Prevention and Management of Perioperative Delirium

Abstract

Delirium, arguably the most important perioperative morbidity in patients undergoing hip fracture surgery, is underdiagnosed, and undertreated in patients with fractures. However, delirium can be diagnosed with high sensitivity and specificity and effective means of reducing the severity of delirium and the improving outcomes are known. A comprehensive history and examination are necessary with a focus on the presence of acute alteration in awareness and attention. The cardinal features of delirium are acute onset of cognitive disturbances or attention deficits, and fluctuating course. Multidisciplinary teams with expertise in geriatrics have shown the most success in controlled studies of delirium postoperative prevention and treatment. Managing delirium is largely a matter of reducing and eliminating risk factors. Screening for cognitive impairment, medications known to increase the risk of delirium, and acute metabolic disturbances and acute infections is key. Treatment should include correction of acute problems and maintenance doses of analgesics. Eliminating physical restraints, mobilization, and minimizing room changes are important. Psychotropics are most helpful in persons with clear psychotic symptoms, and when used, they initially be given on a maintenance schedule.