Delirium (Postanesthetic) and Dementia

Risk factors for the development of POD can be categorized as pt or procedure related.

Pt-related factors:

• Age >75 y.

• Preexisting cognitive dysfunction or depression.

• Male sex.

• Preexisting severe illness.

• Polypharmacy (>3 medications) and use of psychoactive medications.

• History of substance abuse.

• Laboratory abnormalities (anemia, hypoalbuminemia, sodium, potassium, glucose).

Procedure-related factors:

• Cardiac, orthopedic, and vascular procedures associated with highest incidence.

• Emergent or urgent procedures.

• Poorly controlled postop pain.

• Periop administration of anticholinergics, antihistamines, benzodiazepines, and meperidine.

Factors lacking association with risk of POD are operative time, type of anesthetic (general vs. regional), and mode of postop analgesia (regional techniques vs. systemic opioids).

POD associated with increased morbidity and mortality, prolonged hospitalization, higher rates of hospital-acquired complications, persistent functional and cognitive decline, and institutionalization following discharge

Increased risk for falls, development of pressure ulcers, prolonged intubation/reintubation, and need for urinary catheterization

Increased cost of hospitalization

Pt can demonstrate violent behavior that may place themselves or care providers at risk of harm.

Rule out modifiable causes of delirium (metabolic abnormalities, progression of underlying disease, withdrawal).

Drug-drug interactions can commonly precipitate changes in mental status.

Dementia: Decline in cognition that represents a change from baseline level of function that interferes with independence and daily function.

Delirium: Acute (h to d) change in baseline attention and awareness that fluctuates in severity during the course of a day and is accompanied by a disturbance in cognition. Three variants: hyperactive (psychomotor agitation, disturbed emotional state), hypoactive (decreased level of consciousness, apathy), and mixed.

Incidence of POD is estimated to be 36.8%. It may be higher in pts >70 y of age.