Neuroimaging is typically limited to patients with recent falls or head trauma, use of anticoagulation, focal neurologic signs, or fever without other explanation.3 The prescribing practitioner may use antipsychotics at the lowest effective dose for the shortest possible duration to treat patients who are severely agitated or distressed, and are threatening substantial harm to self and/or others. In all cases, treatment with antipsychotics should be employed only if behavioral interventions have failed
or are not possible, and ongoing use should be evaluated daily with in-person examination of patients. The evidence for pharmacologic treatment of postoperative PI3K inhibitor delirium with antipsychotic medications is difficult to interpret because of the heterogeneity in the drugs studied, dosages administered, patient populations, and outcomes examined.87, 88 and 89 The potential benefit of antipsychotics is decreased STA-9090 delirium severity, although results of clinical trials are not consistent. The potential harms associated with antipsychotic medication
are numerous.62, 63, 64, 65, 66 and 90There is no evidence of benefit from treatment of antipsychotics in patients without agitation. The use of antipsychotics should be reserved for short-term management of acute agitation in the setting of possible substantial harm, ie, for treatment of postoperative delirium in older surgical patients with behavior such as agitation that substantially threatens the patient’s safety or the safety of others. No current evidence
supports the routine use of Dimethyl sulfoxide benzodiazepines in the treatment of delirium. There is substantial evidence that benzodiazepines promote delirium.91 However, benzodiazepines remain the recommended treatment of alcohol withdrawal.92 Developing a set of national guidelines for postoperative delirium care is the first step in the translational discovery to delivery cycle. This translational cycle is considered inefficient and expensive.93, 94 and 95 New, emerging “implementation science” may help in speeding the translational cycle by understanding the barriers and facilitators of implementing evidence-based knowledge such as the current guideline on postoperative delirium care into the real world of health care practice. Thus, it is important to translate the current guideline set into locally sensitive implementation tools that can be easily adapted by local quality improvement offices within each health care system. Successful postoperative management of delirium for older adults requires knowledge of approaches for screening, diagnosis, risk factor assessment, and nonpharmacologic and pharmacologic interventions aimed to prevent and treat delirium. The recommendation statements within provide a framework to allow hospital systems and health care professionals to implement actionable, evidence-based measures to address the highly morbid problem of delirium in perioperative patients.