21– 23 Intraoperative EEG monitoring likely prevents excessive anesthetic administration to vulnerable patients and thus prevention of postoperative delirium associated with deeper anesthesia. Recent randomized controlled trials with intraoperative electroencephalogram (EEG) monitoring guiding clinical IV anesthesia and volatile-based general anesthesia administration has shown that it might decrease the incidence of postoperative delirium. 17– 20Īs postoperative delirium is so common, its prevention will have major clinical impact. These include acute medical conditions: sleep disturbance, sensory impairment, pain, social isolation, daylight depression, infections, withdrawal syndrome, dehydration, anemia, blood transfusion, electrolyte abnormalities, acid-base abnormalities, hypoxemia, temperature derangements, seizures, and endocrine dysfunction. But still there are important risk factors for delirium that should be prevented. 7, 15, 16 With such complexity, no single intervention is likely to prevent delirium. 12– 14ĭelirium is difficult to prevent or treat because it has several pathological pathways, including neurotransmitter imbalance, neuroinflammation, endothelial dysfunction, and impaired oxidative metabolic and altered availability of large neutral amino acids. 10, 11 The confusion assessment method for general population versus intensive care unit patients who are unable to speak have been most widely used to diagnose delirium. 6– 9 It is still frequently undiagnosed because the majority of postoperative delirium patients may appear normal or perhaps slightly lethargic. Postoperative delirium is a marker of brain vulnerability, and its occurrence suggests the possibility of underlying neurological disease such as baseline cognitive impairment and early or preclinical dementia. 4 Postoperative delirium has high associated morbidity and mortality, which may extend up to a decade after surgery. 2, 3 Delirium is a common and important postoperative complication to recognize as it has an incidence of 10% to 18% following general surgery, 53% following orthopedic surgery, and 74% after cardiac surgery. 1 We have emphasized on early diagnosis and management strategies of neurological disorders in the perioperative period to minimize morbidity and mortality of patients.ĭelirium is an acute change in mental status with a fluctuating change from baseline mental status, with features of inattention and altered thinking. Most important consideration is the management and understanding of pathophysiology of these disorders and evaluation of new neurological changes that occur preoperatively. In this review, we discuss management of some of the commonly encountered neurological conditions, such as delirium, stroke, epilepsy, myasthenia gravis (MG), and Parkinson disease, in the perioperative phase. This time frame can be short for emergent surgeries and lengthy for elective procedures. Postoperative is a time period between postanesthetic care units and resolution of surgical sequel. Intraoperative is a time period when the patient is transferred to operating room and subsequently to postanesthetic care unit. Preoperative phase includes attempts to limit anxiety, medical tests, and preoperative fasting. Perioperative generally refers to 3 phases of surgery: preoperative, intraoperative, and postoperative. Perioperative management of these patients can be challenging due to the diverse nature of neurological disease, resulting in diverse clinical manifestations. Many patients with neurological disease undergo surgery it can relate to their neurological disease or an unrelated condition.
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