[Clinical practice progress and prospects of "brain enhanced recovery after surgery" in elderly patients]

The concept of "brain enhanced recovery after surgery (Brain-ERAS)" has emerged against the backdrop of population aging, a renewed recognition of the profound consequences of postoperative cerebral complications, the growing accumulation of evidence-based clinical data, and the continuous refinement of the enhanced recovery after surgery (ERAS) paradigm. It represents a multimodal intervention strategy centered on postoperative cognitive recovery and neuroprotection in elderly surgical patients. In this article, we systematically review the latest advances in the clinical application of Brain-ERAS, with a particular focus on a multidisciplinary collaborative management framework spanning the perioperative period. This framework encompasses preoperative cognitive screening and prehabilitation, intraoperative monitoring of cerebral oxygen supply-demand balance and optimization of anesthetic depth, multimodal analgesic regimens, pharmacological and non-pharmacological neuroprotective approaches, as well as early postoperative cognitive training and prevention of complications. By incorporating evidence-based findings into individualized perioperative care, Brain-ERAS has been shown to effectively reduce the incidence of postoperative delirium and cognitive dysfunction, shorten hospital length of stay, and improve long-term neurological prognosis in older adults. Future research should prioritize high-quality clinical trials, the development of standardized implementation protocols, and the promotion of standardized adoption of Brain-ERAS in elderly patients undergoing anesthesia and surgery.