Shaping Anesthetic Techniques to Reduce Post-operative Delirium

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.