| Abstract [eng] |
Background. Postoperative delirium is a current problem in health care, as more and more surgical interventions are performed on elderly people who are prone to neuropsychiatric disorders after surgery. As pharmacological measures for the treatment and prevention of delirium have adverse effects on the patients and their efficacy has not been unequivocally proven, it is important to investigate the effectiveness of non-pharmacological measures for the prevention of post-operative delirium and aim for wider application of those measures in clinical practice. Aim of the study. To review the non-pharmacological means of prevention of postoperative delirium that can be used to prevent this disorder in clinical practice and to evaluate their effectiveness. Objectives. 1. To review the literature on non-pharmacological prevention of postoperative delirium, 2. to compile a list of the most frequently mentioned non-pharmagological measures for the prevention of postoperative delirium, 3. to evaluate the evidence in the literature on the effectiveness of the measures included in the list. Methods. Clinical trials and meta-analyses published between 2015 and 2024 were selected from „PubMed“ and „Cochrane“ databases using the keywords "postoperative delirium" and "prevention". Articles dealing with medication-based prevention measures were excluded. The selected literature was analysed and categorised into groups of prevention measures, and conclusions on the effectiveness of prevention measures were drawn based on the selected scientific articles. Results. This work included 67 clinical trials and systematic reviews and meta-analyses. The main preventive measures identified were: acupuncture, arterial pressure monitoring and control, anaesthetic depth monitoring and control, cognitive stimulation, sleep-wake cycle support, cerebral oxygenation monitoring and control, prevention programs, rehabilitation programs, selection of anaesthetic technique, pain relief and other preventive measures. Conclusions. According to the reviewed literature, the most effective protection against delirium is provided by multifactorial prevention programmes and adequate perioperative pain relief. Anesthetic techniques or other preventive measures are not clearly evaluated in the scientific literature, and therefore no firm conclusions can be drawn about their effectiveness. |
