POD手术后患者谵妄认知障碍的专家共识.ppt

,.,Definition,Deliriumisanacuteandfluctuatingalterationofmentalstateofreducedawarenessanddisturbanceofattention.PODoftenstartsintherecoveryroomandoccursupto5daysaftersurgery.VeryearlyonsetofPODintheimmediatepostanaesthesiaperiodbeforeoronarrivalattherecoveryroomisreferredtoasemergencedelirium,.,Deliriumcanpresentashypoactive(decreasedalertness,motoractivityandanhedonia),ashyperactive(agitatedandcombative)orasmixedforms.Increasedageseemstobeapredisposingfactorforthehypoactiveform.Theprognosismaybeworsewithhypoactivedelirium,possiblyduetorelativeunder-detectionbystaffandconsequentlydelayedtreatment.,.,AdvancedageComorbidities(e.g.cerebrovascularincludingstroke,cardiovascular,peripheralvasculardiseases,diabetes,anaemia,Parkinsonsdisease,depression,chronicpainandanxietydisorders),Evidence-basedandconsensus-basedstatementsregardingriskfactors,.,PreoperativefluidfastinganddehydrationDrugswithanticholinergiceffects(e.g.measuredbyananticholinergicdrugscale)Werecommendevaluatingalcohol-relateddisorders,.,Siteofsurgery(abdominalandcardiothoracic)IntraoperativebleedingDurationofsurgeryasafurtherintraoperativeriskfactorPainasapostoperativeriskfactorforPOD,.,Preventionandtreatment,Wesuggestimplementingfast-tracksurgerytopreventPODWesuggestavoidingroutinepremedicationwithbenzodiazepinesexceptforpatientswithsevereanxietyWerecommendmonitoringdepthofanaesthesia,.,WerecommendadequatepainassessmentandtreatmentWesuggestusingacontinuousintraoperativeanalgesiaregimen(e.g.withremifentanil)Wesuggestusinglow-dosehaloperidolaorlow-doseatypicalneurolepticstotreatPOD,.,SomeobservationaldataareavailablesuggestingthatanalgesiaprovidedwithcontinuousadministrationofremifentanilmightreducetheincidenceofPODcomparedwithabolus-drivenregimenwithfentanyl.PODdoesnotlimitPCAuse.RegionalanaesthesiaandregionalanalgesiahavenotshownanybenefitinrespectofPOD.,.,.,Prevention,.,Monitoring,.,.,Prevention,.,Monitoring,.,.,Prevention,.,Monitoring,.,Therapy,.,.,Prevention,.,Monitoring,.,Therapy,.,Conclusion,PODisafrequentcomplicationandrequirespreventivemeasuresaswellasimmediateandadequatetreatment.AlthoughnumerousstudieshavedocumentedtheclinicalandeconomicconsequencesofPOD,systematicinterventionsaimedtoreduceitsincidenceanddurationarerarelyimplemented.,.,(1)preoperativeevaluationofPODriskandidentificationofpatientsatrisk(2)communicationaboutthisrisktopatients,theirfamilyandcareteammembers(3)bestpossiblepreoperativeconditionstobeachieved(4)perioperativeavoidanceofuseofanticholinergicagentsandbenzodiazepinesexceptwhenneeded.Benzodiazepinescanbeconsideredincasesofalcoholwithdrawal,.,(5)attemptstoreducesurgicalstress,togetherwithorgan-protectiveintraoperativemanagement,includingneuromonitoringtoavoidexcessivelydeepanaesthesia(a)effectivemultimodalopioid-sparinganalgesia(b)implementationofenhancedrecoveryprogrammes,.,(6)cognitivemonitoringtobeaimedatrecognitionofpreoperativecognitivedeclineandtodetectPODasearlyaspossible,includingintherecoveryroom(7)effectivetreatmentofPODbyprotocols(8)follo