Minimizing perioperative sedation to reduce delirium

Evaluation of: Sieber FE, Zakriya KJ, Gottschalk A et al.: Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin. Proc. 85(1), 18-26 (2010). The aim of this study was to determine whether limiting the depth of intraoperative sedation during spinal anesthesia for hip fracture repair in the elderly decreased the prevalence of postoperative delirium. Enrolled patients were assessed for delirium using the valid Confusion Assessment Method. The authors demonstrated that patients (mean age: 81 years) maintained with light levels of sedation (Bispectral Index levels >80) during their spinal anesthetic showed a 50% reduction in delirium rates as compared with those who underwent the procedure with targeted deeper levels of sedation (propofol to achieve Bispectral Index <50). This study points to the importance of minimizing exposure to sedative agents in reducing delirium. However, further studies with larger patient populations are required in order to ascertain whether this relationship exists for other sedative agents, persists even if patients are maintained with moderate levels of sedation, and if sedatives predispose patients to long-term cognitive impairment.