Thinking clearly about postoperative delirium and perioperative medications: how concerned should we be?

Excerpt

Delirium has been described since Hippocrates’ time. In 1837, Sir Charles Dickens wrote the following detailed description of the syndrome in The Pickwick Papers—The Stroller’s Tale, “The mood in this account is also a mixture of frivolous buffoonery and abject terror. Illusions and hallucinations abound”.1 Since then, the understanding of this condition has been evolving. As anesthesiologists, we and other physicians involved in patient care in the perioperative period are concerned about postoperative delirium (POD). In the current issue of the Journal, Katznelson et al.2 have added to the literature by performing a retrospective chart review to determine the association between the perioperative use of beta-blockers and statins and the frequency of postoperative delirium in vascular surgery patients. They report a twofold increase in the odds ratio of postoperative delirium in patients receiving preoperative beta-blockers (odds ratio 2.06 with a 95% confidence interval [1.18–3.6]) and a 44% reduction in the odds ratio of postoperative delirium in patients receiving statins. …