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Prevention of postoperative delirium through the avoidance of potentially inappropriate medications in a geriatric surgical patient
  1. Kevin G Burfeind1,2,
  2. Andrés A Tirado Navales1,
  3. Brandon Michael Togioka1 and
  4. Katie Schenning1
  1. 1Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
  2. 2Medical Scientist Training Program, Oregon Health & Science University, Portland, Oregon, USA
  1. Correspondence to Dr Brandon Michael Togioka; togioka{at}ohsu.edu

Abstract

We demonstrate the utility of risk stratification for postoperative delirium in geriatric patients and show that postoperative delirium can be prevented in high-risk patients when potentially inappropriate medications (PIMs) (medications that are best avoided in older adults) are avoided. In this case, a 65-year-old woman underwent two debridement procedures with similar presurgical risk for postoperative delirium. There was no risk stratification or preoperative cognitive assessment in the first procedure, she received PIMs and developed postoperative delirium. In the second procedure, PIMs were intentionally avoided and postoperative delirium did not occur. This case supports recent recommendations from the European Society of Anaesthesiology, the American Society of Anesthesiologists and the American Geriatrics Society that providers assess a patient’s cognitive function and delirium risk profile preoperatively to appropriately guide perioperative management.

  • anaesthesia
  • geriatric medicine
  • unwanted effects / adverse reactions
  • delirium
  • surgery

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Footnotes

  • KGB and AATN are joint first authors.

  • Contributors The work was supervised by KS. The patient was under the care of KS. All authors shared in the analysis and interpretation of findings. The report was written by KGB, ATN, BMT and KS. All authors give final approval for the version submitted and agree to be accountable for all aspects of the work. KGB and ATN should be considered co-first authors as they shared equally in all aspects of this report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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