Delírio pós-anestésico

Pedro Poso Ruiz-Neto; Neli A. Moreira; Maria Elizabet Furlaneto

doi:10.1590/S0034-70942002000200013

Artigo de Revisão

Delírio pós-anestésico

Postanesthetic delirium

Pedro Poso Ruiz-Neto; Neli A. Moreira; Maria Elizabet Furlaneto

http://dx.doi.org/10.1590/S0034-70942002000200013 Braz J Anesthesiol, vol.52, n2, p.242-250, 2002

PDF

Downloads: 0

Resumo

JUSTIFICATIVA E OBJETIVOS: Delírio pós-anestésico (DPA) é um distúrbio mental agudo, que se desenvolve mais freqüentemente em pacientes geriátricos. A fisiopatologia do DPA é pouco compreendida e muitas vezes pode ser confundido com outros distúrbios psiquiátricos. Neste estudo são revistos aspectos importantes dessa complicação anestésica em pacientes geriátricos. CONTEÚDO: São descritos os mecanismos fisiopatológicos, diagnóstico e o tratamento do DPA. CONCLUSÕES: Delírio é uma complicação comum e importante no pós-operatório de pacientes idosos. Tem sido relativamente negligenciado por pesquisadores e poucos estudos prospectivos têm sido conduzidos. Em nosso meio não há estudos epidemiológicos disponíveis, mas a observação clínica diária nas salas de recuperação pós-anestésica e enfermaria nos mostra que a ocorrência de DPA é freqüente, o que nos leva a crer na necessidade de melhor avaliação pré-operatória, adequado cuidado perioperatório e diagnóstico e tratamento precoces.

Palavras-chave

COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: Postanesthetic Delirium (PAD) is a common acute mental disorder most commonly developed in elderly patients. Its pathophysiology is poorly understood and PAD is often confused with others psychiatric disorders. This study aimed at reviewing important features of this anesthetic complication in geriatric patients. CONTENTS: Postanesthetic delirium pathophysiological mechanisms, diagnosis and treatment are described. CONCLUSIONS: Postanesthetic delirium is a frequent and severe complication for geriatric patients. Little attention has been given to PAD and few prospective studies have been carried out. There are no available epidemiological studies on this subject in Brazil, nonetheless routine observation of geriatric patients admitted to postanesthetic care units and wards shows that PAD is a common event, suggesting the need for better preoperative assessment, adequate perioperative care and early diagnosis and treatment.

Keywords

COMPLICATIONS

Referências

O`Keefe ST, Chonchubhair A. Postoperative Delirium in the elderly. Br J Anaesth. 1994;73:673-687.

Lipowski Z J. Delirium Acute Confusional States. 1990.

Marcantonio ER, Goldman L, Mangione CM. A clinical prediction rule for Delirium after elective non-cardiac surgery. JAMA. 1994;271:134-139.

Millar HR. Psychiatric morbidity in elderly surgical patients. Br J Psychiatry. 1981;138:17-20.

Seymour DG, Pringle R. Postoperative complications in the elderly surgical patients. Gerontology. 1983;29:262-270.

Seymour DG, Vaz FG. A prospective study of elderly general surgical patients: 2-postoperative complications. Age and Ageing. 1989;18:316-326.

Easton C, MacKenzie F. Sensory-perceptual alterations: Delirium in the intensive care unit. Heart and Lung. 1988;17:229-235.

Wilson LM. Intensive care Delirium: The effect of outside deprivation in a windowless unit. Arch Int Med. 1972;130:225-226.

Fisher BW, Flowerdew G. A simple model for predicting postoperative Delirium in older patients undergoing elective surgery. J Am Med Geriatr Soc. 1995;43:175-178.

Marcantonio ER, Flacker JM, Michaels M. Delirium is independently associated with poor functional recovery after hip fracture. J Am Geriatr Soc. 2000;48:618-624.

Gustafson Y, Berggren D, Brännström B. Acute confusional states in elderly patients treated for femoral neck fracture. J Am Geriatr Soc. 1988;36:525-530.

Sandberg O, Gustafson Y, Brännström B. Clinical profile of Delirium in older patients. J Am Geriatr Soc. 1999;47:1300-1306.

Lipowsk ZJ. Delirium (Acute confusional state). JAMA. 1987;258:1789-1792.

Rockwood K. Acute confusion in elderly medical patients. J Am Geriatr Soc. 1989;37:150-151.

Francis J, Martin D, Kapoor WN. A prospective study of Delirium in hospitalized elderly. JAMA. 1990;263:1097-1101.

Lindesay J, Macdonald A, Starke I. Delirium in the Elderly. 1990.

Chan D, Brennan NJ. Delirium: making the diagnosis, improving the prognosis. Geriatrics. 1999;54:28-42.

Mach JR, Dysken MW, Kuskowski M. Serum anticholinergic activity in hospitalized elderly with Delirium: A preliminary study. J Am Geriatr Soc. 1995;43:491-495.

Ross CA. CNS arousal systems: possible role in Delirium. Int Psychogeriatr. 1991;3:353-371.

Reubne DB, Yoshikawa TT, Besdine RW. Geriatrics Review Syllabus: A Core Curriculum in Geriatrics Medicine Am Geriatr Soc. 1996:120-123.

Mori E, Yamadori A. Acute confusional state and acute agitated Delirium: Occurrence after infarction in the right middle cerebral artery territory. Arch Neurol. 1987;44:1139-1143.

Tucker DM, Penland JG, Sandstead HH. Nutrition status and brain function in ageing. Am J Clin Nutrition. 1990;52:93-102.

Harper CG, Giles M, Finley-Jones R. Clinical signs in the Wernike-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. J Neurol Neur Psych. 1986;49:341-345.

Berggren D, Gustafson Y, Erikksson B. Postoperative confusion after anesthesia in elderly patients with femoral neck fractures. Anesth Analg. 1987;66:497-504.

Kaufer C. Etiology of consciousness disturbances in surgery. Minnesota Medicine. 1968;51:1509-1515.

Williams-Russo P, Urquhart BL, Sharrock NE. Post-operative Delirium: predictors and prognosis in elderly orthopedic patients. J Am Geriatr Soc. 1992;40:759-767.

Mesulam MM, Geschwind N. Disordered mental states in the postoperative period. Urol Clin North Am. 1976;3:199-215.

Inouye SK, Viscoli CM, Hormitz RI. A predictive model for Delirium in Hospitalized Elderly Medical Patients Based on Admission Characteristics. Ann Intern Med. 1993;119:474-481.

Willians-Russo P, Sharrock NE. Cognitive effects after epidural vs. general anesthesia in older adults: A randomized trial. JAMA. 1995;274:44-50.

Hole A, Terjesen T, Breivik H. Epidural versus general anesthesia for total hip arthroplasty in elderly patients. Acta Anaesthesiol Scand. 1980;24:279-287.

Inouye SK, van Dyck CH, Alessi CA. Clarifying confusion: The confusion assessment method: a new method for detection of Delirium. Ann Intern Med. 1990;113:941-948.

Fabri R. Estudo de validação e confiabilidade da versão em língua portuguesa do "Confusion Assessment Method" (CAM) na investigação de Delirium. .

Older MWJ, Dickenson JWT. Thiamine and the elderly orthopaedic patient. Age and Ageing. 1982;11:101-107.

Gustafson Y, Berggren D, Brannstrom B. A geriatric-anesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures. Am J Geriatric Soc. 1988;36:525-530.

Jacobson S, Schreibman B. Behavioral and pharmacological treatment of Delirium. Am Fam Physician. 1997;56:2001-2012.

Wolff HG, Curran D. Nature of Delirium and allied states. Arch Neurol Psychiatr. 1935;33:1175-215.

Richeimer SH. Psychological intervention in Delirium: An important component of management. Postgrad Med. 1987;81:173-80.

Jacobson AS. Delirium in the elderly. Psychiatric Clin North Am. 1997;20:91-110.

Salvo TG, OGara PT. Torsades de Poites caused by high dose intravenous haloperidol in cardiac patients. Clin Cardiol. 1995;18:285-290.

Delírio pós-anestésico

Postanesthetic delirium

Pedro Poso Ruiz-Neto; Neli A. Moreira; Maria Elizabet Furlaneto

Resumo

Palavras-chave

Abstract

Keywords

Referências

Links

Compartilhar

Braz J Anesthesiol