Postoperative Cognitive Dysfunction: An Updated Review

Abstract

Post operative Cognitive Dysfunction is a condition that follows immediately after a major surgery or any other serious health ailment. It shows significant clinical and social impact on the patient that may often result in either death or impairment, disabling the individual to enter into the job market. While 30% to 40% of postoperative patients, particularly elders are affected immediately after getting discharged from the hospital, 5% to 12% of patients are affected after three months. The origin and the reasons for POCD are not clearly known and there are no universally acceptable evidence based management strategies to cope with this emergency. There is no consensus among experts across the globe on how to treat these kinds of disorders and the definition for the Post Operative Cognitive Dysfunction is missing in the existing literature, leading to further confusion. This article attains importance as tries to analyze the most recent theories of pathogenesis and the risks that may follow Post operative Cognitive Dysfunction by reviewing articles published on this subjects for the past 60 years, starting from 1955 to 2014 in PubMed and Google Scholar and suggests relevant measures on how to cope with it.

Early postoperative cognitive decline—are there any preventive strategies for surgical patients in the emergency setting?

“…As for the effects of the potent anti-inflammatory dexamethasone on incidence of postoperative neurocognitive decline, the current reports are highly variable, with encouraging results only in animal models [1,4]. A randomized clinical trial of patients receiving dexamethasone intraoperative failed to demonstrate a benefit in both early and late cognitive decline following surgery [34].…”

“…Ever since the first reports of postoperative cognitive decline after cardiac and non-cardiac surgery were published as early as 1887 [3,4], interest in this topic has continued among the scientific community as evidenced by a significant number of insightful papers [4].…”

“…Although several hypotheses have been proposed to be responsible for the pathophysiology of neurocognitive disorders, the entire mechanism is poorly understood [1,4]. These include neuroinflammation triggered by surgical trauma, malfunction of the blood-brain barrier, which may be involved in a neural activity breakdown, as well as neurotransmitter abnormalities [6,7].…”

“…Successful prophylaxis and treatment of the cognitive dysfunctions following surgery have not been demonstrated, although prehabilitation and cognitive training are encouraged in an effort to optimize the postoperative cognitive outcome in elective surgery settings [4,19,20]. The current review will address an essential need to integrate ongoing research into delirium prevention for surgical patients in the emergency settings, since once delirium occurs, both pharmacological and non-pharmacological interventions have a slight effect on severity and duration of the episode or likelihood of recurrence.…”

Inhaled Anesthetics: Environmental Role, Occupational Risk, and Clinical Use

“…Anesthesia and surgical procedures have been associated with cognitive disorders [96]. Postoperative cognitive disorder (POCD) can impact the affected patients clinically and socially, especially at an older age [97]. Although the causes and risks for POCD are not yet fully understood, the type of anesthesia used-TIVA or inhaled anesthetic-has been suggested to play a role and even if still controversial, the currently available data favor TIVA in place of inhaled anesthesia [97][98][99][100][101].…”