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Managing Postoperative Delirium in Hypertensive Geriatric Patients

Managing Postoperative Delirium in Hypertensive Geriatric Patients
06/27/2025

A 78-year-old man with long-standing hypertension undergoes hip replacement and, despite stable intraoperative hemodynamics, awakens confused and agitated—a common presentation of postoperative delirium in geriatric patients.

Managing such presentations challenges geriatric anesthesiologists, particularly when elevated blood pressure primes the central nervous system for cognitive disturbances. In the context of anesthesia management in hypertensive patients, understanding the multifactorial risks is crucial. Postoperative delirium arises from a confluence of vascular and inflammatory insults, and recent work by Dr. Niccolò Terrando illuminates how sustained hypertension worsens blood–brain barrier dysfunction and amplifies neuroinflammation. Insights from Dr. Terrando's study show this correlation, underscoring the urgency of tailoring anesthetic plans to hypertensive physiology.

Building on these observations, the $3.47 million NIH R01 grant supports research into the interactions between vascular stress and neuronal injury. Earlier findings suggest this funding is sharpening our understanding of cognitive decline pathways, with direct implications for perioperative blood pressure targets and anti-inflammatory strategies. In practice, such data inform adjustments to anesthetic depth and choice of vasoactive agents to protect vulnerable neural tissue during surgery.

The anesthesiologist’s scope must extend beyond traditional hemodynamic control. Recent work on e-cigarette–associated toxicity highlights a parallel concern in perioperative care in elderly patients. The study on e-cigarette toxicity suggests that unregulated sweeteners may provoke airway inflammation and oxidative stress—factors that can exacerbate perioperative respiratory complications and interact with hypertensive insults.

Consider an 82-year-old patient with chronic hypertension and daily vaping habits who develops unexpected bronchospasm during induction. This scenario illustrates the need to integrate pulmonary risk assessment into preoperative planning, adjusting ventilation strategies and selecting anesthetics with minimal pro-inflammatory profiles.

When orchestrating anesthetic management for high-risk geriatric patients, clinicians should adopt a multidisciplinary approach: rigorous blood pressure optimization, pulmonary evaluation in the context of e-cigarette use, and incorporation of emerging delirium management strategies, such as early mobilization and tailored pain control, following guidelines from organizations like ASA and NICE. As noted in the earlier report on hypertension and cognitive decline, combining pharmacological and nonpharmacological interventions can reduce the incidence and severity of delirium.

Key Takeaways:
  • The link between hypertension and postoperative delirium is driven by mechanisms like blood–brain barrier dysfunction and neuroinflammation.
  • The NIH R01 grant enables in-depth exploration into these connections, improving perioperative care.
  • E-cigarette additives present respiratory risks that must be factored into anesthetic planning.
  • Ongoing innovation in delirium management strategies is vital for optimizing surgical outcomes in hypertensive patients.
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