This 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.

这篇社论重点介绍了平衡麻醉谵妄研究的结果，该研究是 6644 名患者平衡麻醉试验的 515 名患者亚组研究，该研究发现，针对接受非心脏大手术的患者进行深度麻醉与术后死亡或主要发病率的显着增加无关。子研究发现，使用双谱指数 (BIS) 指导以有意实现基于深度挥发性药物的麻醉（目标 BIS 读数 35对50）显着增加谵妄发生率（28%对19%），尽管不是亚综合征谵妄发生率（45 %对比49%）。我们讨论了这些发现对麻醉实践的影响，并讨论了是否应将 BIS 用作提供精确麻醉以预防谵妄的指南。我们假设这项多中心子研究中基于亚群的差异可能会影响谵妄的发生，因为研究结果似乎依赖于东亚患者的结果。我们的结论是，深度麻醉是否会导致谵妄以及对谁会导致谵妄的问题仍未得到解答。