title: Patients prone for postoperative delirium: preoperative assessment, perioperative prophylaxis, postoperative treatment.
abstract: OBJECTIVE
  The aim of this study was to review current literature on identification of patients at risk for postoperative delirium (POD) and to summarize recent findings on prophylaxis and treatment.
  
  
  RESULTS
  Age and preoperative cognitive impairment are among the most important risk factors of POD. POD is the result of a complex interplay of predisposing and precipitating factors. Thus, both prophylaxis and treatment require multicomponent intervention programs. No single medication to prevent or treat POD is available. Avoiding too deep anesthesia, avoiding additional psychoactive substances including benzodiazepines and intravenous opioids, and effective pain management as well as early mobilization are essential.
  
  
  CONCLUSIONS
  An increase of the proportion of elderly patients undergoing surgery will lead to a higher incidence of POD. Preoperative assessment should facilitate identification of patients at high risk. Perioperative management should include monitoring depth of anesthesia, preference for nonopioid pain therapy, early regular delirium monitoring starting in the recovery room, avoiding ICU-sedation, early mobilization and exercise, and cognitive training.
authors.affiliation: aPD Dr med. Ulf Guenther DESA, EDIC, Linda Riedel, Klinik für Anästhesiologie & Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Germany bPD Dr med. Finn M. Radtke, Anæstesiafdelingen, Næstved Sygehus, Næstved, Denmark.
authors.forename: Ulf
authors.initials: U
authors.lastname: Guenther
authors.forename: Linda
authors.initials: L
authors.lastname: Riedel
authors.forename: Finn M
authors.initials: FM
authors.lastname: Radtke
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000009:adverse effects*; D060825:Cognitive Dysfunction / Q000150:complications; D000071257:Emergence Delirium / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015444:Exercise; D000073496:Frailty / Q000150:complications; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D007362:Intensive Care Units / Q000592:standards; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*
chemical_list: D006993:Hypnotics and Sedatives