手术后患者谵妄认知障碍的专家共识课件.ppt

Definition Delirium is an acute and fluctuating alteration of mental state of reduced awareness and disturbance of attention. POD often starts in the recovery room and occurs up to 5 days after surgery. Very early onset of POD in the immediate postanaesthesia period before or on arrival at the recovery room is referred to as ‘emergence delirium Delirium can present as hypoactive (decreased alertness, motor activity and anhedonia), as hyperactive (agitated and combative) or as mixed forms. Increased age seems to be a predisposing factor for the hypoactive form. The prognosis may be worse with hypoactive delirium, possibly due to relative under-detection by staff and consequently delayed treatment. Advanced age Comorbidities (e.g. cerebrovascular including stroke, cardiovascular, peripheral vascular diseases, diabetes, anaemia, Parkinson’s disease, depression, chronic pain and anxiety disorders) Preoperative fluid fasting and dehydration Drugs with anticholinergic effects (e.g. measured by an anticholinergic drug scale) We recommend evaluating alcohol-related disorders Site of surgery (abdominal and cardiothoracic) Intraoperative bleeding Duration of surgery as a further intraoperative risk factor Pain as a postoperative risk factor for POD Prevention and treatment We suggest implementing fast-track surgery to prevent POD We suggest avoiding routine premedication with benzodiazepines except for patients with severe anxiety We recommend monitoring depth of anaesthesia We recommend adequate pain assessment and treatment We suggest using a continuous intraoperative analgesia regimen (e.g. with remifentanil) We suggest using low-dose haloperidol a or low-dose atypical neuroleptics to treat POD Some observational data are available suggesting that analgesia provided with continuous administration of remifentanil might reduce the incidence of POD compared with a bolus-driven regimen with fentanyl. POD does not limit PCA use. Regional anaesthesia and regional analgesia h