Evaluating Dexmedetomidine Sedation, Neurocognitive Outcomes After Major Orthopedic Surgery

Background: Neurocognitive complications such as postoperative delirium, emergence delirium, and postoperative cognitive dysfunction remain common and clinically important problems in older surgical patients. These conditions often coexist with disturbed sleep and may share overlapping inflammatory and neurochemical mechanisms, particularly in the setting of perioperative stress. Sedative choice during regional anesthesia may influence these outcomes, yet comparative data remain limited. Objective: To determine whether intraoperative sedation with dexmedetomidine reduces the incidence of postoperative delirium compared with propofol in older adults undergoing major lower limb orthopedic surgery under regional anesthesia, and to assess emergence delirium, early postoperative cognitive dysfunction, postoperative sleep quality, and the development of chronic pain. Design: Prospective, double-blind, randomized, controlled clinical trial. Participants: Patients aged >65 years scheduled fo more...