Postoperative Delirium

Abstract

Delirium is a common postoperative complication that is associated with substantial patient morbidity and mortality. Because of the variability in its presentation, delirium has the potential to be overlooked or misdiagnosed. There are few well-designed prospective studies looking at the incidence of delirium; however, retrospective data reveal it to be highly variable. The cause is multifactorial, with the largest predisposing factors being patient age, cerebral disease, and poor preoperative medical status. Common precipitants of delirium postoperatively include infection, hypoxia, myocardial ischemia, metabolic derangements, and anticholinergic drugs. The pathogenesis of delirium is incompletely understood; cholinergic pathways appear to play a crucial role. Physicians evaluating postoperative patients for mental status changes need to identify delirium accurately (the diagnostic criteria for which are clearly set out in the DSM-IV). Further investigations center on searching for organic precipitants, which can be treated effectively. The diagnostic workup is not algorithmic and must be tailored to the specifics of each individual case. If there is no readily identifiable cause, treatment should focus on the disorder itself. Supportive care should consist of a multidisciplinary approach aimed at preventing functional decline. Pharmacologic therapy, usually with haloperidol, may be indicated if patients remain agitated. Investigations have supported the premise that delirium is a potentially preventable condition. This prevention can be accomplished by maximizing the patient's medical status and conscientiously avoiding the conditions that are known to precipitate delirium.

Frequency, Risk Factors, and Prognosis of Prolonged Delirium in Elderly Patients After Hip Fracture Surgery

“…Previous studies reported the efficacy of risperidone for the treatment of delirium [14,42,44]. In our study, 21 patients with delirium were treated with risperidone.…”

Effectiveness of Risperidone in Delirium

“…Apart from a multifaceted interdisciplinary approach involving environmental strategies, antipsychotic medication remains the cornerstone of treatment (1). Among these drugs, the typical antipsychotic haloperidol has been the drug of choice, mainly owing to its lack of anticholinergic (1) and minimal hemodynamic and respiratory side effects (2). Over the last decade, however, evidence has emerged for the use of second generation antipsychotics like risperidone-but only in the form of case reports and case series (3,4).…”

Relation of surgery, tumor site, and age group to the loss of reality testing in Japanese patients with malignant tumors: A study of a hospital‐based sample with a consultation‐liaison service

“…Several risk factors for delirium have been elucidated: infection, hypoxia, myocardial ischemia, metabolic derangements, hypoalbuminemia, electrolyte disturbance, and metastatic brain tumor. 4,10,11 These are systemic etiologic factors rather than local factors. In the present study, surgery for malignant tumors of digestive organs such as the stomach, liver, colon, and pancreas was strongly associated with LRT, especially in men.…”