Anticipating and managing postoperative delirium and cognitive decline in adults

Anticipating and managing postoperative delirium and cognitive decline in adults. BMJ 2011; 343:d4331.

Sanders, RD, et al.

http://www.bmj.com/content/343/bmj.d4331.full?ath_user=nhsckeeling004&ath_ttok=%3CTjEjzaNeydLCjsXQ1g%3E

The brain is vulnerable during the perioperative period in people of all ages. Neurobehavioural disturbances are common complications of perioperative care, manifesting in three distinct forms: emergence delirium, postoperative delirium, and postoperative cognitive decline. Delirium is defined by the presence of disturbed consciousness (reduced clarity of awareness of the environment with reduced ability to focus, sustain, or shift attention) and a change in cognition (such as memory deficit, disorientation, or language disturbance) or the development of a perceptual disturbance that is not better accounted for by a pre-existing, established, or evolving dementia. Emergence delirium occurs on emergence from anaesthesia and sedation, with no lucid interval, and lasts approximately 30 minutes. Postoperative delirium lasts hours or longer, with or without lucid intervals. Postoperative cognitive decline refers to a more subtle cognitive impairment noted on neuropsychological tests that typically assess attention and memory.