Optimal Intraoperative Technique to Prevent Postoperative Delirium

Delirium after surgery is an increasing concern for older adults, caregivers, and health care providers. It is characterized by inattention, confusion, and altered mental state. Delirium is not only disturbing for patients and families during the acute episode but has significant long-term consequences, including an association with long-term cognitive and functional impairment and mortality. In this chapter, we review recommendations and evidence for (1) screening for high-risk patients, (2) medications to avoid, (3) medications to prevent delirium, (4) choice of anesthetic type, (5) electroencephalography (EEG)-guided anesthetic depth, (6) blood pressure control, and (7) cerebral perfusion monitoring. Our final recommendations are to discuss the risk for postoperative delirium with patients. Screen patients for preexisting cognitive impairment and develop protocols for anesthetic management. Be aware of the Beers list criteria medications. Do not apply enhanced recovery after surgery (ERAS) protocols without thinking thorough whether the measures are appropriate for an older adult. Avoid unnecessary deep planes of anesthesia. Optimize pain control. Finally, screen for delirium in the postoperative period or preoperatively in emergency cases.