
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 45: Postop Delirium with Charlie Brown
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May 24, 2017 Dr. Charlie Brown, a cardiac anesthesiologist with a focus on postoperative delirium, dives deep into the world of this acute condition. He breaks down the complexities of delirium subtypes, emphasizing that hypoactive forms are often overlooked. The discussion covers critical risk factors, particularly in high-risk surgeries, and their long-term consequences for patients. Prevention strategies are explored, highlighting the importance of nonpharmacologic interventions and anesthetic choices to mitigate risk. Brown also touches on future research directions aimed at better understanding and treating delirium.
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Core Definition And Subtypes Of Delirium
- Delirium is an acute, fluctuating disorder mainly characterized by inattention and altered thinking.
- It has hyperactive, hypoactive, and mixed subtypes, with hypoactive being most common but often missed.
Practical Delirium Screening Tools
- The CAM and CAM-ICU operationalize DSM-5 criteria for practical bedside delirium screening.
- CAM-ICU is specific and usable for nonverbal intubated patients but can lack sensitivity outside ICU settings.
Orientation Can Be Misleading
- Orientation questions alone can miss delirium; patients may be alert and oriented yet fail attention testing.
- Formal attention tests like digit span or CAM items are needed to detect many cases.
