A systematic review and network meta-analysis study analyzed 158 randomized controlled trials with more than 41,084 participants over 60 years of age who underwent surgery with general or regional anesthesia[1][3][4]. The overall risk of delirium after surgery was 14.5% (n=5957)[3][4]. Dexmedetomidine, an analgesic, sedative, and anti-inflammatory drug, was the most effective in reducing the incidence of delirium in almost every type of surgery, reducing the number from 14 to 7 in 100 people[1][2]. This effect persisted even after excluding studies with a high risk of bias[3][4]. Corticosteroids, melatonin receptor agonists, parecoxib (OR 0.34), olanzapine (OR 0.27) and intranasal insulin (OR 0.13) show potential benefit, although the evidence is of moderate to very low quality[3][4]. Corticosteroids alone reduced the severity of delirium (mean difference -2.42 points on the Memorial Delirium Assessment Scale)[4]. Most interventions did not affect length of hospital stay, mortality, cognition, or quality of life; dexmedetomidine more frequently caused hypotension and bradycardia, but reduced postoperative nausea and vomiting[1][4].