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Zeitschrift für Gerontologie und Geriatrie

, Volume 47, Issue 2, pp 105–109 | Cite as

Pharmacologic prevention of postoperative delirium

  • M. GoschEmail author
  • J.A. Nicholas
Beiträge zum Themenschwerpunkt

Abstract

Background

Delirium is common in older adults in the perioperative period, being a complication in up to 60 % of major surgical procedures. Delirium has a significant impact on the medical, functional, and cognitive outcomes of older patients. Treatment of delirium can be quite complex and requires individualized patient assessment, plan of care, and empirical treatment. In light of the difficulties associated with delirium treatment and the complexity and frequent inadequacy of nonpharmacologic preventive measures, several drugs have been evaluated for efficacy in delirium prevention.

Methods

We performed a literature review using Medline and the Cochrane Database for Systematic Reviews for randomized controlled trials, observational studies, and case reports evaluating pharmacologic treatments for prevention of delirium in older adults. Trials focused on patients with alcohol abuse were excluded.

Conclusion

There is some preliminary evidence that haloperidol, newer neuroleptics (e.g., risperidone or olanzapine), and melatonin may be effective in reducing the incidence of postoperative delirium, but the data are not robust. Health care teams should still focus on traditional delirium prevention efforts, and reserve specific pharmacologic prevention to individual high-risk patients for whom the risks and benefits have been carefully considered.

Keywords

Elderly Prophylaxis Drug therapy Surgery Postoperative complications 

Pharmakologische Prävention des postoperativen Delirs

Zusammenfassung

Hintergrund

Das Delirium hat bei älteren Patienten in der perioperativen Phase eine hohe Prävalenz. Es tritt als Komplikation bei bis zu 60 % aller größeren chirurgischen Eingriffe auf. Das Delir hat auch einen großen Einfluss auf das medizinische, funktionelle und kognitive Outcome der älteren Patienten. Die Behandlung des Delirs ist schwierig und erfolgt überwiegend empirisch. Sie erfordert neben einem Assessment auch eine individuelle Versorgung. Vor diesem Hintergrund sowie den Problemen in der Umsetzung von nichtpharmakologisch präventiven Maßnahmen wurden in den letzten Jahren verschiedene Substanzen im Hinblick auf ihr Potenzial in der pharmakologischen Prävention des Delirs untersucht.

Methoden

Die Autoren führten eine Literatursuche nach randomisierten, kontrollierten Studien, Beobachtungsstudien und Fallberichten in Medline und Cochrane Database of Systematic Reviews durch. Studien mit einem Fokus auf das Alkoholentzugsdelir wurden ausgeschlossen.

Schlussfolgerungen

Es gibt Hinweise, dass Haloperidol und neuere atypische Neuroleptika wie Risperidon und Olanzapin sowie auch Melatonin in der Lage sein könnten, die Inzidenz des postoperativen Delirs zu reduzieren. Behandlungsteams sollten sich aber weiterhin auf Maßnahmen der nichtpharmakologischen Prävention fokussieren. Eine pharmakologische Delirprophylaxe sollte Patienten mit einem hohen Risiko vorbehalten sein, allerdings auch nur nach nach einer individuellen Risiko/Nutzen-Abwägung.

Schlüsselwörter

Ältere Menschen Prophylaxe Medikamentöse Therapie Chirurgie Postoperative Komplikationen 

Notes

Compliance with ethical guidelines

Conflict of interest. Gosch and J.A. Nicholas state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of Geriatrics and Internal MedicineHospital HochzirlZirlAustria
  2. 2.Division of GeriatricsUniversity of Rochester Medical CenterRochesterUSA

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