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Elderly: Lighter Sedation May Reduce Risk of Confusion

Elderly: Lighter Sedation May Reduce Risk of Confusion

A new study suggests that simply limiting the depth of sedation during procedures could safely cut the risk of postoperative delirium which is common in elderly patients by 50 percent.

This common complication following surgery in elderly patients is a state of confusion that can lead to long-term health problems and cause some elderly patients to complain that they "never felt the same" again after an operation.

"Merely by adjusting how a person is sedated can have a profound effect on their postoperative cognitive state," says study leader Frederick E. Sieber, an associate professor of anesthesia at the Johns Hopkins University School of Medicine and director of anesthesiology at Johns Hopkins Bayview Medical Center.

Sieber says propofol, a short-acting anesthetic commonly used to induce anesthesia and keep patients asleep, and similar anesthetics may not behave as the clear "on/off phenomena" they were long thought to be, with effects disappearing as soon as the drugs are withdrawn. "What our study indicates," he says, "is that there may be lingering effects of anesthesia that heretofore may not have been appreciated, especially in the elderly."

In a double-blind randomized study of 114 patients undergoing hip fracture repair at Johns Hopkins Bayview Medical Center, patients first received spinal block anesthesia and were then either lightly sedated with propofol or more deeply sedated with the same medication. The prevalence of postoperative delirium was significantly lower in the group that was lightly sedated. The findings suggest that one incident of delirium could be prevented for every 4.7 patients treated with light sedation. The average age of the patients in the study was 81.

In addition to decreasing the prevalence of postoperative delirium in the study's patients, lighter sedation was associated with a one-day reduction in the duration of delirium in those patients who still emerged from surgery confused and disoriented.

Sieber says reducing the depth of sedation is a simple and cost-effective way to attack this problem, which is seen more often as the population continues to age. He hopes this study will change the practices of fellow anesthesiologists and help reduce the number of patients who suffer from postoperative delirium.

"Elderly patients, when they come to surgery, often are not afraid of dying. They want to know if they'll return to the same functional level – mental as well as physical – as before surgery," Sieber says. "That's what their real worries are."; Source: Johns Hopkins Medical Institutions

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