Other Titles
Anesthesia Agents and the Risk of Postoperative Delirium in Adult Non-cardiac Surgical Patients: An Integrative Review [Title Slide]
Other Titles
Rising Star Poster/Presentation - Rapid Presentation Round
Abstract
Introduction: Surgical patients are given anesthetic agents that render them unconscious for surgery. When the surgical procedure is completed, these agents are discontinued. As patients recover from surgery, they may experience an acute onset of confusion or postoperative delirium (POD) that fluctuates and manifests as inattention with changes in perception or cognition, altered levels of consciousness, and changes in motor activity such as agitation or lethargy. At times, a mixture of these symptoms may occur when patients demonstrate a fluctuation between hyperactive and hypoactive motor forms of delirium. Hyperactive delirium is when patients are highly agitated and restless whereas the patient with hypoactive delirium is withdrawn and lethargic. POD can persist for up to seven days after surgery with variations in the severity of delirium. POD occurs in 20% to 27% of surgical patients with 87% incidence in surgical intensive care units. Additionally, POD is linked to increased morbidity and mortality, prolonged hospitalizations and recovery, and persistent cognitive decline. There are numerous intrinsic risk factors that have been identified with this phenomenon, however it is recognized in the literature that anesthesia is an external risk factor for the development of POD.
Purpose: The purpose of this integrative review is to determine which anesthesia agents prevent postoperative delirium (POD) in non-cardiac surgical patients (ages 19 to 80+ years)?
Methods: The database that was used for this integrative review was NIH PubMed. A systematic approach to searching, filtering, and screening was used. To guide the review process, we followed the Whittemore and Knafl framework for integrative reviews with a data comparison table created to compare and contrast patterns and themes. Additionally, the John Hopkins Nursing Evidence Based Practice Model (JHNEBP) for Nursing and Healthcare Professionals and the associated tools were used to assist with the appraisal, analysis, and synthesis activities.
Results: The initial search of postoperative delirium produced 5,668 articles and established a primary MesH term in the NIH PubMed database. After inclusion of the other MesH terms (non-cardiac, anesthesia, guidelines, or postoperative cognitive dysfunction) and then separately searching five anesthetic agents (sevoflurane, isoflurane, desflurane, ketamine, and propofol), we included 20 articles in the review.
Discussion: Propofol emerged as the best drug to decrease the risk of patients developing POD. As an intravenous anesthetic agent, propofol has advantages over volatile anesthetics. Limitations included smaller sample sizes, varied definitions of POD, different types of delirium assessment approaches, and a range of anesthetic dosages for sedation depth. This integrative review adds to the evidence surrounding care of patients with POD. Future research with larger sample sizes using comparable methods is needed to confirm that propofol is the best anesthetic agent to use in the prevention of POD.
Notes
Presenter notes available in slide deck.
References: Borchers, F., Spies, C. D., Feinkohl, I., Brockhaus, W. R., Kraft, A., Kozma, P., ... & Ottens, T. H. (2021). Methodology of measuring postoperative cognitive dysfunction: a systematic review. British Journal of Anaesthesia, 126(6), 1119-1127.
Daiello, L. A., Racine, A. M., Yun Gou, R., Marcantonio, E. R., Xie, Z., Kunze, L. J., ... & Jones, R. N. (2019). Postoperative delirium and postoperative cognitive dysfunction: overlap and divergence. Anesthesiology, 131(3), 477-491.
Ishii, K., MD, Makita, T., MD, Yamashita, H., MD, Matsunaga, S., MD, Akiyama, D., MD, Toba, K., MD, Hara, K., MD, Sumikawa, K., MD, & Hara, T., MD. (2016). Total intravenous anesthesia with propofol is associated with a lower rate of postoperative delirium in comparison with sevoflurane anesthesia in elderly patients. Journal of Clinical Anesthesia, 33, 428-431. 10.1016/j.jclinane.2016.04.043
Janjua MS, Spurling BC, Arthur ME. Postoperative Delirium. [Updated 2023 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534831/
Kampmeier, T., Rehberg, S., Omar Alsaleh, A. J., Schraag, S., Pham, J., & Westphal, M. (2021). Cost-Effectiveness of Propofol (Diprivan) Versus Inhalational Anesthetics to Maintain General Anesthesia in Noncardiac Surgery in the United States. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 24(7), 939–947. https://doi.org/10.1016/j.jval.2021.01.008
Sigma Membership
Mu Phi at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Anesthesia, Delirium, Anesthesia -- Adverse Effects, Postoperative Complications, Age Factors
Recommended Citation
Latortue, Narah and Wagner, Doreen, "Anesthesia Agents and the Risk of Postoperative Delirium in Noncardiac Surgical Adults an Integrative Review" (2026). Creating Healthy Work Environments (CHWE). 30.
https://www.sigmarepository.org/chwe/2024/presentations_2024/30
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2024
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-02-16
Anesthesia Agents and the Risk of Postoperative Delirium in Noncardiac Surgical Adults an Integrative Review
Washington, DC, USA
Introduction: Surgical patients are given anesthetic agents that render them unconscious for surgery. When the surgical procedure is completed, these agents are discontinued. As patients recover from surgery, they may experience an acute onset of confusion or postoperative delirium (POD) that fluctuates and manifests as inattention with changes in perception or cognition, altered levels of consciousness, and changes in motor activity such as agitation or lethargy. At times, a mixture of these symptoms may occur when patients demonstrate a fluctuation between hyperactive and hypoactive motor forms of delirium. Hyperactive delirium is when patients are highly agitated and restless whereas the patient with hypoactive delirium is withdrawn and lethargic. POD can persist for up to seven days after surgery with variations in the severity of delirium. POD occurs in 20% to 27% of surgical patients with 87% incidence in surgical intensive care units. Additionally, POD is linked to increased morbidity and mortality, prolonged hospitalizations and recovery, and persistent cognitive decline. There are numerous intrinsic risk factors that have been identified with this phenomenon, however it is recognized in the literature that anesthesia is an external risk factor for the development of POD.
Purpose: The purpose of this integrative review is to determine which anesthesia agents prevent postoperative delirium (POD) in non-cardiac surgical patients (ages 19 to 80+ years)?
Methods: The database that was used for this integrative review was NIH PubMed. A systematic approach to searching, filtering, and screening was used. To guide the review process, we followed the Whittemore and Knafl framework for integrative reviews with a data comparison table created to compare and contrast patterns and themes. Additionally, the John Hopkins Nursing Evidence Based Practice Model (JHNEBP) for Nursing and Healthcare Professionals and the associated tools were used to assist with the appraisal, analysis, and synthesis activities.
Results: The initial search of postoperative delirium produced 5,668 articles and established a primary MesH term in the NIH PubMed database. After inclusion of the other MesH terms (non-cardiac, anesthesia, guidelines, or postoperative cognitive dysfunction) and then separately searching five anesthetic agents (sevoflurane, isoflurane, desflurane, ketamine, and propofol), we included 20 articles in the review.
Discussion: Propofol emerged as the best drug to decrease the risk of patients developing POD. As an intravenous anesthetic agent, propofol has advantages over volatile anesthetics. Limitations included smaller sample sizes, varied definitions of POD, different types of delirium assessment approaches, and a range of anesthetic dosages for sedation depth. This integrative review adds to the evidence surrounding care of patients with POD. Future research with larger sample sizes using comparable methods is needed to confirm that propofol is the best anesthetic agent to use in the prevention of POD.
Description
Surgical patients are given anesthetic agents that render them unconscious for surgery. When these agents are discontinued at the end of surgery, patients may experience postoperative delirium up to seven days after surgery. This integrative review determined one anesthetic agent that prevents postoperative delirium more frequently than other agents.