These diagnostic tests vary significantly and depend on the patient population in which they are employed. Accordingly, evidence finds that when screening a

patient for delirium, health care professionals Vemurafenib mw should be trained in and use a screening instrument that has been validated against a reference standard (see Table 5). There are no randomized controlled trials examining routine delirium screening in hospitalized patients.21 Risks of routine delirium screening include misdiagnosis, costs and risks of evaluation, and inappropriate treatment such as with antipsychotic medications. The potential benefits of delirium screening include earlier diagnosis and implementation of appropriate delirium treatment. In one low-quality study, delays in delirium treatment in the intensive care unit were associated with increased mortality.37 Current guidelines and systematic reviews offer BYL719 chemical structure differing recommendations on delirium screening, with some published guidelines recommending delirium screening38 and 39 and a recent systematic review concluding the evidence was insufficient to make a recommendation21 (see Table 6). While many intraoperative factors have been evaluated for their impact on postoperative delirium, few topics have been studied with the rigor to allow an evidence-based recommendation. Previously published topics

upon which there is not adequate information to make a recommendation include specific anesthesia agents, general versus regional anesthetics, systemic arterial pressure monitoring, intraoperative blood transfusion, and use of dexamethasone or statin medications. The anesthesia practitioner may use processed electroencephalographic monitors of anesthetic depth during intravenous sedation

or general anesthesia of older patients to reduce postoperative delirium. Processed electroencephalographic monitoring is one topic with a few studies of adequate quality to form a recommendation. The premise is that providing a lighter depth of anesthesia (thereby administering fewer or lower doses of anesthesia medications) will reduce postoperative delirium in comparison with deeper sedation. In one small, randomized these controlled trial that compared postoperative delirium between light and deep sedation in hip fracture patients, deep sedation was associated with increased rates of postoperative delirium.40 This finding is consistent with a nonrandomized, retrospective observation.41 Two additional trials42 and 43 in patients undergoing general anesthesia have shown that the rates of postoperative delirium were lower in those patients whose anesthesiologists were randomized to utilize the Bispectral Index (BISTM) data to guide anesthesia compared with those who received routine care with no BIS data.