- Of all surgical patients, 37 to 46 percent are affected by POD.1
- Risk increases up to 87 percent depending on the patient age and type of surgery.1
- In-hospital POD costs the U.S. healthcare system $150 billion per year.2
Addressing the Risk of Postoperative Delirium
- POD is a common complication that requires prevention and immediate treatment.
- Prevention is important and possible, and it should be a key priority.
- Providers must focus on the prevention of POD, not just treatment of it after the fact.
- All patients, regardless of age, should be monitored.3
- Monitoring of depth of anesthesia and avoiding deep anesthesia are strongly recommended.3
Brain Monitoring Technology for Enhanced Recovery Protocols
“Just Right” Anesthesia Titration
- Anesthetic drug use is decreased up to 23 percent.7,8,9
- Wake-up time is up to 40 percent faster.8
- Postoperative nausea and vomiting may be reduced up to 37.5 percent.9,10
- Outcomes are improved and patient satisfaction is increased.9,10
Brain Function Monitoring Insights
- Patient-specific drug titration (a 50 percent reduction in propofol administration during hypothermic cardiopulmonary bypass).11
- Faster wake-up, recovery, and discharge from the PACU.7
- Lowered incidence of intraoperative awareness (approximately 80 percent lower compared to routine care in total intravenous, inhaled, and balanced anesthesia patients).6,12,13
- May reduce delirium by an average of 36 percent.1,14–16
1. Whitlock E, Vannucci A, Avidan M. Postoperative delirium. Minerva Anestesiol. 2011 April; 77(4): 448–456.
2. American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. Postoperative delirium in older adults: Best practice statement from the American Geriatrics Society. Intraoperative Measures to Prevent Delirium. J Am Coll Surg. 2014; 220(2):136–148.e1.
3. Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol. 2017;34(4):192–214.
4. Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg. 2013;37(2):259–284.
5. Fritz BA, Kalarickal PL, Maybrier HR, et al. Intraoperative electroencephalogram suppression predicts postoperative delirium. Anesth Analg. 2016;122(1):234–242.
6. Zhang C, Xu L, Ma Y, et al. Bispectral index monitoring prevents awareness during total intravenous anesthesia: a prospective, randomized, double-blinded, multi-center controlled trial. Chin Med J. 2011;124(22):3664-3669.
7. Gan TJ, Glass PS, Windsor A, et al. Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group. Anesthesiology. 1997;87:808-15.
8. Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev. 2014;(6):CD003843.
9. Liu SS. Effects of bispectral index monitoring on ambulatory anesthesia: a meta-analysis of randomized controlled trials and a cost analysis. Anesthesiology. 2004;101(2):311-315.
10. Luginbuhl M, Wuthrich S, Petersen-Felix S, et al. Different benefits of bispectral index (BIS) in desflurane and propofol anesthesia. Acta Anaesthesiol Scand. 2003;47:165-173.
11. Chiu CL, Ong G, Majid AA. Impact of bispectral index monitoring on propofol administration in patients undergoing cardiopulmonary bypass. Anaesthesia Intensive Care. 2007;35:342-347.
12. Myles PS, Leslie K, McNeil J, et al. Bispectral index monitoring to prevent awareness during anesthesia: the B-Aware randomised controlled trial. Lancet. 2004;363(9423):1757-1763.
13. Ekman A, Lindholm ML, Lennmarken, Sandin R. Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand. 2004;48(1):20-26.
14. Chan MT, Cheng BC, Lee TM, et al. BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol. 2013; 25: 33-42.
15. Radtke FM, Franck M, Lendner J, et al. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth. 2013; 110: i98-105.
16. Sieber FE, Zakriya KJ, Gottschalk A, et al. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc. 2010 Jan;85(1):18-26.
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