Older adults often face cognitive challenges, such as delirium and memory issues, after undergoing surgery. These complications can significantly impact their ability to live independently.
To address these concerns, a new set of evidence-based recommendations has been developed to help reduce the risks of postoperative neurocognitive disorders.
These guidelines were published in the journal Anesthesiology and aim to guide anesthesiologists and healthcare teams in improving outcomes for patients aged 65 and older.
Delirium is a common complication in older adults after surgery, presenting symptoms like confusion, lethargy, or agitation. While most patients recover, some experience lasting cognitive impairment.
Recognizing these risks, a task force led by Dr. Frederick Sieber of Johns Hopkins Hospital reviewed current research to create practical strategies for minimizing these complications.
The recommendations emphasize several key points to help healthcare providers take proactive steps:
Thorough Preoperative Evaluation
Older patients undergoing major surgery should have an expanded preoperative evaluation. Identifying cognitive impairments or frailty before surgery allows healthcare teams to tailor patient care.
Involving geriatric specialists, such as geriatricians or geriatric nurses, can help address specific risks. Additionally, educating patients and their families about the potential for postoperative delirium empowers them to recognize and respond to symptoms early.
Collaborative Decision on Anesthesia Type
For older adults, either neuraxial anesthesia (spinal or epidural) or general anesthesia can be appropriate, depending on the procedure.
The choice should be made through shared decision-making between the anesthesiologist and the patient, as no single type has been proven superior for preventing postoperative delirium. Both intravenous and inhaled anesthesia are considered safe options for this population.
Consider Dexmedetomidine
Dexmedetomidine, a sedative commonly used during surgeries, has shown promise in reducing the risk of postoperative delirium in older adults. However, its potential side effects, such as slowed heart rate or low blood pressure, should be carefully weighed when deciding its use.
Limit Certain Medications
Some medications, particularly those affecting the central nervous system, can increase the likelihood of delirium in older patients. It’s crucial to evaluate the risks and benefits of these drugs and minimize their use whenever possible.
While these recommendations provide valuable guidance, the authors acknowledge that further research is needed to fill gaps in the current understanding of postoperative cognitive complications.
Dr. Sieber highlighted the importance of these efforts, stating, “It is critically important for anesthesiologists to be aware of the risks of postoperative delirium and other neurocognitive disorders in older adults.
Our practice advisory aims to encourage an evidence-based approach to assessing and reducing these risks while guiding future research.”
In summary, the report provides practical strategies for managing and reducing cognitive and functional risks in older adults undergoing surgery.
By focusing on preoperative evaluations, thoughtful anesthesia choices, and careful medication management, these guidelines aim to protect the well-being of this vulnerable and growing population.
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The research findings can be found in Anesthesiology.
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