The updated ESAIC guideline on postoperative delirium (POD) comprises a total of 13 recommendations, including five with the recommendation grade \"strong\": 1.) The assessment of preoperative POD risk factors, 2.) the optimisation of the preoperative condition, 3.) the discussion of prevention strategies, 4) the implementation of a non-pharmacological multicomponent intervention in patients at risk of POD and 5.) the risk-benefit assessment of the prophylactic administration of dexmedetomidine. The latter applies in particular due to the partly contradictory data situation and different areas of application (cardiac surgery versus non-cardiac surgery patients). Index-based EEG monitoring of the depth of anaesthesia is also recommended, whereby other parameters such as burst suppression and density spectral array should also be included. If non-pharmacological measures fail, POD should be treated with haloperidol. In contrast, the use of benzodiazepines is not recommended.
UNASSIGNED: Die aktualisierte Leitlinie der ESAIC zum postoperativen Delir (POD) umfasst insgesamt 13 Empfehlungen, darunter fünf mit dem Empfehlungsgrad „stark“: 1.) Die Erfassung der präoperativen POD-Risikofaktoren, 2.) die Optimierung des präoperativen Zustands, 3.) die Besprechung von Präventionsstrategien, 4.) die Durchführung einer nicht-pharmakologischen Multikomponenten-Intervention bei POD-Risikopatienten und 5.) die Nutzen-Risiko-Abwägung bei der prophylaktischen Gabe von Dexmedetomidin. Letzteres gilt insbesondere auf Grund der teils widersprüchlichen Datenlage und unterschiedlicher Einsatzgebiete (herzchirurgische versus nicht-herzchirurgische Patienten). Weiterhin wird die indexbasierte EEG-Überwachung der Narkosetiefe empfohlen, wobei auch weitere Parameter, wie die Burst Suppression und das Density Spectral Array mit einbezogen werden sollten. Wenn nicht-pharmakologische Maßnahmen versagen, sollte das POD mit Haloperidol therapiert werden. Hingegen wird der Einsatz von Benzodiazepinen nicht empfohlen.

暂无摘要。

Postoperative delirium of cardiovascular surgery occurs in up to 26%-52% of patients after cardiovascular surgery and is associated with adverse outcomes, including increased hospital length of stay, higher cost of care, higher rates of readmission. The combination of multiple factors leads to postoperative delirium of cardiovascular surgery, including preoperative (previous psychiatric conditions and cognitive disfunction, cerebrovascular disease, age, cardiac insufficiency, and so on), intraoperative (duration of surgery>5 h, emergency surgery, anesthetic drugs, direct myocardial injury, and so on) and postoperative (pain, sleep disturbance, Deep sedation, duration of mechanical ventilation>72 h) risk factors. On the basis of the latest literature at home and abroad and the clinical experience of many experts, the Cardiac Critical Care Branch of China International Exchange and Promotive Association for Medical and Health sought to develop a consensus document\"Chinese expert consensus on the prevention and treatment of postoperative delirium of cardiovascular surgery\", in order to standardize the management of postoperative delirium of cardiovascular surgery and improve the prognosis of patients.
心脏及大血管术后谵妄对患者预后影响甚大，包括住院时间延长、住院费用和再住院率增加等，发病率高达26%~52%。其发生为多因素综合作用的结果，包括术前（精神病史及认知功能障碍、脑血管病史、高龄及心功能不全等）、术中（手术时间>5 h、急诊手术、术中心肌损伤及麻醉药物使用等）和术后（疼痛、睡眠障碍、深度镇静、机械通气时间>72 h等）的因素。为规范其管理，中国医疗保健国际交流促进会心脏重症分会结合国内外研究结果和多位专家的临床经验，在充分讨论和沟通的基础上制订了“心脏及大血管术后谵妄的防治中国专家共识”，为我国心脏及大血管术后谵妄诊治及预防提供规范化的标准，以期减少我国在心脏及大血管外科术后谵妄的发生和获得更好的预后。.

Postoperative delirium (POD) remains a common, dangerous and resource-consuming adverse event but is often preventable. The whole peri-operative team can play a key role in its management. This update to the 2017 ESAIC Guideline on the prevention of POD is evidence-based and consensus-based and considers the literature between 01 April 2015, and 28 February 2022. The search terms of the broad literature search were identical to those used in the first version of the guideline published in 2017. POD was defined in accordance with the DSM-5 criteria. POD had to be measured with a validated POD screening tool, at least once per day for at least 3 days starting in the recovery room or postanaesthesia care unit on the day of surgery or, at latest, on postoperative day 1. Recent literature confirmed the pathogenic role of surgery-induced inflammation, and this concept reinforces the positive role of multicomponent strategies aimed to reduce the surgical stress response. Although some putative precipitating risk factors are not modifiable (length of surgery, surgical site), others (such as depth of anaesthesia, appropriate analgesia and haemodynamic stability) are under the control of the anaesthesiologists. Multicomponent preoperative, intra-operative and postoperative preventive measures showed potential to reduce the incidence and duration of POD, confirming the pivotal role of a comprehensive and team-based approach to improve patients\' clinical and functional status.

Postoperative delirium (POD) is an acute change in the mental state with consciousness and attention deficits. It is a common complication after surgical procedures and can have serious consequences. Thus, the evidence- and consensus-based guidelines for POD appeals with the highest recommendation level that patients be regularly screened for delirium in the postoperative phase, from the recovery room to the fifth postoperative day and at least once per shift, using a validated test instrument for the detection of POD. In 2014, Marcantonio et al. published the 3D-CAM (3-Minute Diagnostic Interview for CAM-defined Delirium). In the 3D-CAM, the algorithm of the Confusion Assessment Method (CAM) is maintained by using individual elements that operationalize the evaluation of the criteria. Therefore, it requires less training, be faster to use, and, due to a standardized approach, has less interrater variability than the CAM, whereas the high sensitivity and specificity are maintained. Our goal was to translate the 3D-CAM from English to German, so as to make this instrument available to German-speaking countries. The translation of the 3D-CAM was based on the 2005 published guideline on Translation and Cultural Adaptation of Patient Reported Outcome Measures of the International Society for Pharmacoeconomics and Outcome Research. Three independent forward translations were harmonized to a preliminary translation, which then was translated back into the original language. Original authors reviewed the back translation. According to a cognitive debriefing, the translation was revised and in addition was adapted for use in the recovery room. Due to close contact with the original authors during the translation process, it was possible to ensure that the contents of the test instrument were remained intact during the translation process.
Das postoperative Delir (POD) ist eine häufige und schwerwiegende Komplikation nach chirurgischen Eingriffen. Darum müssen Patienten postoperativ gezielt auf die Entwicklung eines POD untersucht werden. Hierfür steht die Weiterentwicklung des bekannten Delir-Testinstruments CAM, das 3D-CAM, nun auch in deutscher Fassung zur Verfügung.