Moderate alcohol consumption, intraoperative bleeding and postsurgical pain may increase the risk of postoperative delirium in patients undergoing radical retropubic prostatectomy

Nikola Ladjevic, Nebojsa Knezevic, Andjela Magdelinic, Ivana Likic-Ladjevic, Otas Durutovic, Dusica Stamenkovic, Vesna Jovanovic, Nebojsa Ladjevic
2019 Vojnosanitetski Pregled  
Background/Aim. The incidence of postoperative delirium (POD) after non-cardiac surgery is a problem often not recognized by many anesthesiologists. The objective of our study was to detect POD and its possible cause, in patients undergoing Radical Retropubic Prostatectomy (RRP) under general anesthesia. Methods. After Ethical Committee approval, we enrolled 80 patients, ASA status II, in a prospective study, who were scheduled to undergo RRP under general anesthesia. All patients completed
more » ... tests (Folstein Mini Mental State Exam) evening before, and 48 hours after surgery. Assessment for the presence and severity of delirium was performed using CAM (Confusion assessment method), and an assessment of the degree of agitation and sedation using RASS (The Richmond Agitation and Sedation Scale). Results. The average preoperative MMSE score (28.59±1.04) significantly decreased following the surgery (27.74±1.52) (p<0.0001). The average postoperative MMSE score trend descended in comparison to intraoperative bleeding (p=0.036). Patients with higher pain scores had significant decline in MMSE after surgery (28.75 vs 26.25; p<0.001). Five patients were considered positive for delirium, and four of them reported regular alcoholic drinks intake (>1 drink per day) preoperatively (p<0.0001). Based on RASS score, 13 patients (16.3%) were agitated or sedated, and they had statistically significantly higher intraoperative bleeding (p<0.001). Conclusion. Results of this study emphasize the importance of proper preoperative evaluation; especially regarding the alcohol consumption since all patients that developed POD reported moderate alcohol consumption. Furthermore, greater intraoperative bleeding and postoperative pain scores did not influence the occurrence of delirium, but resulted in lower postoperative MMSE scores, which highlights the importance of proper intraoperative management from both surgery and anesthesia to lower risk for developing POD. Keywords: postoperative delirium, alcohol consumption, intraoperative bleeding, postoperative pain, radical retropubic prostatectomy. Iako veće intraoperativno krvarenje i postoperativni bol višeg intenziteta nisu uticali na učestalost pojave delirijuma, snižavali su MMSE skorovi, što ukazuje na značaj adekvatnog intraoperativnog tretmana pacijenta u toku hirurgije i anestezije u cilju smanjenja rizika za razvoj POD. Ključne reči: postoperativni delirijum, konzumiranje alkohola, intraoperativno krvarenje, postoperativni bol, radikalna retropubična prostatektomija.
doi:10.2298/vsp190303088l fatcat:rl33bpxiazci3gxn6shlajmynq