The effect of perioperative anesthetics for prevention of postoperative delirium on general anesthesia: A network meta-analysis

Cui, Yu; Li, Gen; Cao, Rong; Luan, Liming; Kla, Koffi M.

doi:10.1016/j.jclinane.2019.06.028

Cited by 35 publications

(27 citation statements)

References 65 publications

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“…To our knowledge, there was only one previous network meta-analysis comparing the effect of drugs to prevent postoperative delirium 24 . This network meta-analysis compared only the anesthetic agents including propofol, sevoflurane, desflurane, ketamine, midazolam, and dexmedetomidine.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of pharmacological interventions to prevent postoperative delirium: a network meta-analysis

Park

Lim

Cho

et al. 2021

Sci Rep

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Many pharmacologic agents were investigated for the effect to prevent delirium. We aimed to comprehensively compare the effect of the pharmacological interventions to prevent postoperative delirium. A Bayesian network meta-analysis of randomized trials was performed using random effects model. PubMed, the Cochrane Central Register of Controlled Trials, and Embase were searched on 20 January 2021. Randomized trials comparing the effect of a drug to prevent postoperative delirium with another drug or placebo in adult patients undergoing any kind of surgery were included. Primary outcome was the postoperative incidence of delirium. Eighty-six trials with 26,992 participants were included. Dexmedetomidine, haloperidol, and atypical antipsychotics significantly decreased the incidence of delirium than placebo [dexmedetomidine: odds ratio 0.51, 95% credible interval (CrI) 0.40–0.66, moderate quality of evidence (QOE); haloperidol: odds ratio 0.59, 95% CrI 0.37–0.95, moderate QOE; atypical antipsychotics: odds ratio 0.27, 95% CrI 0.14–0.51, moderate QOE]. Dexmedetomidine and atypical antipsychotics had the highest-ranking probabilities to be the best. However, significant heterogeneity regarding diagnostic time window as well as small study effects precludes firm conclusion.

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Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of pharmacological interventions to prevent postoperative delirium: a network meta-analysis

Park

Lim

Cho

et al. 2021

Sci Rep

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“…The strongest evidence for pharmacological delirium prevention involves medication avoidance, specifically benzodiazepines, with a two-to five-fold increased incidence of delirium in patients given peri-operative benzodiazepines [28,30].…”

Section: Avoidance Of Certain Medicationsmentioning

confidence: 99%

Evidence‐based strategies to reduce the incidence of postoperative delirium: a narrative review

Swarbrick

Partridge

2022

Anaesthesia

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Delirium is one of the most commonly occurring postoperative complications in older adults. It occurs due to the vulnerability of cerebral functioning to pathophysiological stressors. Identification of those at increased risk of developing delirium early in the surgical pathway provides an opportunity for modification of predisposing and precipitating risk factors and effective shared decision-making. No single delirium prediction tool is used widely in surgical settings. Multi-component interventions to prevent delirium involve structured risk factor modification supported by geriatrician input; these are clinically efficacious and cost effective. Barriers to the widespread implementation of such complex interventions exist, resulting in an 'implementation gap'. There is a lack of evidence for pharmacological prophylaxis for the prevention of delirium. Current evidence suggests that avoidance of peri-operative benzodiazepines, careful titration of anaesthetic depth guided by processed electroencephalogram monitoring and treatment of pain are the most effective strategies to minimise the risk of delirium. Addressing postoperative delirium requires a collaborative, whole pathway approach, beginning with the early identification of those patients who are at risk. The research agenda should continue to examine the potential for pharmacological prophylaxis to prevent delirium while also addressing how successful models of delirium prevention can be translated from one setting to another, underpinned by implementation science methodology.

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“…In ICU patients, the α2-adrenergic blocker, dexmedetomidine, has been shown to be less deliriogenic than benzodiazepines or opiates for sedation. [73][74][75] Major side effects include hypotension and bradycardia. It should be avoided in patients with certain arrhythmias (particularly bradycardia), and requires close monitoring in those with hemodynamic compromise or heart failure.…”

Section: Sedationmentioning

confidence: 99%

“…76 While there is no high-quality evidence to recommend other sedatives for delirium prevention, midazolam is sometimes more clearly associated with increased risks of delirium compared with other options. 1,2,75 Importantly, sedation holidays and close monitoring to prevent oversedation are recommended to prevent delirium. 77,78…”

Section: Sedationmentioning

confidence: 99%

Evaluation and Management of Delirium

Ryan

Kimchi

2021

Semin Neurol

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Delirium, sometimes referred to as encephalopathy, is an acute confusional state that is both common in hospitalized patients and associated with poor outcomes. For patients, families, and caregivers, delirium can be a traumatic experience. While delirium is one of the most common diagnoses encountered by the consulting neurologist, the majority of the time it will have been previously unrecognized as such by the care team. Neurologic syndromes such as dementia or aphasia can either be misdiagnosed as delirium or may coexist with it, necessitating careful neurologic assessment. Once the diagnosis of delirium has been established, a careful evaluation for predisposing and precipitating factors can help uncover modifiable contributors, which should be addressed as part of a multicomponent, primarily nonpharmacologic intervention. Importantly, delirium management, which begins with comprehensive prevention, should emphasize the humanity of the delirious patient and the challenges of caring for this vulnerable population. When considered, delirium represents an important opportunity for the neurologist to substantially enhance patient care.

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The effect of perioperative anesthetics for prevention of postoperative delirium on general anesthesia: A network meta-analysis

Cited by 35 publications

References 65 publications

Comparative effectiveness of pharmacological interventions to prevent postoperative delirium: a network meta-analysis

Comparative effectiveness of pharmacological interventions to prevent postoperative delirium: a network meta-analysis

Evidence‐based strategies to reduce the incidence of postoperative delirium: a narrative review

Evaluation and Management of Delirium

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