Delirium in the elderly patient after anesthesia: associated factors
Postoperative delirium is defined as an acute confusional state with altered levels of attention and consciousness. It presents for a short period of time with a transient and fluctuating evolution, with long-term outcomes of cognitive dysfunction. It has been observed mostly in extreme age groups and has been associated with factors that increase the risk of occurrence.
To identify any factors associated with the development of postoperative delirium in the elderly following anesthesia.
Materials and methods:
An analytical cross-section study was conducted in elderly patients receiving anesthesia at a second-level hospital, from November 2016 to November 2017. The confusion assessment method was used based on 4 items for making the diagnosis of delirium. The data obtained were statistically analyzed with measures of central tendency, and the risk probability was estimated.
A total of 100 patients aged between 60 and 93 years old were studied, with postoperative delirium present in 18% of the sample. There was a statistically significant association among patients with severe pain, those with a low level of education, and those who did not have a stable partner.
It is important to study the postoperative delirium factors to be able to identify the population at higher risk of experiencing postoperative delirium, with a view to reducing the number of long-term complications.
2. Taylor D, Lewis S. Delirium. J Neurol Neurosurg Psych 1993;56:742-751.
3. Jankowski CJ, Trenerry MR, Cook DJ, et al. Cognitive and functional predictors and sequelae of postoperative delirium in elderly patients undergoing elective joint arthroplasty. Anesth Analg 2011;112:1186-1193.
4. Markar SR, Smith IA, Karthikesalingam A, et al. The clinical and economic costs of delirium after surgical resection for esophageal malignancy. Ann Surg 2013;258:77e81.
5. Ocádiz-Carrasco J, Gutiérrez-Padilla RA, Páramo-Rivas F, et al. Preventive program for postoperative delirium in the elderly. Cir Cir 2013;81:181-186.
6. Popp J, Arlt S. Prevention and treatment options for postoperative delirium in the elderly. Curr Opin Psychiatr 2012;25:515-521.
7. Radtke FM, Franck M, MacGuill M, et al. Duration of fluid fasting and choice of analgesic are modifiable factors for early postoperative delirium. Eur J Anesth 2010;27:411-416.
8. Leung J, Sands L, Wang Y, et al. Apolipoprotein E e4 allele increases the risk of early postoperative delirium in older patients undergoing noncardiac surgery. Anesthesiology 2007;107:406-411.
9. Monk TG, Price CC. Postoperative cognitive disorders. Curr Opin Crit Care 2011;17:376-381.
10. Vaurio LE, Sands L, Wang Y, et al. Postoperative delirium: the importance of pain and pain management. Anesth Analg 2006;102:1267-1273.
11. Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990;113:941-948.
12. Benavides-Caro CA. Anesthesia and the elderly patient, seeking better neurological outcomes. Rev Colomb Anestesiol 2016;44:128-133.
13. Carrillo R, Medrano T. Delirium and postoperative cognitive dysfunction. Rev Mex Anest 2011;34:211-219.
14. Winter A, Steurer MP, Dullenkopf A. Postoperative delirium assessed by post anesthesia care unit staff utilizing the Nursing Delirium Screening Scale: a prospective observational study of 1000 patients in a single Swiss institution. BMC Anesthesiol 2015;15:184.
15. Hernández AS, Sánchez J. Anesthetic factors associated with postoperative cognitive deterioration in the geriatric patient. Rev Mex Anest 2014;37 (suppl 1):S349-S351.
16. Guenther U, Riedel L, Radtke FM. Patients prone for postoperative delirium: preoperative assessment, perioperative prophylaxis, postoperative treatment. Curr Opin Anaesthesiol 2016;29:384-390.
17. Bedford PD. Adverse cerebral effects of anaesthesia on old people. Lancet 1955;2:259-263.
18. Bekker A, Korban A, Esochaghi S. Long-term cognitive decline in the elderly is not attributable to surgery/anesthesia. Int J Anesth Res 2017;5:490-493.
19. Wassenaar A, van den Boogaard M, van Achterberg T, et al. Multinational development and validation of an early prediction model for delirium in ICU patients. Intens Care Med 2015;41:1048-1056.
20. Drews T, Franck M, Radtke FM, et al. Postoperative delirium is an independent risk factor for posttraumatic stress disorder in the elderly patient: a prospective observational study. Eur J Anaesthesiol 2015;32:147-151.
21. Scott J, Mathias J, Kneebone A. Postoperative cognitive dysfunction after total joint arthroplasty in the elderly: a meta-analysis. J Arthroplasty 2014;29:261-267.
22. Ramsay M. The biological cost of the depression of consciousness. Rev Colomb Anestesiol 2015;43:119-121.