Delirium is a common and serious postoperative complication that manifests as an acute, fluctuating failure of the brain to support normal arousal, attention, and organized thinking. Postoperative delirium has been associated with delayed recovery from surgery and persistent neurocognitive disorders, as well as with other adverse outcomes. There is a long-standing and widely held concern that general anesthetic and sedative agents are implicated in postoperative delirium and other neurocognitive disorders. Conclusions regarding the neurotoxicity of sedative-hypnotic anesthetic agents have been mainly derived from basic science studies demonstrating neuropathology, neurocognitive impairment, or behavioral changes after general anesthesia in animals and observational studies of anesthetized patients undergoing surgery. However, the translational and causal relevance of these studies is best examined by a randomized clinical trial methodology in which patients presenting for the same operation receive either general anesthesia or a regional technique in which no sedative-hypnotic drugs are administered.
Source: JAMA Online First