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Perioperative cognitive evaluation

Borozdina, Anastasiaa; Qeva, Egab; Cinicola, Marcob; Bilotta, Federicob

Current Opinion in Anesthesiology: December 2018 - Volume 31 - Issue 6 - p 756–761
doi: 10.1097/ACO.0000000000000658
TECHNOLOGY, EDUCATION AND SAFETY: Edited by Stephan A. Loer
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Purpose of review This article reviews the recent clinical evidence published between January 2017 and June 2018 – related to perioperative cognitive evaluation. Namely, new insights into risk factors, prevention, diagnosis and diagnostic tools and treatment.

Recent findings Several risk factors (preoperative, intraoperative and postoperative) have been found to be associated with the development of postoperative delirium (POD) and/or postoperative cognitive dysfunction (POCD). Short-term and long-term postoperative consequences can be reduced by targeting risk factors, introducing preventive strategies and including frequent cognitive monitoring. Administration of medications such as ketamine, opioids and benzodiazepines are associated with increased cognitive dysfunction. Prevention of POD/POCD starts with creating an environment, which promotes return to preoperative baseline functioning. This includes frequent monitoring of cognitive status, access to rehabilitation and psychological and social supports, and avoiding polypharmacy. In addition, patients should have early access to their sensory aids and maintain normal circadian rhythm. Treatment of POD/POCD has pharmacological and nonpharmacological approaches.

Summary Clinical evidence on POD/POCD is continuously evolving, which is essential in guiding clinical management to provide the highest quality of clinical care.

aDepartment of Anaesthesiology and Intensive Care, First Moscow City Hospital named after N.I. Pirogov, Moscow, Russia

bDepartment of Anesthesiology, Critical Care and Pain Medicine, ‘Sapienza’ University, Rome, Italy

Correspondence to Federico Bilotta, MD, PhD, Department of Anesthesiology, Critical Care and Pain Medicine, ‘Sapienza’ University, Rome, Italy. Tel: +39 6 8608273; fax: +39 6 8608273; e-mail: bilotta@tiscali.it

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