IMPROVEMENT OF TECHNOLOGIES OF PERIOPERATIVE PREVENTION OF DELIRIUM IN ELDERLY PATIENTS

Demiter I. N., Dolya O. S., Gudz D. P., Danylyuk M. B., Vorotintsev S. I.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Abstract. Background. Postoperative delirium is an acute nonspecific polyetiological syndrome, which is manifested by intermittent disorders of attention, consciousness, thinking and perception. The purpose of the work is improvement of technologies for postoperative prevention of delirium with the use of regional anesthesia techniques and alpha-2 agonists. Materials and Methods. The single-center prospective study consistently included 135 elderly patients who underwent abdominal surgery, including 30 patients (comparison group) who underwent routine surgery, 105 patients who underwent emergency surgery, of whom 60 (study group) with a high risk of POD, which was used to prevent postoperative delirium. Results. The incidence of delirium in planned patients was 3% (n=1), in control patients - 36% (n=16), in patients of subgroup EA - 5% (n=1), RA - 10% (n=2), RA+D - 15% (n=3). When using narcotic analgesics for postoperative analgesia AMD occurs 6 times more often (odds ratio 6.6 to 95%, confidence interval 1.62-27.5). Restoration of cognitive function in patients of the study group was recorded on the second day after surgery with significant improvement on the fifth day (p=0.04). In planned patients in the first five days of the postoperative period, the cognitive status relative to baseline did not change (p=0.2). In patients of the control group, cognitive impairment during the study significantly worsened on the second postoperative day - 3.0 [2.0; 4.0] points (p=0.02) and on the third day after surgery - 3.0 [1.0; 4.0] points (p=0.01), when the return to baseline was observed on the fifth day after surgeryConclusions. The level of wear and tear does not significantly affect the incidence of postoperative delirium, when preoperative cognitive impairment increases the risk of delirium.. The use of regional methods of anesthesia in the postoperative period reduces the incidence of POD by 30% in epidural anesthesia, by 26% in the performance of anterior abdominal wall blockades and by 20% in the combination of regional techniques with dexmedetomedin.

: postoperative delirium, elderly patients, abdominal surgery

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«Bulletin of problems biology and medicine» Issue 1 (159), 2021 year, 47-53 pages, index UDK 616-089.5-06:616.89-008.42]-039.71-053.9

10.29254/2077-4214-2021-1-159-47-53