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Prevention and Treatment of Postoperative Delirium and Postoperative Cognitive Dysfunction

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Anesthesia and Neurotoxicity

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Abstract

Postoperative delirium (POD) is a common complication of surgery and an acute and fluctuating neurological disorder that is characterized by disturbances of consciousness, attention, and perception. Postoperative cognitive dysfunction (POCD) is a subtle transient cognitive decline that occurs for weeks or months after surgery. POCD may influence isolated cognition domains, such as verbal memory, visual memory, attention, and concentration, and is not necessarily accompanied by a change in consciousness. Although POD is a transient and curable clinical condition, it may encompass POCD and increase postoperative mortality. Saczynski et al. demonstrated that patients with POD had more severe POCD at 1 week and 1 year after surgery and that the longer the POD continued, the worse the cognitive dysfunction. Prevention and treatment of POD may prevent POCD. POCD influences both the short-term and long-term prognosis. Patients with POCD at 1 week after surgery had greater difficulty returning to work and tended to receive social transfer payments, whereas those with POCD at 3 months after surgery were associated with increased mortality. In this chapter, we describe POD and POCD and particularly focus on their prevention and treatment.

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References

  1. Dyer CB, Ashton CM, Teasdale TA (1995) Postoperative delirium. A review of 80 primary data-collection studies. Arch Intern Med 155:461–465

    Article  CAS  PubMed  Google Scholar 

  2. Dasgupta M, Dumbrell AC (2006) Preoperative risk assessment for delirium after noncardiac surgery: a systematic review. J Am Geriatr Soc 54:1578–1589

    Article  PubMed  Google Scholar 

  3. Vochteloo AJ, Moerman S, van der Burg BL et al (2011) Delirium risk screening and haloperidol prophylaxis program in hip fracture patients is a helpful tool in identifying high-risk patients, but does not reduce the incidence of delirium. BMC Geriatr 11:39. doi:10.1186/1471-2318-11-39

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kalisvaart KJ, Vreeswijk R, de Jonghe JF et al (2006) Risk factors and prediction of postoperative delirium in elderly hip-surgery patients: implementation and validation of a medical risk factor model. J Am Geriatr Soc 54:817–822

    Article  PubMed  Google Scholar 

  5. Marcantonio ER, Goldman L, Mangione CM (1994) A clinical prediction rule for delirium after elective noncardiac surgery. JAMA 271:134–139

    Article  CAS  PubMed  Google Scholar 

  6. Ouimet S, Kavanagh BP, Gottfried SB et al (2007) Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 33:66–73

    Article  PubMed  Google Scholar 

  7. Chaput AJ, Bryson GL (2012) Postoperative delirium: risk factors and management: continuing professional development. Can J Anaesth 59:304–320

    Article  PubMed  Google Scholar 

  8. Mason SE, Noel-Storr A, Ritchie CW (2010) The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. J Alzheimers Dis 22:67–79

    Article  PubMed  Google Scholar 

  9. Nishikawa K, Nakayama M, Omote K et al (2004) Recovery characteristics and post-operative delirium after long-duration laparoscope-assisted surgery in elderly patients: propofol-based vs. sevoflurane-based anesthesia. Acta Anaesthesiol Scand 48:162–168

    Article  CAS  PubMed  Google Scholar 

  10. Sieber FE, Zakriya KJ, Gottschalk A et al (2010) Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc 85:18–26

    Article  PubMed  PubMed Central  Google Scholar 

  11. Radtke FM, Franck M, Lendner J et al (2013) Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth 110:i98–105

    Article  CAS  PubMed  Google Scholar 

  12. Mashour GA, Woodrum DT, Avidan MS (2015) Neurological complications of surgery and anaesthesia. Br J Anaesth 114:194–203

    Article  CAS  PubMed  Google Scholar 

  13. Nunomiya S (2012) Delirium. ICU & CCU 36:507–513

    Google Scholar 

  14. Marcantonio ER, Flacker JM, Wright RJ et al (2001) Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 49:516–522

    Article  CAS  PubMed  Google Scholar 

  15. Lundström M, Olofsson B, Stenvall M et al (2007) Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study. Aging Clin Exp Res 19:178–186

    Article  PubMed  Google Scholar 

  16. Gosch M, Nicholas JA (2014) Pharmacologic prevention of postoperative delirium. Z Gerontol Geriatr 47:105–109

    Article  CAS  PubMed  Google Scholar 

  17. Wang W, Li HL, Wang DX et al (2012) Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial. Crit Care Med 40:731–739

    Article  PubMed  Google Scholar 

  18. Prakanrattana U, Prapaitrakool S (2007) Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery. Anaesth Intensive Care 35:714–719

    CAS  PubMed  Google Scholar 

  19. Larsen KA, Kelly SE, Stern TA et al (2010) Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial. Psychosomatics 51:409–418

    Article  CAS  PubMed  Google Scholar 

  20. Aizawa K, Kanai T, Saikawa Y et al (2002) A novel approach to the prevention of postoperative delirium in the elderly after gastrointestinal surgery. Surg Today 32:310–314

    Article  PubMed  Google Scholar 

  21. Sultan SS (2010) Assessment of role of perioperative melatonin in prevention and treatment of postoperative delirium after hip arthroplasty under spinal anesthesia in the elderly. Saudi J Anaesth 4:169–173

    Article  PubMed  PubMed Central  Google Scholar 

  22. Liptzin B, Laki A, Garb JL et al (2005) Donepezil in the prevention and treatment of post-surgical delirium. Am J Geriatr Psychiatry 13:1100–1106

    Article  PubMed  Google Scholar 

  23. Gamberini M, Bolliger D, Lurati Buse GA et al (2009) Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery—a randomized controlled trial. Crit Care Med 37:1762–1768

    Article  CAS  PubMed  Google Scholar 

  24. Leung JM, Sands LP, Rico M et al (2006) Pilot clinical trial of gabapentin to decrease postoperative delirium in older patients. Neurology 67:1251–1253

    Article  CAS  PubMed  Google Scholar 

  25. Radtke FM, Franck M, Lorenz M et al (2010) Remifentanil reduces the incidence of post-operative delirium. J Int Med Res 38:1225–1232

    Article  CAS  PubMed  Google Scholar 

  26. Pasin L, Landoni G, Nardelli P et al (2014) Dexmedetomidine reduces the risk of delirium, agitation and confusion in critically ill patients: a meta-analysis of randomized controlled trials. J Cardiothorac Vasc Anesth 28:1459–1466

    Article  CAS  PubMed  Google Scholar 

  27. Fok MC, Sepehry AA, Frisch L et al (2015) Do antipsychotics prevent postoperative delirium? A systematic review and meta-analysis. Int J Geriatr Psychiatry 30:333–344

    Article  PubMed  Google Scholar 

  28. Devlin JW, Roberts RJ, Fong JJ et al (2010) Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med 38:419–427

    Article  CAS  PubMed  Google Scholar 

  29. van Eijk MM, Roes KC, Honing ML et al (2010) Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomised trial. Lancet 376:1829–1837

    Article  PubMed  Google Scholar 

  30. Moller JT, Cluitmans P, Rasmussen LS et al (1998) Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International study of post-operative cognitive dysfunction. Lancet 351:857–861

    Article  CAS  PubMed  Google Scholar 

  31. Abildstrom H, Rasmussen LS, Rentowl P et al (2000) Cognitive dysfunction 1-2 years after non-cardiac surgery in the elderly. ISPOCD group. International study of post-operative cognitive dysfunction. Acta Anaesthesiol Scand 44:1246–1251

    Article  CAS  PubMed  Google Scholar 

  32. Monk TG, Weldon BC, Garvan CW et al (2008) Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology 108:18–30

    Article  PubMed  Google Scholar 

  33. Hudetz JA, Iqbal Z, Gandhi SD et al (2007) Postoperative cognitive dysfunction in older patients with a history of alcohol abuse. Anesthesiology 106:423–430

    Article  PubMed  Google Scholar 

  34. Hudetz JA, Patterson KM, Amole O et al (2011) Postoperative cognitive dysfunction after noncardiac surgery: effects of metabolic syndrome. J Anesth 25:337–344

    Article  PubMed  Google Scholar 

  35. Krenk L, Rasmussen LS, Kehlet H (2010) New insights into the pathophysiology of postoperative cognitive dysfunction. Acta Anaesthesiol Scand 54:951–956

    Article  CAS  PubMed  Google Scholar 

  36. Cibelli M, Fidalgo AR, Terrando N et al (2010) Role of interleukin-1beta in postoperative cognitive dysfunction. Ann Neurol 68:360–368

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Hole A, Terjesen T, Breivik H (1980) Epidural versus general anaesthesia for total hip arthroplasty in elderly patients. Acta Anaesthesiol Scand 24:279–287

    Article  CAS  PubMed  Google Scholar 

  38. Evered L, Scott DA, Silbert B et al (2011) Postoperative cognitive dysfunction is independent of type of surgery and anesthetic. Anesth Analg 112:1179–1185

    Article  PubMed  Google Scholar 

  39. Hartholt KA, van der Cammen TJ, Klimek M (2012) Postoperative cognitive dysfunction in geriatric patients. Z Gerontol Geriatr 45:411–416

    Article  CAS  PubMed  Google Scholar 

  40. Tian A, Ma H, Cao X et al (2015) Vitamin D improves cognitive function and modulates Th17/T reg cell balance after hepatectomy in mice. Inflammation 38:500–509

    Article  CAS  PubMed  Google Scholar 

  41. Jin WJ, Feng SW, Feng Z et al (2014) Minocycline improves postoperative cognitive impairment in aged mice by inhibiting astrocytic activation. Neuroreport 25:1–6

    PubMed  Google Scholar 

  42. Zhang J, Tan H, Jiang W et al (2014) Amantadine alleviates postoperative cognitive dysfunction possibly by increasing glial cell line-derived neurotrophic factor in rats. Anesthesiology 121:773–785

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Kawano T, Takahashi T, Iwata H et al (2014) Effects of ketoprofen for prevention of postoperative cognitive dysfunction in aged rats. J Anesth 28:932–936

    Article  PubMed  Google Scholar 

  44. Sun D, Yang L, Wu Y et al (2014) Effect of intravenous infusion of dobutamine hydrochloride on the development of early postoperative cognitive dysfunction in elderly patients via inhibiting the release of tumor necrosis factor-α. Eur J Pharmacol 741:150–155

    Article  CAS  PubMed  Google Scholar 

  45. Tian Y, Zhao P, Li L et al (2014) Pre-emptive parecoxib and post-operative cognitive function in elderly patients. Int Psychogeriatr 15:1–8

    Google Scholar 

  46. Fang Q, Qian X, An J et al (2014) Higher dose dexamethasone increases early postoperative cognitive dysfunction. J Neurosurg Anesthesiol 26:220–225

    Article  PubMed  Google Scholar 

  47. Ottens TH, Dieleman JM, Sauër AM et al (2015) Effects of dexamethasone on cognitive decline after cardiac surgery: a randomized clinical trial. Anesthesiology 121:492–500

    Article  Google Scholar 

  48. Sun JH, Wu XY, Wang WJ et al (2012) Cognitive dysfunction after off-pump versus on-pump coronary artery bypass surgery: a meta-analysis. J Int Med Res 40:852–858

    Article  CAS  PubMed  Google Scholar 

  49. van Harten AE, Scheeren TW, Absalom AR (2012) A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia. Anaesthesia 67:280–293

    Article  PubMed  Google Scholar 

  50. Goto T, Maekawa K (2014) Cerebral dysfunction after coronary artery bypass surgery. J Anesth 28:242–248

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan

    Mitsuru Ida & Masahiko Kawaguchi

Authors
  1. Mitsuru Ida
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  2. Masahiko Kawaguchi
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Correspondence to Mitsuru Ida .

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Editors and Affiliations

  1. Graduate School of Medicine, Hokkaido University Graduate, School of Medicine, Sapporo, Hokkaido, Japan

    Yuji Morimoto

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Ida, M., Kawaguchi, M. (2017). Prevention and Treatment of Postoperative Delirium and Postoperative Cognitive Dysfunction. In: Morimoto, Y. (eds) Anesthesia and Neurotoxicity. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55624-4_8

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  • DOI: https://doi.org/10.1007/978-4-431-55624-4_8

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  • Print ISBN: 978-4-431-55623-7

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