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Postoperative Delirium


  • Def'n: acute, fluctuating alteration in awareness and disturbance of attention

  • Timeline: PACU to POD5

  • Associated with: ↓ surgical outcomes, ↑ LOS, functional decline, ↑ cost, ↑ mortality

  • Two forms:

    • Hyperactive - classic well-known type

    • Hypoactive - may go unnoticed


  • Risk factors:

    • Age > 65, pre-existing cognitive impairment, severe illness, multiple comorbid conditions, hearing/visual impairment, active infection

    • Major surgery, longer surgery

  • Need for pre-operative risk assessment


  • Screen for delirium before PACU discharge

  • Avoid deliriogenic medications post-op: anticholinergics, benzos, meperidine

  • Frequent reorientation and reassurance, having familiar objects in the room

  • Ensure glasses/hearing aids are on as soon as possible

  • Good pain control via multi-modal analgesia

  • Ensuring circadian rhythm

  • Eliminate restraint use


  • Employ prevention measures as above

  • Evaluate and address precipitating factors:

    • Pain, hypoxia, pneumonia, infection, electrolyte abn, hypoglycemia, medications

  • Haldol 0.5mg-1mg IV/IM when all other measures have failed



  • Miller, R. D. (2020). Chapter 80: The Post-Anesthesia Care Unit. In Miller's Anesthesia. Elsevier Churchill Livingstone.

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