Postoperative delirium: Risk factors, diagnosis and perioperative care.

Postoperative delirium (PD) relates to increased morbidity-associated with prolonged hospital stay, institutionaliza­ tion and persistem functional and cognitive decline- poor long term outcome and higher perioperative mo rtality. Aim of this literature review is to identify established risk factors for PD and to categorize them according timing of occurrence (pre, intra and post operative), and clinica! impact (Odds ratio [OR], o/o increase in incidence of PD). Source of information: medicai literature databases (medline and embase) were searched for published manuscripts on "postoperative delirium". Predictors and preoperative risk factors for PD were categorized imo 4 groups: demo­ graphics; co morbidities; surgery and anesthesia-related (age , education, laboratory anomalies, smoking habits , ben­ zodiazepines premedication, cardiac and thoracic surgery, etc). Intra operative risk factors for PD were categorized imo 2 groups: surgery and anesthesia-related (anemia, duration and type of surgery, selected opioid, imraoperative hypotension, etc). Post operative risk factors and precipitating factors include various pathophysiological and en­ vironmental conditions, (i.e., ICU admission, low cardiac output requiring inotropes infusion; new onset atrial fibrillation; persistem hypoxia or hypercarbia; use of narcotic analgesics, delayed ambulation, inadequate nutritional status; sensory deprivation, etc). In conclusion, the effective idemification, prevemion and treatmem of pre, imra and postoperative risk factors are the cornerstones for the prevention of PD. A dedicateci perioperative care path that encompasses a tailored selection of drugs used perioperatively, the appropriate anesthesia strategy, qualified nursing surveillance, systematic use of diagnostic tools and accurate staff communication reduces the incidence and clinica! impact of PD. (Minerva Anestesiol 2013;79:1066-76)