Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients

Postoperative delirium (POD) remains a common, dangerous and resource-consuming adverse event but is often preventable. The whole peri-operative team can play a key role in its management. This update to the 2017 ESAIC Guideline on the prevention of POD is evidence-based and consensus-based and considers the literature between 01 April 2015, and 28 February 2022. The search terms of the broad literature search were identical to those used in the first version of the guideline published in 2017. POD was defined in accordance with the DSM-5 criteria. POD had to be measured with a validated POD screening tool, at least once per day for at least 3 days starting in the recovery room or postanaesthesia care unit on the day of surgery or, at latest, on postoperative day 1. Recent literature confirmed the pathogenic role of surgery-induced inflammation, and this concept reinforces the positive role of multicomponent strategies aimed to reduce the surgical stress response. Although some putative precipitating risk factors are not modifiable (length of surgery, surgical site), others (such as depth of anaesthesia, appropriate analgesia and haemodynamic stability) are under the control of the anaesthesiologists. Multicomponent preoperative, intra-operative and postoperative preventive measures showed potential to reduce the incidence and duration of POD, confirming the pivotal role of a comprehensive and team-based approach to improve patients' clinical and functional status.

[Pharmacological Management of Postoperative Delirium]

Postoperative delirium (POD) is a complex disorder with significant implications for health and well-being. Over the last few years, there has been a significant increase in awareness of the pathophysiological processes, the different clinical forms and the prevention of POD. It is known that POD develops when anaesthetic- and surgery-related precipitating factors coincide with the patient's predisposing vulnerability. Consequently, assessing the preoperative physical, cognitive, psychological, social and resilience capabilities of patients scheduled for surgery is critical to assessing overall risk and determining optimal preoperative, intraoperative and postoperative management, particularly as pharmacological treatment options remain limited. For treatment, non-pharmacological measures remain in the foreground, pharmacological therapy is only used for severe symptoms, and should be symptom-oriented and low-dosed. There is no drug that is suitable for delirium treatment alone.