Frederick Sieber,Karin J. Neufeld,Allan Gottschalk,George E. Bigelow,Esther S. Oh,Paul B. Rosenberg,Simon C. Mears,Kerry J. Stewart,Jean-Pierre P. Ouanes,Mahmood Jaberi,Erik A. Hasenboehler, and Nae-Yuh Wang
Br J Anaesth. 2019 Apr; 122(4): 480–489.
Postoperative delirium (POD) is one of the most common complications after hip fracture repair.1 POD after hip fracture repair is associated with an increased likelihood of dependency in activities of daily living (ADLs) and instrumental activities of daily living (IADLs),2, 3 and a higher risk of not returning to pre-fracture level of mobility.4 Furthermore, both duration of POD5 and POD superimposed on dementia6 are risk factors for mortality after surgery. Given the above, interventions which decrease POD have the potential to influence both functional and mortality outcomes.
One anaesthetic approach reported to decrease incident delirium is limitation of sedation depth during spinal anaesthesia. In a small clinical trial, patients undergoing spinal anaesthesia for hip fracture repair were randomly assigned to receive heavier or lighter sedation, based on a processed EEG index. Heavier sedation was found to be a risk factor for POD on the 2nd postoperative day7 and was associated with higher mortality in patients with greater medical comorbidity.8 These results were hypothesis generating regarding the relationship between depth of sedation and POD. The study also raised the question whether depth of sedation influenced the intermediate-term outcomes of mortality and day-to-day function. Read More