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Bret D. Alvis

, and Christopher G. Hughes

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date: 19 June 2021

Delirium in the postoperative period, characterized by inattention, disorganized thinking, disorientation, and/or altered levels of consciousness within the first few days after surgery, has been associated with significant increases in hospital stay, functional decline, prolonged cognitive dysfunction, and mortality. It is underdiagnosed without routine assessments with validated tools such as the Confusion Assessment Method (CAM), the 4AT, the Confusion Assessment Method for Intensive Care Unit (CAM-ICU), or the Intensive Care Delirium Screening Checklist (ICDSC). Prevention strategies for postoperative delirium include multimodal pain control, judicious use of medications that affect the sensorium, including benzodiazepines and anticholinergics, maintenance of appropriate volume status, and optimization of the patient’s environment. In patients who develop delirium with severe agitation, antipsychotic and alpha-2 agonist medications may be useful. Because postoperative delirium occurs commonly and is associated with worse outcomes, an understanding of its disease process, risk factors, and management is essential for an anesthesiologist.

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