Shaping Anesthetic Techniques to Reduce Post-operative Delirium

Shaping Anesthetic Techniques to Reduce Post-Operative Delirium

The purpose of this study is to determine if light sedation with spinal anesthesia reduces the incidence of delirium compared to receiving general anesthesia during spinal surgery in older adults.

Post-operative delirium is a common occurrence in older adults. Post -operative delirium has been associated with cognitive decline after hospitalization. Developing perioperative management strategies to prevent delirium may also reduce potential cognitive decline in older adults after surgery. The choice and dose of anesthetic and sedative drugs are known risk factors in the development of delirium. Excessive doses of anesthetic and sedation drugs during surgery have been associated with poor outcomes that occur after surgery. Currently depth of anesthesia can be measured by an additional monitoring technique called Bispectral Index (BIS).

The purpose of this study is to determine if light sedation with spinal anesthesia reduces the incidence of delirium compared to receiving general anesthesia during spinal surgery in older adults. Previous studies have shown that using light sedation and spinal anesthesia during surgery may reduce the incidence of delirium up to 50%.

Inclusion Criteria:

• Male or female patients age 65 and over.
• Patients undergoing lumbar fusion performed by Dr. Charles Edwards II, Dr. Charles Edwards, Dr. Clayton Dean , or Dr. Justin Park at Mercy Medical Center.
• Expected length of surgery <3 hours.
• Ability to understand study procedures and to comply with them for the entire length of the study

Exclusion Criteria:

• Contradictions to spinal anesthesia (severe aortic stenosis, anti-coagulant or antiplatelet medications, other)
• Body mass index > 40 kg/m2
• prior lumbar fusion from L2-L5 in entirety
• Communication issues precluding delirium assessment or sedation
• Dementia or mini-mental status exam score < 24
• Psychiatric disease that would preclude cooperation with sedation with spinal anesthesia
• Any other reason that the attending anesthesiologist or surgeon feels that clinical circumstances dictate a strong preference for either spinal or general anesthesia.
• Inability or unwillingness of individual or legal guardian/representative to give written informed consent.