Improving the Pharmacological Approach to Prevention of Postoperative Delirium in Elderly Surgical Patients: A Quality Improvement Project

Postoperative delirium (POD) is a serious complication of surgery and anesthesia that occurs preferentially in elderly patients aged 65 years and over. POD is associated with increased morbidity and mortality rates, longer hospital stays, and increased healthcare costs. Current mainstay treatment of POD is focused on preventing precipitating events in the perioperative period. Prophylactic pharmacological intervention is an underutilized strategy amongst anesthesia providers in preventing POD. Dexmedetomidine used in the perioperative period is a promising anesthetic adjunct that has been shown to lower incidence rates of POD. Furthermore, the advent of the ultra-short acting agent, remimazolam besylate, offers the possibility of replacing traditional short-acting benzodiazepines in the perioperative period, which has shown to be a strong causative agent in the development of POD. The intent of this project was to assess current knowledge and perioperative use of dexmedetomidine and remimazolam, educate anesthesia providers of the risk factors and benefits of the use of these drugs, and reassess knowledge of these agents in practice.