What simple things can we do in the operating room which might make a difference to the issue of post operative delirium? 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?   And 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).