The Relationship Between the Perioperative Transition of Serum Anticholinergic Activity and Postoperative Delirium in Patients Undergoing Esophagectomy and Gastrectomy

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  • KITAJIMA YUKA
    Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine
  • YAMAGUCHI KEISUKE
    Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine
  • HORI KOJI
    Department of Psychiatry, Showa University Northern Yokohama Hospital
  • MURAKAMI TAISUKE
    Department of Host Defense and Biochemical Research, Juntendo University Faculty of Medicine
  • SOMEYA AKIMASA
    Department of Host Defense and Biochemical Research, Juntendo University Faculty of Medicine
  • KONISHI KIMIKO
    Tokyo Metropolitan Tobu Medical Center for Persons With Developmental/Multiple Disabilities
  • HARA ATSUKO
    Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine
  • HACHISU MITSUGU
    Department of Clinical Psychopharmacy, School of Pharmaceutical Sciences, Showa University
  • KAJIYAMA YOSHIAKI
    Department of Esophageal and Gastroenterological Surgery, Juntendo University Faculty of Medicine
  • NAGAOKA ISAO
    Department of Host Defense and Biochemical Research, Juntendo University Faculty of Medicine
  • INADA EIICHI
    Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine

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Purpose: Delirium is one of the most common postoperative complications among elderly patients undergoing major surgery. However, biomarkers for delirium have not yet been elucidated. We therefore investigated the relationship between postoperative delirium and the serum anticholinergic activity (SAA).<br>Materials: Patients undergoing elective esophagectomy or gastrectomy under combined thoracic epidural and general anesthesia were prospectively studied.<br>Methods: The levels of SAA were measured inside the operating room after the induction of anesthesia before the surgery began, and immediately after the surgery had finished, but before the patient awoke from anesthesia. The occurrence of postoperative delirium was determined using the Confusion Assessment Method (CAM).<br>Results: Postoperative delirium was identified in 41.2% of the 34 patients enrolled in this study. Compared with the non-delirious group, the delirious group had a significantly higher number of preoperatively SAA (+) patients whose elevated SAA levels were still detectable after surgery (p < 0.05).<br>Conclusions: Patients who had incomplete or no ability to compensate for the elevated anticholinergic activity were more likely to develop postoperative delirium.

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