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During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
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Updated: Jul 11, 2025

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Postoperative neurocognitive disorders: A clinical guide.

Ozlem Korkmaz Dilmen1, Basak Ceyda Meco2, Lisbeth A Evered3

  • 1Istanbul University- Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Anaesthesiology and Intensive Care, Istanbul, Turkey.

Journal of Clinical Anesthesia
|November 9, 2023
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Summary

Postoperative cognitive dysfunction can negatively impact patients, especially the elderly. Implementing a bundle of preventive measures, guided by the Safe Brain Initiative, can reduce its incidence and duration.

Keywords:
AnaesthesiologyDeliriumElectroencephalographyEnhanced recovery after surgeryPostoperative neurocognitive disordersSafe brain initiative

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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.