Table 3.

Common medications in the perioperative period with potential neurological effects that are also on the 2012 Beers criteria list for potentially inappropriate medication use in older adults

Drug	Rationale
Diphenhydramine	Highly anticholinergic; may increase confusion
Hydroxyzine	Highly anticholinergic; may increase confusion
Scopolamine	Highly anticholinergic
Amitriptyline	Highly anticholinergic; sedating
Antipsychotics	Increased risk of stroke and mortality in persons with dementia
Benzodiazepines	Older adults have increased sensitivity and decreased metabolism. Risk of cognitive impairment, delirium, and falls
Metoclopramide	Extrapyramidal side-effects; risk may be increased in older adults
Pethidine	Not effective analgesic; may cause neurotoxicity
Pentazocine	May cause central nervous system adverse events, including confusion and hallucinations
Neuromuscular blocking drugs	Poorly tolerated by older adults, with anticholinergic adverse effects