Postoperative neurocognitive disorders: A clinical guide.

Area of Science:

• Anesthesiology
• Neuroscience
• Geriatrics

Background:

• Postoperative cognitive outcomes are a growing concern, impacting patient autonomy, quality of life, and increasing morbidity/mortality, particularly in elderly patients.
• Surgical and anesthetic stress can trigger neuroinflammation, neurotoxicity, and hypercoagulopathy, contributing to cognitive decline.
• Multifaceted strategies to mitigate perioperative stress show promise in improving patient outcomes.

Purpose of the Study:

• To present evidence-based recommendations for preventing, diagnosing, and treating postoperative neurocognitive disorders.
• To advocate for the Safe Brain Initiative approach in patient care.
• To highlight the importance of a holistic, team-based strategy.

Main Methods:

• Review of empirical research on postoperative cognitive outcomes.
• Analysis of pathophysiological processes involved in cognitive dysfunction.
• Examination of preventive strategies, including EEG-guided anesthesia, analgesia, and hemodynamic stability.
• Consideration of the ESAIC Safe Brain Initiative recommendations.

Main Results:

• Multi-faceted preventive initiatives (preoperative, intraoperative, postoperative) can decrease the incidence and duration of postoperative delirium.
• Personalized anesthesia depth, adequate analgesia, and hemodynamic stability are modifiable risk factors.
• A team-based approach enhances clinical and functional outcomes.

Conclusions:

• Implementing a bundle of non-invasive preventive measures is recommended for patient-centered care.
• Evidence supports the efficacy of comprehensive strategies in mitigating postoperative neurocognitive disorders.
• The Safe Brain Initiative provides a framework for improved patient care and outcomes.