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European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium


European Journal of Anaesthesiology: September 2018 - Volume 35 - Issue 9 - p 718-719
doi: 10.1097/EJA.0000000000000872
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Figure 2 in the guideline, ‘European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium’ contained errors.1 The correct Figure 2 and figure legend are provided below.


Algorithm for pre-operative, intra-operative and post-operative management of post-operative delirium in adult patients. The algorithm presents preventive (top), diagnostic (middle) and therapeutic (lower) actions that should be taken in the respective perioperative stages (left to right). The red ‘Start Button’ points the user to the first step of the flowchart in each stage/setting. (1) Risk estimation (clinical assessment considering predisposing and precipitating risk factors); details to the risk factors can be found in the guideline recommendation, risk stratification into a high and a low-risk categories can be made as a clinical decision. (2) Neuromonitoring (EEG/EMG-based) is recommended, if available; (3) DSI, Delirium Screening Instrument (validated in the used language); (4) Non-pharmacological measures to reduce postoperative delirium should include re-orientation (clock, communication, etc.), visual/hearing aids, noise reduction, and facilitation of sleep, avoidance of unnecessary indwelling catheters, early mobilisation, and early nutrition; pharmacological treatment should be instituted to improve patient safety in case non-pharmacological measures fail; (5) Differential causes include the assessment and possible intervention against underlying causes for delirium: use, for example, the ‘I WATCH DEATH’-acronym: Infections (e.g. UTI and pneumonia); Withdrawal (e.g. alcohol, opioids and benzodiazepines); Acute metabolic disorder (electrolyte imbalance and renal dysfunction); Trauma (operative trauma); CNS pathology (e.g. stroke and perfusion); Hypoxia (e.g. anaemia, cardiac failure and pulmonary failure); Deficiencies (e.g. vitamin B 12, folic acid and thiamine); Endocrine pathologies (e.g. T3/T4 and glucose); Acute vascular (e.g. hyper-/hypotension); Toxins or drugs (e.g. anaesthetics, drugs with anticholinergic side-effects); Heavy metals (rare cause); (6) Detailed pre/post-surgical assessment of cognitive function with validated tools. EEG, Electroencephalograph; EMG, Electromyography; UTI, urinary tract infection; CNS, central nervous system.

The record is hereby corrected.


1. Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol 2017; 34:192–214.
© 2018 European Society of Anaesthesiology