Penn State College of Medicine, Hershey, PA, USA.
Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular Anesthesiology, Mayo Clinic, Rochester, MN, USA.
Curr Neurol Neurosci Rep. 2024 Dec;24(12):681-689. doi: 10.1007/s11910-024-01385-4. Epub 2024 Oct 7.
Postoperative delirium (POD) is a common complication that has important implications for surgical patients, often leading to both short- and long-term cognitive deficits, worse outcomes, and increased healthcare costs. Given these implications, there may be a benefit in reducing the incidence of POD. Pharmacologic interventions may have the potential to reduce the risk of a patient developing POD.
Recently studied therapies include dexmedetomidine, propofol, haloperidol, ketamine, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, acetaminophen, melatonin/ramelteon, corticosteroids, midazolam, physostigmine, and neostigmine. In addition, the implementation of regional anesthesia and reduction of overall anesthetic depth have been examined. Of these therapies, dexmedetomidine has been studied the most and has the most supporting evidence for prevention of POD, but current studies lack clarity on optimal dosing and timing of dexmedetomidine administration. Acetaminophen, corticosteroids, and melatonin/ramelteon are other plausible medications that have potential for reducing POD incidence, but they all require further investigation. Reduction of anesthetic depth and regional anesthetics are options for anesthetic management that show promise but still lack enough supporting evidence in recent literature to receive a strong recommendation. Future research should focus on identifying optimal strategies for the implementation of the pharmacological options listed, including doses and timing of administration. Attention should be given to dexmedetomidine given its promise demonstrated by recent literature.
术后谵妄（POD）是一种常见的并发症，对手术患者有重要影响，常导致短期和长期认知功能障碍、更差的预后和更高的医疗保健费用。鉴于这些影响，降低 POD 的发生率可能有益。药物干预可能有潜力降低患者发生 POD 的风险。
最近研究的治疗方法包括右美托咪定、丙泊酚、氟哌啶醇、氯胺酮、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、对乙酰氨基酚、褪黑素/雷美尔通、皮质类固醇、咪达唑仑、毒扁豆碱和新斯的明。此外，还研究了区域麻醉的实施和整体麻醉深度的降低。在这些治疗方法中，右美托咪定研究最多，并有最多的证据支持预防 POD，但目前的研究对于右美托咪定给药的最佳剂量和时间缺乏明确性。对乙酰氨基酚、皮质类固醇和褪黑素/雷美尔通是其他可能减少 POD 发生率的合理药物，但它们都需要进一步研究。降低麻醉深度和区域麻醉是麻醉管理的选择，有希望但在最近的文献中仍然缺乏足够的支持证据，无法得到强烈推荐。未来的研究应侧重于确定列出的药物选择的最佳策略，包括给药剂量和时间。鉴于最近的文献证明了右美托咪定的潜力，应给予关注。
