Blood-brain barrier dysfunction in surgery and anesthesia: a potential mechanistic contributor to postoperative...

Area of Science:

• Neuroscience
• Immunology
• Gerontology

Background:

• The blood-brain barrier (BBB) maintains central nervous system homeostasis.
• Surgical interventions and anesthesia can compromise BBB integrity, especially in elderly patients, leading to postoperative cognitive dysfunction (POCD).

Purpose of the Study:

• To provide a BBB-centered perspective on POCD.
• To evaluate BBB dysfunction as a unifying mechanism linking surgical stress, inflammation, anesthesia, and cognitive decline.

Main Methods:

• This narrative review integrates current experimental and clinical evidence.
• It critically evaluates the role of BBB disruption in perioperative neurocognitive impairment.

Main Results:

• Surgical trauma and anesthesia can increase BBB permeability, allowing neurotoxic substances into the brain and promoting neuroinflammation.
• BBB dysfunction is highlighted as a central contributor to POCD, though direct human causal evidence is limited.

Conclusions:

• BBB disruption may be a key mechanistic link between perioperative stress and cognitive impairment.
• Targeting BBB stabilization offers potential neuroprotective strategies against POCD.
• Further research is needed to clarify neuroinflammatory pathways and identify effective therapies in humans.