Proc Jennifer L, Jordan Helen, Docherty Annemarie B
Department of Anaesthesia, NHS Fife, Kirkcaldy, Scotland.
South East Scotland School of Anaesthesia, Edinburgh, Scotland.
Br J Hosp Med (Lond). 2020 Feb 2;81(2):1-9. doi: 10.12968/hmed.2019.0345. Epub 2020 Feb 13.
As the population ages, there is a higher prevalence of both dementia and conditions that require major surgery. However, patients with dementia undergoing surgery have poorer outcomes than surgical patients without dementia. This article explores new guidance about delivering perioperative care for patients with dementia presenting for surgery. Management of patients with cognitive changes begins with developing an understanding of the classifications and pathophysiology of these disease processes, and addressing any modifiable risk factors for developing dementia, postoperative cognitive decline and postoperative delirium. Thorough preoperative assessment provides the opportunity to identify patients with and at risk of these cognitive impairments and to involve the appropriate multidisciplinary team in care planning. Once patients are identified, an individualised perioperative management plan addressing any issues surrounding capacity and consent, conduct of anaesthesia, possible polypharmacy and potential drug interactions, and postoperative pain management can improve quality of care and outcomes for these patients.
随着人口老龄化，痴呆症和需要进行大手术的疾病的患病率都更高。然而，患有痴呆症的患者接受手术的结果比没有痴呆症的手术患者更差。本文探讨了为接受手术的痴呆症患者提供围手术期护理的新指南。对认知变化患者的管理始于了解这些疾病过程的分类和病理生理学，并解决任何可改变的患痴呆症、术后认知功能下降和术后谵妄的风险因素。全面的术前评估提供了识别患有这些认知障碍和有患这些认知障碍风险的患者的机会，并让适当的多学科团队参与护理计划。一旦确定了患者，针对任何围绕能力和同意、麻醉实施、可能的多种药物治疗和潜在药物相互作用以及术后疼痛管理等问题的个性化围手术期管理计划，可以提高这些患者的护理质量和治疗效果。
