Table of contents

Postoperative delirium

What's new

Added 2024 ESICM, 2022 WSES/GAIS, 2019 SIGN, and 2015 AGS guidelines for the prevention and management of 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 ...
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Classification and risk stratification

Preoperative risk assessment: as per ESICM 2024 guidelines, 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.
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American Society of Anesthesiologists score (ASA score)
Absence of systemic disease
Mild systemic disease without functional limitations
Moderate systemic disease with functional limitations
Severe systemic disease that is a constant threat to life
A moribund patient who is not expected to survive without the operation
Brain-dead patient whose organs are being removed for donor purposes
Emergency surgery
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Diagnostic investigations

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

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  • EEG

Medical management

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

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  • Haloperidol

  • Benzodiazepines

  • Dexmedetomidine

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.
Consider obtaining multiparameter intraoperative EEG monitoring (burst suppression, density spectral array, density spectral array) during anesthesia to reduce the risk of postoperative delirium.

Preventative measures

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

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  • Pharmacological prophylaxis