What can practitioners do to preoperatively screen for signs that their patients may have issues with post operative delirium? How do we get patients fit for surgery, particularly with regard to delirium? Can you build up mental resilience in the run up to an operation? Do puzzles and mental activity - such as sudoku or a good crossword - help and is there any evidence of that?

Should preoperative sedation be, generally speaking, withheld from people over 60? How do we explain the risks of this procedure to those who need it? Also - are we seeing a rise in post operative delirium and if so why?

Finally - what should we make of the "triple low" story where patients with low blood pressure, a low bispectral index, and a low minimum alveolar concentration of volatile anesthesia are said to face an increased risk of adverse outcomes?

This piece features Monty Mythen and Desiree Chappell in conversation with Dan Cole, professor of clinical anesthesiology at the David Geffen School of Medicine, University of California, Los Angeles and former president of the American Society of Anesthesiologists (ASA).

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