#298 New APSF Brain Health Guidance For Older Adults

Postoperative delirium is one of the most common adverse events after surgery for older adults, and it can change a patient’s recovery, independence, and quality of life. We take a practical, evidence-focused look at what anesthesia teams can actually do to support perioperative brain health, using the latest recommendations from the APSF Brain Health Patient Safety Advisory Group.We walk through the four questions clinicians keep asking at the bedside. First, does intraoperative hypotension drive delirium? We break down why the data is mixed, what mechanisms make hypotension plausible, and why individualized hemodynamic goals with rapid correction still belong in a modern patient safety strategy. Next, we tackle benzodiazepines and the Beers Criteria: newer trials and practice advisories suggest short-acting agents like midazolam and ultra-short-acting options like remimazolam do not need to be avoided solely to prevent postoperative delirium, while medication review, deprescribing, and cognitive screening remain essential.From there, we get into anesthetic depth and intraoperative EEG monitoring. EEG guidance can reduce burst suppression and may help tailor dosing as part of precision anesthesia, but the evidence is still inconclusive on whether it prevents delirium in older adults. We close with the long-debated choice between general anesthesia and regional anesthesia, highlighting recent meta-analyses and trials showing no significant difference in delirium incidence once confounders are controlled, with a key nuance around avoiding excessive sedation.Subscribe for more anesthesia patient safety updates, share this with a colleague, and leave a review if the conversation helps you bring a brain health lens to your next case.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/298-new-apsf-brain-health-guidance-for-older-adults/© 2026, The Anesthesia Patient Safety Foundation