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      Postoperative delirium

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          Abstract

          Delirium can be defined as an ‘acute brain dysfunction.’ Compared to dementia, which is a disease that deteriorates the brain function chronically, delirium shows very similar symptoms but is mostly ameliorated when the causative factors are normalized. Due to the heterogeneity in etiologies and symptoms, people including health care workers often mistake delirium for dementia or other psychiatric disorders. Delirium has attracted global interest increasingly and a vast amount of research on its management has been conducted. Experts in the field have constantly suggested that systematic intervention should be implemented through a team-based multicomponent approach aimed to reduce the incidence and duration of delirium. Surgery involves many health care workers with different expertise who are not familiar with delirium. For a team-based approach on the management of delirium, it is vital that all medical personnel concerned have a common understanding of delirium and keep in constant communication. Postoperative delirium is a common complication and exerts an enormous burden on patients, their families, hospitals, and public resources. To alleviate this burden, this article aimed to review general features and the latest evidence-based knowledge of delirium with a focus on postoperative delirium.

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          Most cited references59

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          Predictors of cognitive dysfunction after major noncardiac surgery.

          The authors designed a prospective longitudinal study to investigate the hypothesis that advancing age is a risk factor for postoperative cognitive dysfunction (POCD) after major noncardiac surgery and the impact of POCD on mortality in the first year after surgery. One thousand sixty-four patients aged 18 yr or older completed neuropsychological tests before surgery, at hospital discharge, and 3 months after surgery. Patients were categorized as young (18-39 yr), middle-aged (40-59 yr), or elderly (60 yr or older). At 1 yr after surgery, patients were contacted to determine their survival status. At hospital discharge, POCD was present in 117 (36.6%) young, 112 (30.4%) middle-aged, and 138 (41.4%) elderly patients. There was a significant difference between all age groups and the age-matched control subjects (P < 0.001). At 3 months after surgery, POCD was present in 16 (5.7%) young, 19 (5.6%) middle-aged, and 39 (12.7%) elderly patients. At this time point, the prevalence of cognitive dysfunction was similar between age-matched controls and young and middle-aged patients but significantly higher in elderly patients compared to elderly control subjects (P < 0.001). The independent risk factors for POCD at 3 months after surgery were increasing age, lower educational level, a history of previous cerebral vascular accident with no residual impairment, and POCD at hospital discharge. Patients with POCD at hospital discharge were more likely to die in the first 3 months after surgery (P = 0.02). Likewise, patients who had POCD at both hospital discharge and 3 months after surgery were more likely to die in the first year after surgery (P = 0.02). Cognitive dysfunction is common in adult patients of all ages at hospital discharge after major noncardiac surgery, but only the elderly (aged 60 yr or older) are at significant risk for long-term cognitive problems. Patients with POCD are at an increased risk of death in the first year after surgery.
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            European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium.

            The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care, postoperative detection of delirium and management of delirious patients. The scope of this guideline is not to cover ICU delirium. Considering that many medical disciplines are involved in the treatment of surgical patients, a team-based approach should be implemented into daily practice. This guideline is aimed to promote knowledge and education in the preoperative, intraoperative and postoperative setting not only among anaesthesiologists but also among all other healthcare professionals involved in the care of surgical patients.
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              Relations between personality and coping: a meta-analysis.

              Personality may directly facilitate or constrain coping, but relations of personality to coping have been inconsistent across studies, suggesting a need for greater attention to methods and samples. This meta-analysis tested moderators of relations between Big Five personality traits and coping using 2,653 effect sizes drawn from 165 samples and 33,094 participants. Personality was weakly related to broad coping (e.g., Engagement or Disengagement), but all 5 traits predicted specific strategies. Extraversion and Conscientiousness predicted more problem-solving and cognitive restructuring, Neuroticism less. Neuroticism predicted problematic strategies like wishful thinking, withdrawal, and emotion-focused coping but, like Extraversion, also predicted support seeking. Personality more strongly predicted coping in young samples, stressed samples, and samples reporting dispositional rather than situation-specific coping. Daily versus retrospective coping reports and self-selected versus researcher-selected stressors also moderated relations between personality and coping. Cross-cultural differences were present, and ethnically diverse samples showed more protective effects of personality. Richer understanding of the role of personality in the coping process requires assessment of personality facets and specific coping strategies, use of laboratory and daily report studies, and multivariate analyses. (c) 2007 APA, all rights reserved.
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                Author and article information

                Journal
                Korean J Anesthesiol
                Korean J Anesthesiol
                KJA
                Korean Journal of Anesthesiology
                Korean Society of Anesthesiologists
                2005-6419
                2005-7563
                February 2019
                24 August 2018
                : 72
                : 1
                : 4-12
                Affiliations
                [1 ]Institute of Behavioral Science in Medicine at Yonsei University College of Medicine, Korea
                [2 ]Department of Psychiatry, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea
                [3 ]Department of Psychiatry, The Armed Forces Hongcheon Hospital, Hongcheon, Korea
                Author notes
                Corresponding author: Jin Young Park, M.D., Ph.D. Department of Psychiatry, Yonsei University College of Medicine, Research Center for Future Medicine, 20 Eonju-ro 63-gil, Gangnamgu, Seoul 06229, Korea Tel: 82-2-2019-3342, Fax: 82-2-3462-4304 Email: empathy@ 123456yuhs.ac
                Author information
                http://orcid.org/0000-0001-6351-6440
                http://orcid.org/0000-0002-5351-9549
                Article
                kja-d-18-00073-1
                10.4097/kja.d.18.00073.1
                6369344
                30139213
                08c87fc1-8b99-4a1c-8a3c-7de645f08d7c
                Copyright © The Korean Society of Anesthesiologists, 2019

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 March 2018
                : 2 August 2018
                : 16 August 2018
                Categories
                Review Article

                Anesthesiology & Pain management
                cognitive decline,current practice,delirium,postoperative complication,prevention,prognosis,risk factor

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