Management of Postoperative Cognitive Dysfunction
Sarah Ahmed Salem Ahmed Elbadawy;
Abstract
Summary
T
he precise mechanisms for POCD are still far from being clearly elucidated. Due to the pharmacological properties, the application of anestheticsinduces acute effects which on one hand blocks learning and memory and on the other hand exerts neuroprotective activities. These in vitrocharacteristics wouldexhibit a preferable profile of anesthetics: the patient is protected from undesirable memories and possible neurodegeneration which might be induced during surgery. Unfortunately, there is clear evidencethat a considerable proportion of people, dependent on riskfactors, suffer from cognitive dysfunction described either asanticholinergic syndrome, delirium or POCD after surgery.At this point it should be stressed that the choice of anesthetic most probably does not influence the incidence ofPOCD and thus rather speaks in favor of a minor role foranesthesia in contributing to the development of cognitiveimpairment after surgery.
Theinterpretation of available data on POCD is accompanied bynumerous methodological deficits. Overcoming those problems would imply the planning and performance of powerfulclinical studies with comparable surgery, standardized neuopsychological tests and defined diagnostic criteria used toclassify individuals as having POCD. Concomitantly, theavailability of such meaningful data would be useful for thedevelopment and application of non-pharmacological andpharmacological neuroprotective strategies.
Improvementinsurgicaltechnique, anesthesiaandintensivecarehasmadeitpossibleforelderlypatientstoundergomajorsurgicalproceduresthatsuccessfully prolonglife.However, theoccurrenceofpostoperativecognitivedeclinemayaffecttheirqualityoflife. POCDismultifactorialinorigin, withincreasingageastheleadingriskfactor, yetthemechanismisnotfullyunderstood.Thereisnoconvincingevidence tosuggestgeneralanesthesiacausesoccurrenceofPOCD, astheincidenceofPOCDisequivalentbetweenpatientsreceivinggeneralandregionalanesthesia.
At the present time it is impossible to recommend an ideal anesthetic technique that willchange cognitive outcome until furtherevidence accumulates. All available datasupport the concept that maintenance of adequate tissue oxygenation, hemodynamic stability and a well planned anesthetic techniquemay improve cognitive outcomein elderly patients. Anesthesiologists should inform the concerned patients and their families about the nature and risk of postoperative cognitive problems.
T
he precise mechanisms for POCD are still far from being clearly elucidated. Due to the pharmacological properties, the application of anestheticsinduces acute effects which on one hand blocks learning and memory and on the other hand exerts neuroprotective activities. These in vitrocharacteristics wouldexhibit a preferable profile of anesthetics: the patient is protected from undesirable memories and possible neurodegeneration which might be induced during surgery. Unfortunately, there is clear evidencethat a considerable proportion of people, dependent on riskfactors, suffer from cognitive dysfunction described either asanticholinergic syndrome, delirium or POCD after surgery.At this point it should be stressed that the choice of anesthetic most probably does not influence the incidence ofPOCD and thus rather speaks in favor of a minor role foranesthesia in contributing to the development of cognitiveimpairment after surgery.
Theinterpretation of available data on POCD is accompanied bynumerous methodological deficits. Overcoming those problems would imply the planning and performance of powerfulclinical studies with comparable surgery, standardized neuopsychological tests and defined diagnostic criteria used toclassify individuals as having POCD. Concomitantly, theavailability of such meaningful data would be useful for thedevelopment and application of non-pharmacological andpharmacological neuroprotective strategies.
Improvementinsurgicaltechnique, anesthesiaandintensivecarehasmadeitpossibleforelderlypatientstoundergomajorsurgicalproceduresthatsuccessfully prolonglife.However, theoccurrenceofpostoperativecognitivedeclinemayaffecttheirqualityoflife. POCDismultifactorialinorigin, withincreasingageastheleadingriskfactor, yetthemechanismisnotfullyunderstood.Thereisnoconvincingevidence tosuggestgeneralanesthesiacausesoccurrenceofPOCD, astheincidenceofPOCDisequivalentbetweenpatientsreceivinggeneralandregionalanesthesia.
At the present time it is impossible to recommend an ideal anesthetic technique that willchange cognitive outcome until furtherevidence accumulates. All available datasupport the concept that maintenance of adequate tissue oxygenation, hemodynamic stability and a well planned anesthetic techniquemay improve cognitive outcomein elderly patients. Anesthesiologists should inform the concerned patients and their families about the nature and risk of postoperative cognitive problems.
Other data
| Title | Management of Postoperative Cognitive Dysfunction | Other Titles | معالجةالخلل الإدراكىما بعد العملية الجراحية | Authors | Sarah Ahmed Salem Ahmed Elbadawy | Issue Date | 2014 |
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