Postoperative delirium: Rx
Basic, Clinical Sciences: Anesthesia Procedures, Methods, and Techniques
Postoperative delirium is an acute altered and fluctuating mental status with features of inattention and an altered level of consciousness. It is becoming increasingly recognized in the aging population as a complication following surgery, especially in high operative stress surgeries.
The treatment for postoperative delirium is multifactorial and involves preventative measures as well as pharmacologic therapy. Preventative measures should start in the operating room by maintaining good hemodynamic stability, adequate oxygenation, minimizing electrolyte disturbances and administering appropriate drug dosages. In addition to intraoperative strategies, post operative environmental strategies such as sleep protocols and early mobility can add to preventative management. Pharmacologic treatment of postoperative delirium is achieved using neuroleptic agents, particularly haloperidol.
It should be noted that haloperidol is no longer recommended to treat delirium in the ICU according to the 2013 SCCM guidelines. The Guidelines note, “We provide no recommendation for using a pharmacologic delirium prevention protocol in adult ICU patients, as no compelling data demonstrate that this reduces the incidence or duration of delirium in these patients." Other notable points in the 2013 update include the recommendation that dexmedetomidine be favored over benzodiazepines for sedation, that sedation be interrupted daily, that mechanically ventilated patients receive an "analgesia-first” approach to sedation, and that sleep be optimized by controlling light, noise, and the frequency of interventions.”