A randomized study suggests limiting sedation, at least in those with low comorbidity scores, during hip fracture repair under spinal anesthesia to reduce delirium. They conclude: “In the primary analysis, limiting the level of sedation provided no significant benefit in reducing incident delirium. However, in a prespecified subgroup analysis, lighter sedation levels benefitted reducing postoperative delirium for persons with a Charlson comorbidity index of 0“.
Whereas benzodiazepines are increasingly out of favour, this study used Propofol for sedation. The current winner for sedation is Dexmedetomidine and needs further study, as does the relationship of comorbidity to delirium, a serious issue linked to outcome and mortality.