Multicomponent non-drug measures have the strongest evidence for preventing postoperative delirium in older patients, and most cost nothing. They work best when they start before surgery and continue on the ward.
The anaesthetist's contribution is to identify risk, avoid deliriogenic drugs and hand over clearly.
- Screen for cognitive impairment and frailty before surgery in patients over 65.
- Avoid benzodiazepines and centrally acting anticholinergics such as hyoscine where practical, and minimise pethidine.
- Make sure glasses and hearing aids return with the patient from theatre.
- Treat pain well, prefer regional techniques where suitable, and avoid excessive depth of anaesthesia.
- Hand over delirium risk to the ward team so screening and orientation continue.
Why it matters
Non-drug measures remain the best-supported prevention, whatever ketamine trials eventually show.
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