手术后患者谵妄认知障碍的专家共识ppt课件.pptVIP

;Definition;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 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 have not shown any benefit in respect of POD. ;;Prevention;Monitoring;;Prevention;Monitoring;;Prevention;Monitoring;Therapy;;Prevention;Monitoring;Therapy;Conclusion;(1) preoperative evaluation of POD risk and identification of patients at risk (2) communication about this risk to patients, their family and care team members (3) best possible preoperative conditions to be achieved (4) perioperative avoidance of use of anticholinergic agents and benzodiazepines except when needed. Benzodiazepines can be considered in cases of alcohol wit