity for learning and memory which may be considered as basal intelligence. Here, we introduce a new experimental model for testing the learning ability of Physarum polycephalum, a model organism frequently used to study single-celled “intelligence”. In this study, the impact of propofol on Physarum’s “intelligence” was tested. The model consists of a labyrinth of subsequent bifurcations in which food (oat flakes soaked with coconut oil-derived medium chain triglycerides [MCT] and soybean oil-derived long chain triglycerides [LCT]) or propofol in MCT/LCT) is placed in one of each Y-branch. In this setting, it was tested whether Physarum memorized the rewarding branch. We saw that Physarum was a quick learner when capturing the first bifurcations of the maze; thereafter, the effect decreased, perhaps due to reaching a state of satiety. In contrast, when oat flakes were soaked with propofol, Physarum’s preference for oat flakes declined significantly. Several possible actions, including the blocking of gamma-aminobutyric acid (GABA) receptor signaling, are suggested to account for this behavior, many of which can be tested in our new model.

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Pharmacological strategies to prevent postoperative delirium: a systematic review and network meta-analysis

Cited by 11 publications

References 80 publications

Postoperative delirium in geriatric patients with hip fractures

Postoperative delirium in geriatric patients with hip fractures

Evidence-Based Guideline on Management of Postoperative Delirium in Older People for Low Resource Setting: Systematic Review Article

Learning in the Single-Cell Organism Physarum polycephalum: Effect of Propofol

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