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DefinitionDeliriumisanacuteandfluctuatingalterationofmentalstateofreducedawarenessanddisturbanceofattention.PODoftenstartsintherecoveryroomandoccursupto5daysaftersurgery.VeryearlyonsetofPODintheimmediatepostanaesthesiaperiodbeforeoronarrivalattherecoveryroomisreferredtoas‘emergencedelirium
Deliriumcanpresentashypoactive(decreasedalertness,motoractivityandanhedonia),ashyperactive(agitatedandcombative)orasmixedforms.Increasedageseemstobeapredisposingfactorforthehypoactiveform.Theprognosismaybeworsewithhypoactivedelirium,possiblyduetorelativeunder-detectionbystaffandconsequentlydelayedtreatment.
AdvancedageComorbidities(e.g.cerebrovascularincludingstroke,cardiovascular,peripheralvasculardiseases,diabetes,anaemia,Parkinson’sdisease,depression,chronicpainandanxietydisorders)Evidence-basedandconsensus-basedstatementsregardingriskfactors
PreoperativefluidfastinganddehydrationDrugswithanticholinergiceffects(e.g.measuredbyananticholinergicdrugscale)Werecommendevaluatingalcohol-relateddisorders
Siteofsurgery(abdominalandcardiothoracic)IntraoperativebleedingDurationofsurgeryasafurtherintraoperativeriskfactorPainasapostoperativeriskfactorforPOD
PreventionandtreatmentWesuggestimplementingfast-tracksurgerytopreventPODWesuggestavoidingroutinepremedicationwithbenzodiazepinesexceptforpatientswithsevereanxietyWerecommendmonitoringdepthofanaesthesia
WerecommendadequatepainassessmentandtreatmentWesuggestusingacontinuousintraoperativeanalgesiaregimen(e.g.withremifentanil)Wesuggestusinglow-dosehaloperidolaorlow-doseatypicalneurolepticstotreatPOD
SomeobservationaldataareavailablesuggestingthatanalgesiaprovidedwithcontinuousadministrationofremifentanilmightreducetheincidenceofPODcomparedwithabolus-drivenregimenwithfentanyl.PODdoesnotlimitPCA
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