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Anesthesia and Cognitive Outcome in Elderly Patients

A Narrative Viewpoint

Cottrell, James E. MD; Hartung, John PhD

doi: 10.1097/ANA.0000000000000640
Review Article: PDF Only

Better ways to manage preoperative, intraoperative and postoperative care of surgical patients is the bailiwick of anesthesiologists. Although we care for patients of all ages, protecting the cognitive capacity of elderly patients more frequently requires procedures and practices that go beyond routine care for nonelderly adults. This narrative review will consider current understanding of the reasons that elderly patients need enhanced care, and recommendations for that care based on established and recent empirical research. In that latter regard, unless and until we are able to classify anesthetic neurotoxicity as a rare complication, the first-do-no-harm approach should: (1) add anesthesia to surgical intervention on the physiological cost side of the cost/benefit ratio when making decisions about whether and when to proceed with surgery; (2) minimize anesthetic depth and periods of electroencephalographic suppression; (3) limit the duration of continuous anesthesia whenever possible; (4) consider the possibility that regional anesthesia with deep sedation may be as neurotoxic as general anesthesia; and (5) when feasible, use regional anesthesia with light or no sedation.

Department of Anesthesiology, State University of New York, Downstate Health Sciences Center, Brooklyn, NY

Details of previous presentation of the work (or part thereof):

Some sections of this manuscript are similar to sections of American Society of Anesthesiologists (ASA) Refresher Course Lecture (RCL) Outlines for RCL’s that Dr. Cottrell has presented at ASA Annual Meetings over the past 30+ years. Those RCL Outlines have been distributed to attendees of ASA Annual Meetings as part of the fee for attending the meetings (formerly in print, subsequently digital only). They have also been made available to ASA members that do not attend Annual Meetings at a substantial cost at the ASA “store,” and to nonmembers at a substantially higher cost at the ASA “store.” For examples, see:

Under the original meaning of “publish”—to make written material available to the public—given the limited distribution and cost of ASA Refresher Course Lecture Outlines, we do not consider those Outlines to have been “published” in the conventional sense. That view is supported by the ASA’s stipulation that authors of RCL Outlines retain copyright of their material.

The authors have no funding or conflicts of interest to disclose.

Address correspondence to: John Hartung, PhD. E-mail:

Received February 5, 2019

Accepted July 30, 2019

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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