Preoperative management and postoperative delirium

Abstract

PubMed search shows that more than 140 articles on postoperative delirium (POD) have been published (28 articles in anesthesia journals) between January 1 and April 30, 2019. Two such articles regarding POD were published in the February issue of this journal [ 1 , 2 ]. These articles raised two perioperative risk factors for POD, handover of anesthesia care [ 1 ] and postoperative hypotonic fluid administration [ 2 ]. As handover of anesthesia care for long-duration surgery is inevitable, this facet of POD may be difficult to reduce. However, careful intraoperative handover between anesthesiologists might prevent POD although there are no studies to address this. Regarding hypotonic fluid administration, although the National Institute for Health and Care Excellence (NICE) guideline has recommended administration of hypotonic fluid (sodium; 35 mmol/L) for postoperative maintenance, hypotonic fluid administration was associated with a higher risk of postoperative delirium with hyponatremia [ 2 ]. Serum sodium level should be monitored during hypotonic fluid administration.