Anesthesiology

Desflurane vs propofol for PND in older adults undergoing major urological surgery

In 126 patients aged ≥65 undergoing major urological surgery, overall perioperative neurocognitive disorder did not differ between propofol (n=64) and desflurane (n=62). Postoperative delirium incidence was similar (14.1% vs 9.8%, P=0.467), but delirium-present days were longer with desflurane (P=0.044). Interleukin-6 rose postoperatively and was higher on day 3 in patients with delirium, suggesting a biomarker association. Anesthesia was guided with BIS and NIRS; the prolonged delirium finding is exploratory given the small number of delirium cases. 1

Network meta-analysis: dexmedetomidine reduces POD after elderly orthopaedic surgery

This Bayesian network meta-analysis included 79 RCTs and 16,012 patients aged ≥60 undergoing orthopaedic surgery. Dexmedetomidine reduced postoperative delirium versus placebo (RR 0.49, 95% CrI 0.39–0.61). Ketamine, rivastigmine, olanzapine, and lidocaine showed heterogeneous but potentially beneficial effects. Authors call for high-quality confirmatory trials before routine adoption of agents other than dexmedetomidine. 2

Unilateral epidural vs combined spinal-epidural in older hip fracture patients

In this retrospective study of 106 patients aged ≥65, unilateral epidural anesthesia (UEA) produced higher systolic blood pressures at 5–20 minutes post‑anesthesia than CSEA (all P<0.05). UEA had a longer induction time but similar vasopressor use, hypotension rates, complications, hospital stay, mortality, and limb function. No differences were found in postoperative complications or mortality, making UEA a viable option for hemodynamic stability. Results are hypothesis-generating due to retrospective, nonrandomized design and require prospective validation. 3