A CLINICAL CASE OF SYMPTOMATIC DELIRIUM OF THE EARLY POSTOPERATIVE PERIOD AFTER SURGERY FOR A FEMORAL FRACTURE

Symptomatic delirium of the early postoperative period (SDEPP) is a common clinical type of postoperative cerebral dysfunction in surgery. The most common and common risk factors for all types of surgical interventions are: age, concomitant comorbid diseases, previous cognitive deficit, impaired vision and hearing. An important provoking factor of SDEPP is the use of anticholinergics, narcotic drugs, withdrawal symptoms, systemic infections, iatrogenic complications, metabolic disorders and pain. Severe infectious complications are typical risk factors of SDEPP and some authors consider delirium to be the earliest clinical manifestation of these complications. At present, it is also known that dementia increases the risk of SDEPP, while a higher initial educational level significantly reduces it. SDEPP is frequently found after structural alteration of the reticular formation, ventrolateral area of the hypothalamus and frontal lobes. There is evidence that alteration to the basal ganglia, lingual gyrus (on both sides), bilateral or right-sided damage to the prefrontal gyrus, superficial parietal cortex, and thalamus may be associated with the development of SDEPP. The current understanding of the pathogenesis of SDEPP includes supposed role of systemic inflammatory reaction that starts during the perioperative period, and is possibly exacerbated by the anticholinergic effect of drugs administered during this period. However, this hypothesis and the relationship between peripheral inflammation and neuroinflammation need further study. An important element in the pathogenesis of postoperative cerebral dysfunction in trauma and orthopedic surgery is cerebral embolism. During the surgical operations on the hip and knee joints, cerebral microemboli were found in 40-100% of patients. But at present, the connection of this fact with the onset of postoperative cerebral dysfunction has not been proved. The article presents a clinical case of symptomatic delirium of the early postoperative period in a patient according to the profile of traumatology and orthopedics.

Symptomatic delirium of the early postoperative period, surgery, fractures of the long bones, assessment of the level of consciousness, fracture of the femur, cognitive impairment