Postoperative delirium in elderly patients is BEST prevented by which perioperative strategy?
- A Prophylactic haloperidol 0.5 mg TID given to all patients >65 years
- B Avoidance of regional anaesthesia as it can cause confusion from local anaesthetic systemic toxicity
- C Routine benzodiazepine premedication to reduce preoperative anxiety
- D Multicomponent non-pharmacological interventions (HELP protocol) including early mobilisation, sleep hygiene, cognitive orientation, and dehydration prevention ✓
Explanation
The Hospital Elder Life Program (HELP) multicomponent non-pharmacological intervention is the only strategy proven to prevent postoperative delirium in RCTs, reducing its incidence by 30–40%. Components include: cognitive stimulation, early mobilisation, vision/hearing aids, sleep promotion (non-pharmacological), hydration optimisation, and pain management. Prophylactic haloperidol and antipsychotics do NOT prevent delirium (HOPE-ICU, REDUCE trials negative). Benzodiazepines are a RISK FACTOR for delirium (STOPP/START criteria). Regional anaesthesia reduces opioid requirements and is beneficial, not harmful.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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