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1 Definition Deliriumisanacuteandfluctuatingalterationofmentalstateofreducedawarenessanddisturbanceofattention PODoftenstartsintherecoveryroomandoccursupto5daysaftersurgery VeryearlyonsetofPODintheimmediatepostanaesthesiaperiodbeforeoronarrivalattherecoveryroomisreferredtoas emergencedelirium 2 Deliriumcanpresentashypoactive decreasedalertness motoractivityandanhedonia ashyperactive agitatedandcombative orasmixedforms Increasedageseemstobeapredisposingfactorforthehypoactiveform Theprognosismaybeworsewithhypoactivedelirium possiblyduetorelativeunder detectionbystaffandconsequentlydelayedtreatment 3 AdvancedageComorbidities e g cerebrovascularincludingstroke cardiovascular peripheralvasculardiseases diabetes anaemia Parkinson sdisease depression chronicpainandanxietydisorders Evidence basedandconsensus basedstatementsregardingriskfactors 4 PreoperativefluidfastinganddehydrationDrugswithanticholinergiceffects e g measuredbyananticholinergicdrugscale Werecommendevaluatingalcohol relateddisorders 5 Siteofsurgery abdominalandcardiothoracic IntraoperativebleedingDurationofsurgeryasafurtherintraoperativeriskfactorPainasapostoperativeriskfactorforPOD 6 Preventionandtreatment Wesuggestimplementingfast tracksurgerytopreventPODWesuggestavoidingroutinepremedicationwithbenzodiazepinesexceptforpatientswithsevereanxietyWerecommendmonitoringdepthofanaesthesia 7 WerecommendadequatepainassessmentandtreatmentWesuggestusingacontinuousintraoperativeanalgesiaregimen e g withremifentanil Wesuggestusinglow dosehaloperidolaorlow doseatypicalneurolepticstotreatPOD 8 SomeobservationaldataareavailablesuggestingthatanalgesiaprovidedwithcontinuousadministrationofremifentanilmightreducetheincidenceofPODcomparedwithabolus drivenregimenwithfentanyl PODdoesnotlimitPCAuse RegionalanaesthesiaandregionalanalgesiahavenotshownanybenefitinrespectofPOD 9 10 Prevention 11 Monitoring 12 13 Prevention 14 Monitoring 15 16 Prevention 17 Monitoring 18 Therapy 19 20 Prevention 21 Monitoring 22 Therapy 23 Conclusion PODisafrequentcomplicationandrequirespreventivemeasuresaswellasimmediateandadequatetreatment AlthoughnumerousstudieshavedocumentedtheclinicalandeconomicconsequencesofPOD systematicinterventionsaimedtoreduceitsincidenceanddurationarerarelyimplemented 24 1 preoperativeevaluationofPODriskandidentificationofpatientsatrisk 2 communicationaboutthisrisktopatients theirfamilyandcareteammembers 3 bestpossiblepreoperativeconditionstobeachieved 4 perioperativeavoidanceofuseofanticholinergicagentsandbenzodiazepinesexceptwhenneeded Benzodiazepinescanbeconsideredincasesofalcoholwithdrawal 25 5 attemptstoreducesurgicalstress togetherwithorgan protectiveintraoperativemanagement includingneuromonitoringtoavoidexcessivelydeepanaesthesia a effectivemultimodalopioid sparinganalgesia b implementationofenhancedrecoveryprogrammes 26 6 cognitivemonitoringtobeaimedatrecognitionofpreoperativecognitivedeclineandtodetectPODasearlyaspossible includingintherecoveryroom 7 effectivetreatmentofPODbyprotocols 8 follo
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