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

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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).
Materials: Patients undergoing elective esophagectomy or gastrectomy under combined thoracic epidural and general anesthesia were prospectively studied.
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).
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).
Conclusions: Patients who had incomplete or no ability to compensate for the elevated anticholinergic activity were more likely to develop postoperative delirium.