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    Does anesthesia cause post-operative delirium and post-operative cognitive decline?

       

    Daniel Jolley.

    9 articles.

    Created May 21, 2015, last updated 3 months ago.


    Collection: 19, Score: 1197, Trend score: 0, Read count: 1195, Articles count: 9, Created: 2015-05-21 04:22:48 UTC. Updated: 2020-01-09 07:24:07 UTC.

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    Collected Articles

    • Anaesthesia · Jan 2014

      Review

      Should general anaesthesia be avoided in the elderly?

      A brief review of post-operative delirium and post-operative cognitive decline, the possibility that anaesthesia and surgery may contribute (though for which evidence is observational and low quality), and potential methods for detection, quantification and avoidance.

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    • J Neurosurg Anesthesiol · Jan 2013

      Randomized Controlled Trial

      BIS-guided anesthesia decreases postoperative delirium and cognitive decline.

      BIS use in elderly patients targeting a BIS of 40-60 may reduce post-operative delirium and post-operative cognitive decline at 3 months.

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    • Br J Anaesth · Jun 2013

      Randomized Controlled Trial Multicenter Study

      Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction.

      Monitoring depth of anaesthesia in those over 60 yo decreases the incidence of post-operative delirium, though not post-operative cognitive decline.

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    • Eur J Anaesthesiol · Sep 2011

      Review

      Postoperative delirium. Part 1: pathophysiology and risk factors.

      Delirium presents clinically with differing subtypes ranging from hyperactive to hypoactive. The clinical presentation is not clearly linked to specific pathophysiological mechanisms. Nevertheless, there seem to be different mechanisms that lead to delirium; for example the mechanisms leading to alcohol-withdrawal delirium are different from those responsible for postoperative delirium. ⋯ Well documented predisposing factors are age, medical comorbidities, cognitive, functional, visual and hearing impairment and institutional residence. Important precipitating factors apart from surgery are admission to an ICU, anticholinergic drugs, alcohol or drug withdrawal, infections, iatrogenic complications, metabolic derangements and pain. Scores to predict the risk of delirium based on four or five risk factors have been validated in surgical patients.

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    • Eur J Anaesthesiol · Oct 2011

      Review

      Postoperative delirium. part 2: detection, prevention and treatment.

      To target pharmacological prevention, instruments giving an approximation of an individual patient's risk of developing postoperative delirium are available. In view of the variable clinical presentation, identifying patients in whom prophylaxis has failed (that is, who develop delirium) remains a challenge. Several bedside instruments are available for the routine ward and ICU setting. ⋯ Currently, cholinesterase inhibitors cannot be recommended and the data on dexmedetomidine are inconclusive. With the exception of alcohol-withdrawal delirium, there is no role for benzodiazepines in the treatment of delirium. It is unclear whether treating delirium prevents long-term sequelae.

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    • Minerva anestesiologica · Jul 2011

      Review

      Postoperative delirium and postoperative cognitive dysfunction in the elderly - what are the differences?

      Postoperative cognitive impairment is an increasingly common problem as more elderly patients undergo major surgery. Cognitive deficits in the postoperative period cause severe problems and are associated with a marked increase in morbidity and mortality. ⋯ Both have multifactorial pathogenesis but differ in numerous other ways, with delirium being well-defined and acute in onset and postoperative cognitive dysfunction (POCD) being subtler and with longer duration. This review aims to provide an overview of the differences in the diagnosis of the two entities and to illustrate the methodological problems that can be encountered when evaluating cognitive deficits postoperatively.

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    • Can J Anaesth · Mar 2012

      Review

      Postoperative delirium: risk factors and management: continuing professional development.

      Postoperative delirium often remains undiagnosed and therefore untreated. The purpose of this continuing professional development module is to identify patients at high risk of developing delirium following non-cardiac surgery and to provide tools to aid in the diagnosis of delirium at the bedside. Optimal prevention and treatment strategies are recommended. ⋯ Delirium is a serious condition that must be recognized early and treated promptly to minimize deleterious outcomes. In order to institute prevention strategies and treat the condition effectively when it occurs, the anesthesiologist must be vigilant in identifying patients at risk and in screening for this condition.

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    • Anaesthesia · Jun 2019

      Randomized Controlled Trial Multicenter Study

      A multicentre randomised controlled trial of the effect of intra-operative dexmedetomidine on cognitive decline after surgery.

      Dexmedetomidine may reduce post-operative delirium and at one month post-operative cognitive decline in elderly patients, associated with changes in brain-derived neurotrophic factor.

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    • Cochrane Db Syst Rev · Aug 2018

      Review Meta Analysis

      Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery.

      The use of anaesthetics in the elderly surgical population (more than 60 years of age) is increasing. Postoperative delirium, an acute condition characterized by reduced awareness of the environment and a disturbance in attention, typically occurs between 24 and 72 hours after surgery and can affect up to 60% of elderly surgical patients. Postoperative cognitive dysfunction (POCD) is a new-onset of cognitive impairment which may persist for weeks or months after surgery.Traditionally, surgical anaesthesia has been maintained with inhalational agents. End-tidal concentrations require adjustment to balance the risks of accidental awareness and excessive dosing in elderly people. As an alternative, propofol-based total intravenous anaesthesia (TIVA) offers a more rapid recovery and reduces postoperative nausea and vomiting. Using TIVA with a target controlled infusion (TCI) allows plasma and effect-site concentrations to be calculated using an algorithm based on age, gender, weight and height of the patient.TIVA is a viable alternative to inhalational maintenance agents for surgical anaesthesia in elderly people. However, in terms of postoperative cognitive outcomes, the optimal technique is unknown. ⋯ We are uncertain whether maintenance with propofol-based TIVA or with inhalational agents affect incidences of postoperative delirium, mortality, or length of hospital stay because certainty of the evidence was very low. We found low-certainty evidence that maintenance with propofol-based TIVA may reduce POCD. We were unable to perform meta-analysis for intraoperative hypotension or length of stay in the PACU because of heterogeneity between studies. We identified 11 ongoing studies from clinical trials register searches; inclusion of these studies in future review updates may provide more certainty for the review outcomes.

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