5 Topic Commentaries

Does Sedative Choice Shape Later Cognition?

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  George A. Mashour, MD, PhD

  Anesthesiology (Neuroanesthesiology)

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  University of Michigan Medical School

  Ideally, we want to ensure that we are providing enough anesthesia to the brain to suppress consciousness and memory. But we don’t want to provide so much that we induce unwanted effects on brain function after surgery, says Mashour.

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  Sharon K. Inouye, MD, MPH

  Geriatrics

  •

  Harvard Medical School; Hebrew SeniorLife (Marcus Institute for Aging Research)

  We need to get on a better path with the management of delirium. We need to minimize the use of these sedating medications when possible.

  Source
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  Dale M. Needham, MD, PhD

  Critical Care Medicine; Physical Medicine & Rehabilitation

  •

  Johns Hopkins University School of Medicine

  Doctors and nurses have traditionally been of the mind-set that if we just give patients the ‘right’ medication, their psychological status will improve. In fact, we probably need to give less medicine and rely more on nonpharmaceutical interventions, such as music therapy, relaxation training and animal assisted therapy to help improve patients’ psychological status.

  Source
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  Juraj Sprung, MD, PhD

  Anesthesiology

  •

  Mayo Clinic

  We need to be sure that patients considering surgery, and their families, are properly informed that the risk of cognitive dysfunction is possible. In addition, alternative strategies should be discussed with patients before surgery is undertaken for those deemed to be at high risk.

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  Ashley Thompson, PharmD

  Clinical Pharmacy (Critical Care)

  •

  University of California, San Francisco (UCSF)

  Historically, if we saw a patient agitated who couldn’t seem to settle down, they would get [benzodiazepines] to calm down. Today, we try to determine if that patient is in pain, because we know untreated pain leads to agitation and that sedation isn’t necessarily benign.

  Source