Depth of Propofol Sedation and Postoperative Delirium: The Jury Is Still Out

Perioperative delirium is an incredibly complex multifactorial syndrome, which despite a rapidly growing body of inquiry into its risk factors remains one of the most common complications of surgery and anesthesia. Acknowledging that most risk factors, such as underlying cognitive impairment and medical comorbidities, are unmodifiable in the short term, the causal contribution of anesthetic medications to postoperative delirium has proven difficult, and yet is crucial, to determine. In this issue of JAMA Surgery, Sieber and colleagues¹ describe an important and ultimately “negative” efficacy trial that investigated the potential contribution of the depth of anesthesia (and anesthetic dosages, which are inextricable) to postoperative delirium.