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Postoperative delirium

Key sources
The following summarized guidelines for the evaluation and management of postoperative delirium are prepared by our editorial team based on guidelines from the European Society of Intensive Care Medicine (ESICM 2024), the American Academy of Family Physicians (AAFP 2023), the Global Alliance for Infection in Surgery (GAIS/WSES/AAST/SIAARTI 2022), the The Scottish Intercollegiate Guidelines Network (SIGN 2019), and the American Geriatrics Society (AGS 2015).
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Guidelines

1.Classification and risk stratification

Preoperative risk assessment: assess the following preoperative risk factors for postoperative delirium:
older age
ASA physical status > 2
Charlson Comorbidity Index > 2
mini Mental State Examination score < 25
B
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2.Diagnostic investigations

Initial assessment: as per AAFP 2023 guidelines, use the Confusion Assessment Method for diagnosing delirium in adult patients.
B

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  • EEG

3.Medical management

General principles: as per WSES 2022 guidelines, minimize possible causes of delirium, including drug-induced delirium, and optimize pain control before initiating pharmacotherapy.
B

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  • Haloperidol

  • Benzodiazepines

  • Dexmedetomidine

4.Perioperative care

Monitoring depth of anesthesia
As per ESICM 2024 guidelines:
Consider obtaining index-based EEG monitoring for guiding the depth of anesthesia to reduce the risk of postoperative delirium.
C
Consider obtaining multiparameter intraoperative EEG monitoring (burst suppression, density spectral array, density spectral array) during anesthesia to reduce the risk of postoperative delirium.
C

5.Preventative measures

Nonparmacological prevention program
As per ESICM 2024 guidelines:
Implement multicomponent nonpharmacological interventions for all patients at risk of postoperative delirium.
B
Insufficient evidence to suggest a specific type of surgery or anesthesia to reduce the incidence of postoperative delirium in patients undergoing surgery.
I

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  • Pharmacological prophylaxis