Delirium is a common postoperative complication that occurs in 5 to 52% of older adult patients after noncardiac surgery.Delirium is characterized by disturbance in attention, awareness, and cognition that develops acutely and fluctuates frequently throughout the course of the condition..Various pharmacological modalities like typical and atypical antipsychotics, alpha 2 agonists like dexmedetomidine and non-pharmacological techniques like early mobilization, adequate nutrition and sleep hygiene have been employed for the prevention of delirium.

Dexmedetomidine (DEX) is a highly selective α2-receptor agonist that provides sedation, analgesia, and anxiety relief. As an α2-adrenergic receptor agonist, Dexmedetomidine can also reduce the systemic inflammatory response and regulate the immune system by inhibiting the central sympathetic nervous system. Ketamine is a non-competitive NMDA receptor antagonist and also possess neuroprotective and antidepressant property.It has been reported in systematic reviews that intraoperative ketamine administration reduces postoperative markers of inflammation as well as postoperative pain and opioid consumption.Furthermore, delirium and depression in elderly people appear to be overlapping syndromes caused by similar pathophysiological mechanisms.In addition to these theoretical benefits, ketamine is inexpensive and there is extensive experience among anaesthetists internationally.Therefore, dexmedetomidine and ketamine can play a role in reducing the incidence of postoperative delirium in elderly patients undergoing hip surgeries alongside with the levels of pro inflammatory markers.