• Elizabeth L Whitlock, Eric R Gross, C Ryan King, and Michael S Avidan.
• Department of Anesthesia & Perioperative Care, University of California, School of Medicine, San Francisco, CA, USA.
• Br J Anaesth. 2021 Nov 1; 127 (5): 667-671.

AbstractThis editorial highlights the findings of the Balanced Anaesthesia Delirium study, a 515-patient substudy of the 6644 patient Balanced Anaesthesia trial, which found that targeting deep anaesthesia in patients undergoing major noncardiac surgery was not associated with significantly increased postoperative death or major morbidity. The substudy found that using bispectral index (BIS) guidance with the intention of deliberately achieving deep volatile agent-based anaesthesia (target BIS reading 35 vs 50) significantly increased delirium incidence (28% vs 19%), although not subsyndromal delirium incidence (45% vs 49%). We discuss the implications of these findings for anaesthetic practice, and address whether the BIS should be used as a guide to deliver precision anaesthesia for delirium prevention. We posit that subpopulation-based differences within this multicentre substudy could have affected delirium occurrence, since the findings appeared to rest on outcomes in patients from East Asia. We conclude that questions of whether and for whom deep anaesthesia is deliriogenic remain unanswered.Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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