Knowledge, opinions and clinical practice regarding postoperative delirium in older patients: A survey of nurses and anaesthetists

Influence of emergence delirium-related knowledge and nursing stress, practice, and confidence levels on the performance of recovery room nurses: A cross-sectional study

In this study, we aimed to explore the relationships between knowledge of emergence delirium (ED) and nursing stress, practice, confidence, and performance levels, as well as to identify factors influencing the performance of recovery room nurses. We conducted a cross-sectional study with 135 recovery room nurses at a general hospital in South Korea. The nurses completed a questionnaire from April 12 to April 25, 2023. Data were analyzed using multiple linear regression to examine factors associated with nursing performance in relation to ED. Nursing performance showed a significant negative correlation with nursing stress levels and a moderate positive correlation with nursing practice and confidence levels. Furthermore, ED education, nursing practice, and nursing confidence are factors influencing nursing performance. To enhance the performance of recovery room nurses in caring for patients with ED, we recommend developing a tailored educational program that focuses on increasing both the confidence levels and practical skills of nurses, thereby meeting the specific needs of the patients.

National survey on perioperative cognitive dysfunction

BACKGROUND

Perioperative cognitive dysfunction (PCD) is a very prevalent clinical syndrome due to the progressive aging of the surgical population.The aim of our study is to evaluate the clinical practice of Spanish anesthesiologists surveyed regarding this entity.

MATERIAL AND METHODS

Prospective online survey conducted by the Neurosciences Section and distributed by SEDAR.

RESULTS

544 responses were obtained, with a participation rate of 17%. 54.4% of respondents never make a preoperative assessment of cognitive impairment, only 7.5% always do it. 79.6% lack an intraoperative management protocol for the patient at risk of PCD. In the anesthetic planning, only 23.3% of the patients was kept in mind. Eighty-nine percent considered regional anesthesia with or without sedation preferable to general anesthesia for the prevention of PCD. 88.8% considered benzodiazepines to present a high risk of PCD. 71.7% considered that anesthetic depth monitoring could prevent postoperative cognitive deficit. Routine evaluation of postoperative delirium is low, only 14%. More than 80% recognize that PCD is underdiagnosed.

CONCLUSIONS

Among Spanish anesthesiologists surveyed, PCD is still a little known and underappreciated entity. It is necessary to raise awareness of the need to detect risk factors for PCD, as well as postoperative assessment and diagnosis. Therefore, the development of guidelines and protocols and the implementation of continuing education programs in which anesthesiologists should be key members of multidisciplinary teams in charge of perioperative care are suggested.

A survey about postoperative delirium in older patients among nurses and anaesthetists: implications for future practice and policy

BACKGROUND

Postoperative delirium is a major complication associated with anaesthesia and surgery, more commonly seen in older people.

AIMS

The aims of this study were to explore the knowledge and understanding of anaesthetists and nurses involved in anaesthesia through their responses to two case scenarios of postoperative delirium experienced by older people.

METHODS

A 30-item online survey was sent to 500 potential respondents.

RESULTS

Two hundred and twenty-six practitioners from Australia, New Zealand and Scotland responded. Most had no workplace protocols for anaesthesia planning in older people. There was substantial variability in practice in relation to postoperative delirium screening, detection, prevention and management.

CONCLUSIONS

Improvements in education and awareness, together with a more coherent approach, for example, as recommended in the European Society of Anaesthesiology Guidelines, could help to reduce the impact of postoperative delirium in older people. This should be combined with ongoing research into perioperative optimisation of detection, prevention and management of postoperative delirium.

Relation of serum melatonin levels to postoperative delirium in older patients undergoing major abdominal surgery

Objective

Postoperative delirium (POD) is a perennial and distressing complication in older patients, and it may be caused by various factors. This study aimed to determine whether serum melatonin levels are associated with POD in older patients who undergo major abdominal surgery.

Methods

We collected serum samples from patients undergoing major abdominal surgery. Melatonin was measured by enzyme-linked immunosorbent assay and delirium was assessed by the Confusion Assessment Method after surgery. We classified the patients into the POD group and non-POD group.

Results

A total of 120 patients met the inclusion criteria and 104 patients were included in the analysis. Postoperative serum melatonin levels were significantly lower than preoperative levels. Multivariate analyses showed that a longer duration of anesthesia (odds ratio [OR] = 1.29, 95% confidence interval [CI] = 1.02–1.64), advanced age (OR = 3.36, 95% CI = 1.37–8.22), and lower postoperative levels of melatonin (OR = 0.50, 95% CI = 0.25–1.00) were associated with POD.

Conclusions

Serum melatonin levels significantly decline after surgery and anesthesia. Significantly decreased serum melatonin concentrations postoperatively may be a biomarker for predicting POD in older patients undergoing major abdominal surgery with general anesthesia.

Multi-disciplinary and pharmacological interventions to reduce post-operative delirium in elderly patients: A systematic review and meta-analysis

STUDY OBJECTIVE

An estimated 80% of older people undergoing surgery develop postoperative delirium (POD) making them a high-risk group. Research in this area is growing fast but there is no established consensus on strategies for POD prevention or management. A systematic review and meta-analysis were conducted to synthesise data on clinical interventions used to reduce POD among older people undergoing elective and emergency surgery.

METHODS

A range of database searches generated 336 papers. A total of 25 studies met the inclusion criteria and were assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The studies were undertaken across the world.

RESULTS

This review identified a range of intervention approaches: comparisons between anaesthetic and sedatives agents, medication-specific interventions and multidisciplinary models of care. Results found more consistencies across multidisciplinary interventions than the pharmacological interventions. In pooled analyses, haloperidol (OR 0.74; 95% CI (confidence interval) 0.44, 1.26) was not statistically significantly associated with reduced POD incidence any more than a placebo.

CONCLUSION

There is a need to implement multidisciplinary interventions, as well as collaboration between clinicians on pre- and postoperative care practices regarding pharmacological interventions to more effectively reduce and manage POD in older people.