With the significant improvement of anesthesia and surgical safety, the proportion of surgery in elderly patients is increasing year by year, and postoperative complications in elderly patients are also increasing. In clinical observation, we have encountered many elderly people with some neurological abnormalities after surgery, and some family members will report the relevant situation during the postoperative visit:
"My dad became grumpy and irritable after the operation, and he didn't cooperate with nursing and treatment......"
"It doesn't hurt and there is no other discomfort, but I don't like to talk, I don't like to talk to people, I don't like to talk to people, I don't like to ...... before surgery" "I don't sleep at night, I always sleep during the day, and black and white are reversed......"
"The old man always said that he saw insects crawling on the window......"
"She didn't know that she was in the hospital, so she said that she was at home now, and she still had a lot of work to do, and she was always clamoring to work......"
Whenever we see such a patient, we know that postoperative delirium has occurred, and successive visits will show that most patients gradually recover within a week.
Postoperative delirium (POD) is a very common complication in patients over 65 years of age, and the prognosis is a kind of acute and transient central nervous system dysfunction characterized by inattention, decreased level of consciousness, decreased mental activity, cognitive dysfunction, and sleep-wake cycle disorders.
There are three types: hyperactive (agitated), reduced activity (quiet), and mixed. The clinical manifestations are impaired consciousness (decreased clarity of awareness of the environment, accompanied by loss of attention); cognitive impairment (memory loss, disorientation, language impairment, perceptual impairment and dementia syndrome); sleep disturbances (alterations in the sleep-wake cycle); Affective disorders (intermittent fear, delusions, anxiety, depression, agitation, apathy, anger, euphoria, irregular transitions).
This disorder of consciousness and cognition manifests itself in a short period of time and has a fluctuating process. Severe disease can lead to prolonged mechanical ventilation and ICU stays, as well as long-term early postoperative cognitive impairment (POCD), increasing hospital costs, dementia, and mortality.
Postoperative delirium occurs in 9% to 87% of patients and is complex and can be precipitated by a number of factors. Including: age >65 years old, preoperative depression and dementia, preoperative use of psychotropic drugs, cardiopulmonary diseases, alcoholism, long-term use of opioid analgesics, intraoperative hypotension, hypertension, hypothermia, hyperglycemia, hypoglycemia, intraoperative anesthetic drug application, surgical stress reaction, postoperative pain, infection, etc.
The most commonly reported risk factors include baseline cognitive impairment, advanced age, and multiple medical complications, with older age being an independent risk factor.
The best way to reduce delirium and its associated complications is to prevent it.
1. Preoperative comorbidities should be improved, and preoperative anti-anxiety should be done for patients with advanced age and low baseline level of cognitive function, so as to give them a sufficient sense of security and gain full trust.
2. Minimize the use of drugs that are easy to cause delirium during surgery, prophylactically apply drugs that can reduce the incidence of postoperative delirium, or use them in combination with postoperative analgesic drugs. Studies have shown that dexmedetomidine combined with sufentanil for postoperative analgesia can effectively reduce the incidence of postoperative delirium.
Postoperative delirium has occurred, and we can do the following:
1. Recommended drugs: haloperidol, olanzapine, risperidone, dexmedetomidine. (Apply as directed by a physician)
2. Actively treat pain and other postoperative comorbidities.
3. Keep the rest environment quiet and well-lit after surgery. Strengthen care to avoid urinary retention and infection.
4. Give more companionship, encourage the patient to be taken care of by family members who are familiar with the patient, and try to avoid physical coercion.
A full understanding and understanding of postoperative delirium will reduce unnecessary fear, actively cope with and deal with accompanying symptoms, and most patients will gradually recover within a week.
Wang Xifan, Department of Anesthesiology, Mudanjiang Cancer Hospital
【Tips】Pay attention, there are a large number of professional medical science popularization, revealing those things about surgical anesthesia for you~