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Have you ever wondered about the potential impact of surgery and anesthesia on cognitive function? Today’s show will discuss the complexities of Perioperative Neurocognitive Disorders (PND), a term encompassing conditions like postoperative delirium (POD), postoperative cognitive decline (POCD), and delayed neurocognitive recovery (DNR).
These disorders can affect memory, attention, and overall cognitive well-being, potentially leading to prolonged hospital stays, reduced quality of life, and increased morbidity. As surgical procedures become more common, especially among the aging population, understanding the impact of anesthesia on cognitive function is crucial.
Through insightful discussions rooted in the latest research, we aim to shed light on:
- The prevalence and impact of PND, drawing from studies highlighting its occurrence after various surgical procedures.
- Potential risk factors that may make individuals more susceptible to developing PND.
- Innovative approaches for prevention and management, including the investigation of medications like dexmedetomidine and anesthetic techniques such as total intravenous anesthesia (TIVA) with propofol, which some studies suggest may have neuroprotective properties.
- The intricate underlying mechanisms of PND, exploring the roles of neuroinflammation, oxidative stress, and even insulin signaling in the central nervous system.
- The use of monitoring techniques like electroencephalography (EEG) to better understand and potentially mitigate neurocognitive complications.
- The importance of early identification and comprehensive care for individuals experiencing PND.
Join us as we explore the science behind PND and strive to improve perioperative outcomes for all.
Important Links:
"Brain health should be at the forefront, no pun intended, of our minds as we're interacting with our patients."
- Garry & Terry
References
Alhamdah, Y., Li, W.-Y., Nagappa, M., Yan, E., He, D., Sarieplla, A., Englesakis, M., Elias, Z., Chan, M. T. V., Wang, D.-X., & Chung, F. (2025). Perioperative approaches to prevent delayed neurocognitive recovery and postoperative neurocognitive disorder in older surgical patients: A systematic review and meta-analysis of randomized controlled trials. Journal of Anaesthesiology, Clinical Pharmacology, 41(1), 3–14. https://doi.org/10.4103/joacp.joacp_396_23
Chen, J., Ding, Q., Jiao, X., Wang, B., Sun, Z., Zhang, Y., & Zhao, J. (2022). Dexmedetomidine attenuates hippocampal neuroinflammation in postoperative neurocognitive disorders by inhibiting microRNA-329-3p and activating the CREB1/IL1RA axis. Psychopharmacology, 239(7), 2171–2186. https://doi.org/10.1007/s00213-022-06091-y
Dilmen, O. K., Meco, B. C., Evered, L. A., & Radtke, F. M. (2024). Postoperative neurocognitive disorders: A clinical guide. Journal of Clinical Anesthesia, 92, 111320–111320. https://doi.org/10.1016/j.jclinane.2023.111320
Ding, L., Chen, D. X., & Li, Q. (2020). Effects of electroencephalography and regional cerebral oxygen saturation monitoring on perioperative neurocognitive disorders: a systematic review and meta-analysis. BMC Anesthesiology, 20(1), 254–13. https://doi.org/10.1186/s12871-020-01163-y
Fislage, M., Zacharias, N., & Feinkohl, I. (2024). The Thalamus in Perioperative Neurocognitive Disorders. Neuropsychology Review, 34(3), 850–859. https://doi.org/10.1007/s11065-023-09615-1
He, J., Zhang, X., Li, C., Fu, B., Huang, Y., & Li, H. (2024). Dexmedetomidine nasal administration improves perioperative sleep quality and neurocognitive deficits in elderly patients undergoing general anesthesia. BMC Anesthesiology, 24(1), 42–10. https://doi.org/10.1186/s12871-024-02417-9
Qeva, E., Sollazzo, C., & Bilotta, F. (2022). Insulin signaling in the central nervous system, a possible pathophysiological mechanism of anesthesia-induced delayed neurocognitive recovery/postoperative neurocognitive disorder: a narrative review. Expert Review of Neurotherapeutics, 22(10), 839–847. https://doi.org/10.1080/14737175.2022.2144234
Rengel, K. F., Pandharipande, P. P., & Hughes, C. G. (2019). Special Considerations for the Aging Brain and Perioperative Neurocognitive Dysfunction. Anesthesiology Clinics, 37(3), 521–536. https://doi.org/10.1016/j.anclin.2019.04.010
Sun, Z., Shi, J., Liu, C., Zhang, J., Liu, Y., Wu, Y., Han, X., Dai, H., Wu, J., Bo, L., & Wang, F. (2024). The Effect of Low-Dose Dexmedetomidine on Perioperative Neurocognitive Dysfunction in Elderly Patients Undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP): A Randomized, Controlled, Double-Blind Trial. Drug Design, Development and Therapy, 18, 3715–3725. https://doi.org/10.2147/DDDT.S470514
Wang, T., Huang, X., Sun, S., Wang, Y., Han, L., Zhang, T., Zhang, T., & Chen, X. (2025). Recent Advances in the Mechanisms of Postoperative Neurocognitive Dysfunction: A Narrative Review. Biomedicines, 13(1), 115-. https://doi.org/10.3390/biomedicines13010115
Wang, H., Lv, X., Wu, L., Ma, F., Wang, L., Wang, Y., Wang, X., & Li, Y. (2025). The effect of neuromuscular blocking reversal agents on perioperative neurocognitive function after general anaesthesia: a systematic review and meta-analysis. BMC Anesthesiology, 25(1), 152–11. https://doi.org/10.1186/s12871-025-03019-9
[9] Neuroleptic malignant syndrome - UpToDate
