title: Perioperative management in order to minimise postoperative delirium and postoperative cognitive dysfunction: Results from a Swedish web-based survey.
abstract: Cognitive side-effects such as emergence agitation (EA), postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are not infrequently complicating the postoperative care especially in elderly and fragile patients. The aim of the present survey was to gain insight regarding concern and interest in prevention and treatment strategies for postoperative delirium and dysfunction, and the use of EEG-based depth-of-anaesthesia monitoring possibly reducing the risk for cognitive side effects among anaesthesia personnel.
  
  
  METHODS
  A web-based validated questionnaire was sent to all Swedish anaesthesiologists and nurse anaesthetists during summer 2013. The questionnaire consisted of 3 sections, subjective preferences, routines and practices related to the perioperative handling of EA, POD, POCD.
  
  
  RESULTS
  The response rate was 52%. Cardiovascular/pulmonary risks where assessed as importance by 98, 97% of responders while 69% considered the risk of neurocognitive side-effects important. When asked explicitly around cognitive side-effects 89%, 37% and 44% assessed awareness, POC and POD respectively of importance. EEG-based depth-of-anaesthesia monitors were used in 50% of hospitals. The responders were not convinced about the benefits of such monitors even in at-risk patients. Structured protocols for the management of postoperative cognitive side-effects were available only in few hospitals.
  
  
  CONCLUSIONS
  Swedish anaesthesia personnel are concerned about the risk of postoperative cognitive side-effects but are more concerned about cardiovascular/pulmonary risks, pain, PONV and the rare event of awareness. Most respondents were not convinced about the use of depth-of-anaesthesia monitors. There is a need to improve knowledge around risk factors, prevention and management of postoperative cognitive side effects.
authors.affiliation: Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
authors.forename: Pether K
authors.initials: PK
authors.lastname: Jildenstål
authors.affiliation: Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
authors.forename: Narinder
authors.initials: N
authors.lastname: Rawal
authors.affiliation: Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
authors.forename: Jan L
authors.initials: JL
authors.lastname: Hallén
authors.affiliation: Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden ; CAMTÖ, Centre for Assessment of Medical Technology in Örebro, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Berggren
authors.affiliation: Institution for Clinical Science, Karolinska Institutet, Danderyds Hospital, 182 88 Stockholm, Sweden.
authors.forename: Jan G
authors.initials: JG
authors.lastname: Jakobsson
keywords: Auditory evoked potential; Bi-spectral index; Depth of anaesthesia monitors; Emergence agitation; General anaesthesia; Postoperative cognitive dysfunction; Postoperative cognitive side effects; Postoperative delirium; Surgery