Abstract
As the world population ages, the number of older patients undergoing
surgery will increase significantly. Postoperative cognitive dysfunction (POCD) and
other perioperative neurocognitive disorders (PND) affecting patients after surgery
have long been recognized in older patients and are considered some of the most
common postoperative complications. POCD has been correlated with significant
morbidity and mortality, and greater healthcare costs. Historically, the lack of
standardized nomenclature used to describe cognitive change after surgery and
anesthesia has made it challenging to conduct systematic reviews or analyze the results
of similar studies to further understand the clinical implications of this disorder. This
has led to minimal recognition of this disorder outside of the specialty of
anesthesiology. Patient and surgery-related risk factors include old age, preexisting
cognitive changes, and emergency surgery amongst others. Proposed etiologies include
postsurgical neuroinflammation, impairment of neurotransmitter systems, and cerebral
vascular events in the perioperative period. The medical literature offers little guidance
to recommend a particular anesthetic to decrease the risk of POCD in the postoperative
patient. Most studies found similar risks of POCD after general and regional anesthesia
techniques. While there is no standardized test for diagnosing preoperative cognitive
impairment, it is critical to identify high-risk patients so that timely interventions can
be made to minimize POCD.
Keywords: Delayed neurocognitive recovery, Intraoperative risk reduction, Perioperative neurocognitive disorder, Postoperative cognitive dysfunction, Risk factors.