Pharmacologic prevention of postoperative delirium

Delirium is common in older adults in the perioperative period, being a complication in up to 60 % of major surgical procedures. Delirium has a significant impact on the medical, functional, and cognitive outcomes of older patients. Treatment of delirium can be quite complex and requires individualized patient assessment, plan of care, and empirical treatment. In light of the difficulties associated with delirium treatment and the complexity and frequent inadequacy of nonpharmacologic preventive measures, several drugs have been evaluated for efficacy in delirium prevention. We performed a literature review using Medline and the Cochrane Database for Systematic Reviews for randomized controlled trials, observational studies, and case reports evaluating pharmacologic treatments for prevention of delirium in older adults. Trials focused on patients with alcohol abuse were excluded. There is some preliminary evidence that haloperidol, newer neuroleptics (e.g., risperidone or olanzapine), and melatonin may be effective in reducing the incidence of postoperative delirium, but the data are not robust. Health care teams should still focus on traditional delirium prevention efforts, and reserve specific pharmacologic prevention to individual high-risk patients for whom the risks and benefits have been carefully considered.