Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, UK.
Department of Anesthesiology, Luoyang Central Hospital Affiliated to Zhengzhou University, Henan, China.
Br J Anaesth. 2020 Oct;125(4):492-504. doi: 10.1016/j.bja.2020.06.063. Epub 2020 Aug 11.
Postoperative delirium is a relatively common and serious complication. It increases hospital stay by 2-3 days and is associated with a 30-day mortality of 7-10%. It is most prevalent in older patients, those with existing neurocognitive disorders, and those undergoing complex or emergency procedures. Preclinical and clinical research in recent years has uncovered more about the pathophysiology of postoperative delirium and may yield more potential therapeutic options. Using the enhanced recovery pathway framework of risk stratification, risk reduction, and rescue treatment, we have reviewed the current clinical evidence on the validity of delirium prediction scores for the surgical population, the effectiveness of perioperative delirium risk reduction interventions, and management options for established delirium. Effective perioperative interventions include depth of anaesthesia monitoring, intraoperative dexmedetomidine infusion, and multimodal analgesia. Choice of general anaesthetic agent may not be associated with significant difference in delirium risk. Several other factors, such as preoperative fasting, temperature control, and blood pressure management have some association with the risk of postoperative delirium; these will require further studies. Because of the limited treatment options available for established delirium, we propose that risk assessment and perioperative risk reduction may be the most effective approaches in managing postoperative delirium.
术后谵妄是一种相对常见且严重的并发症。它会使住院时间延长 2-3 天，并与术后 30 天的死亡率 7-10%相关。它在老年患者、存在神经认知障碍的患者以及接受复杂或紧急手术的患者中更为普遍。近年来，临床前和临床研究揭示了更多关于术后谵妄的病理生理学知识，可能会产生更多潜在的治疗选择。我们使用强化康复途径的风险分层、风险降低和抢救治疗框架，回顾了目前关于手术人群谵妄预测评分的有效性、围手术期谵妄风险降低干预措施以及既定谵妄的管理选择的临床证据。有效的围手术期干预措施包括麻醉深度监测、术中右美托咪定输注和多模式镇痛。全身麻醉药物的选择可能与谵妄风险无显著差异相关。其他一些因素，如术前禁食、体温控制和血压管理与术后谵妄的风险有一定关联；这些需要进一步研究。由于对已确立的谵妄的治疗选择有限，我们提出风险评估和围手术期风险降低可能是管理术后谵妄的最有效方法。
