ASA recommendations target postoperative delirium in older patients

Editor's Note

Efforts to reduce the risk of postoperative delirium in older patients should focus on preoperative evaluation, anesthesia choices, and medication management, according to the American Society of Anesthesiologists (ASA).

Designed specifically for treating adults aged 65 and older undergoing inpatient surgery, these new, evidence-based recommendations are presented in detail in the journal Anesthesiology. According to a December 10 ASA statement, they include:

• Expand preoperative evaluation. Older patients scheduled for inpatient surgery should undergo comprehensive assessments for cognitive impairment and frailty. Identified risks should prompt involvement of multidisciplinary teams, including geriatric specialists, and patient education on delirium risks.
• Collaborate on anesthesia selection. Neuraxial or general anesthesia should be chosen based on clinical appropriateness and shared decision-making. Evidence indicates no significant difference between techniques in reducing delirium risk. Both intravenous and inhaled methods are acceptable for general anesthesia in this population.
• Use dexmedetomidine when appropriate. This sedative may lower delirium risk but requires caution due to its potential effects on heart rate and blood pressure.
• Minimize medications that impact the central nervous system (CNS), which should be carefully evaluated for risks and benefits in older adults.   

ASA emphasizes the need for further research to address evidence gaps and refine approaches. More details are available from the ASA Perioperative Brain Health Initiative.