Newly Published
Editorial  |   January 2020
Oxidative Stress Response and Delirium after Cardiac Surgery: Can Circulating Biomarkers Refine New Therapeutic Paradigms?
Author Notes
  • From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
  • Accepted for publication November 13, 2019.
    Accepted for publication November 13, 2019.×
  • This editorial accompanies the article on p. XXX.
    This editorial accompanies the article on p. XXX.×
  • Correspondence: Address correspondence to Dr. Podgoreanu: mihai.podgoreanu@duke.edu
Article Information
Editorial / Cardiovascular Anesthesia / Central and Peripheral Nervous Systems
Editorial   |   January 2020
Oxidative Stress Response and Delirium after Cardiac Surgery: Can Circulating Biomarkers Refine New Therapeutic Paradigms?
Anesthesiology Newly Published on January 8, 2020. doi:https://doi.org/10.1097/ALN.0000000000003097
Anesthesiology Newly Published on January 8, 2020. doi:https://doi.org/10.1097/ALN.0000000000003097
Although postoperative delirium afflicts as many as half of cardiac surgery patients1  and is associated with prolonged hospitalization, long-term cognitive decline, and mortality, we know little of the pathophysiologic mechanisms that subtend this common neurobehavioral syndrome. Delirium is an acute confusional state, generally viewed as a marker of increased brain vulnerability and an aberrant response to stress. As such, its neuropathogenesis depends on complex interrelationships between predisposing and precipitating factors, with a number of overlapping mechanistic theories involving neuronal aging, neuroinflammation, oxidative stress, neurotransmitter deficiency, neuroendocrine activation, circadian dysregulation, and breakdown in brain network connectivity.2  While anesthesia/surgery are clearly inciting factors for delirium, intraoperative strategies to reduce it are sorely lacking. This is in part because prevailing theories have focused on preoperative (older age, frailty, medical comorbidities, and preexisting cognitive impairment) and postoperative recovery factors (disrupted sleep, altered sensorium, pain, and sedating medication use/polypharmacy) as drivers of postoperative delirium.