Associated Factors of Postoperative Cognitive Dysfunction: A Literature Review
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Published:
Nov 18, 2021
Keywords:
Cognitive impairment, Postoperative Cognitive Dysfunction, POCD, Protective factor, Risk factor
Main Article Content
Abstract
Postoperative Cognitive Dysfunction (POCD) is defined as declining of one or more discrete areas of mental state postoperatively. The pathogenesis is unclear, but the most possible is inflammatory process in the brain. There is no specific treatment. Hence, POCD prevention by adjusting risk and protective factors should be conducted. This literature review shows 3 groups of associated factors. First, patient risk factors are old age, low education level, history of anticholinergic or sedative drugs usage, neurological diseases, diabetes mellitus, renal disease, carrier of ApoE ε4 gene, delirium, Systemic Inflammatory Response Syndrome and anemia. Second, anesthetic risk factors are benzodiazepine and high amount of opioid usage. Anesthetic protective factors are the usage of dexmedetomidine, ketamine, parecoxib, monitoring depth of anesthesia, patient-controlled epidural analgesia, and peripheral nerve block. Third, surgical risk factors are cardiac surgery, major surgery, long duration of surgery, blood loss and long waiting time before surgery. Previous studies have shown that these factors contributed differently to POCD, but the results were mostly modest. These studies are heterogeneity due to lack of definite diagnosis criteria of POCD. The further large and welldesigned studies are needed to confirm this association.
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Review articles
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References
1. Rasmussen LS, Larsen K, Houx P, Skovgaard LT, Hanning CD, Moller JT. The assessment of postoperative cognitive
function. Acta Anaesthesiol Scand 2001;45:275-89.
2. Bedford PD. Adversecerebraleffectsofanaesthesiaonold people.Lancet1955;269:259-63.
3. Norkiene I, Samalavicius R, Misiuriene I, Paulauskiene K, Budrys V, Ivaskevicius J. Incidence and risk factors for early postoperative cognitive decline after coronary artery bypass grafting. Medicina(Kaunas)2010;46:460-4.
4. CanetJ, RaederJ, RasmussenLS,etal.Cognitive dysfunction after minor surgery in the elderly. Acta Anaesthesiologica Scandinavica2003;47:1204-10.
5. Daiello LA, Racine AM, Yun Gou R, et al. Postoperative delirium and postoperative cognitive dysfunction: overlap and divergence. Anesthesiology2019;131:477-91.
6. HudetzJA, Iqbal Z, Gandhi SD,etal. Postoperativecognitive dysfunctioninolder patients withahistoryofalcoholabuse. Anesthesiology2007;106:423-30.
7. Evered L, Silbert B, Knopman DS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Acta Anaesthesiol Scand 2018;62:1473-80.
8. TerrandoN, ErikssonLI, RyuJK,etal. Resolving postoperative neuroinflammation and cognitive decline. Ann Neurol 2011;70:986-95.
9. Li Y, He R, Chen S, Qu Y. Effect of dexmedetomidine on early postoperativecognitive dysfunctionand peri-operative inflammation in elderly patients undergoing laparoscopic cholecystectomy. Exp Ther Med 2015;10:1635-42.
10. Zhang H, Wu Z, Zhao X, Qiao Y. Role of dexmedetomidine inreducingtheincidenceofpostoperativecognitivedysfunction caused bysevofluraneinhalationanesthesiainelderly patients with esophageal carcinoma. J Cancer Res Ther 2018;14: 1497-502.
11. Peng L, Xu L, Ouyang W. Role of peripheral inflammatory markers in postoperative cognitive dysfunction (POCD): a meta-analysis. PLoS One2013;8:e79624.
12. NeedhamMJ,Webb CE, Bryden DC. Postoperativecognitive dysfunction and dementia: what we need to know and do. Br J Anaesth2017;119(suppl_1):i115-i25.
13. Vizcaychipi MP. Post-operative cognitive dysfunction: pre-operative risk assessment and peri-operative risk minimization: A pragmaticreview of theliterature.JIntensive & Crit Care2016;02(02).
14. Feinkohl I, Winterer G, Spies CD, Pischon T. Cognitive reserveand theriskof postoperativecognitive dysfunction. Dtsch Arztebl Int2017;114:110-7.
15. Shoair OA, Grasso Ii MP, Lahaye LA, Daniel R, Biddle CJ, Slattum PW. Incidence and risk factors for postoperative cognitive dysfunction in older adults undergoing major noncardiacsurgery: A prospectivestudy.J Anaesthesiol Clin Pharmacol2015;31:30-6.
16. American Geriatrics Society. American Geriatrics Society updatedBeersCriteriafor potentiallyinappropriatemedication useinolderadults. J Am Geriatr Soc2012;60:616-31.
17. Silbert B, Evered L, Scott DA, et al. Preexisting cognitive impairment is associated with postoperative cognitive dysfunctionafterhipjointreplacementsurgery.Anesthesiology 2015;122:1224-34.
18. Knaak C, BrockhausWR, Spies C,etal. Presurgicalcognitive impairment is associated with postoperative delirium and postoperative cognitive dysfunction. Minerva Anestesiol 2020;86:394-403.
19. Monk TG, Weldon BC, Garvan CW, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology2008;108:18-30.
20. MonkTG, Price CC. Postoperativecognitive disorders. Curr Opin Crit Care2011;17:376-81.
21. Yeh YC, Kuo YT, Huang MF,etal. Associationof brain white matter lesionsand atrophy withcognitivefunctioninchronic kidney disease. Int J Geriatr Psychiatry2019;34:1826-32.
22. Kadoi Y, Goto F. Factors associated with postoperative cognitive dysfunctionin patientsundergoing cardiacsurgery. SurgeryToday2006;36:1053-7.
23. Miyagawa N, Baba T, Maekawa K, et al. Chronic kidney diseaseand postoperativecognitive dysfunctionincoronary surgical patients. Cardiovascular Anesthesia2017;21:123-9.
24. Feinkohl I, Winterer G, Pischon T. Diabetes is associated withriskofpostoperativecognitivedysfunction:Ameta-analysis. Diabetes Metab Res Rev2017;33(5).
25. Kadoi Y, Saito S, Fujita N, Goto F. Risk factors for cognitive dysfunction after coronary artery bypass graft surgery in patients with type 2 diabetes. J Thorac Cardiovasc Surg 2005;129:576-83.
26. He X,Long G, Quan C, Zhang B, ChenJ, Ouyang W. Insulin resistance predicts postoperative cognitive dysfunction in elderly gastrointestinal patients. Front Aging Neurosci 2019;11:197.
27. Nakao S, Yamamoto T, Kimura S, Mino T, Iwamoto T. Brain whitematter lesionsand postoperativecognitive dysfunction: areview. J Anesth2019;33:336-40.
28. Feinkohl I, Winterer G, Pischon T. Hypertension and risk of post-operative cognitive dysfunction (POCD): A systematic review and meta-analysis. Clin Pract Epidemiol Ment Health 2017;13:27-42.
29. Cao L, Wang K, Gu T, Du B, Song J. Association between APOE epsilon4alleleand postoperativecognitive dysfunction: A meta-analysis. Int J Neurosci2014;124:478-85.
30. BickelH,Gradinger R, Kochs E,FörstlH. Highriskofcognitive and functional decline after postoperative delirium: A three-year prospectivestudy. Dement Geriatr Cogn Disord 2008;26:26-31.
31. Goldberg TE, Chen C, Wang Y,etal. Associationof delirium with long-term cognitive decline: A meta-analysis. JAMA Neurology2020.
32. Ge Y, Ma Z, Shi H, Zhao Y, Gu X, Wei H. Incidenceand risk factors of postoperative cognitive dysfunction in patients underwent coronary artery bypass grafting surgery. Zhong nan da xue xue bao Yi xue ban = Journal of Central South University Medical sciences2014;39:1049-55.
33. Safavynia SA, Goldstein PA. The role of neuroinflammation inpostoperativecognitivedysfunction:movingfromhypothesis totreatment.Front Psychiatry2019;9:752.
34. RousselJKS. Postoperativecognitive dysfunction:anupdated review.JournalofNeurology &Neurophysiology.2015;06(03).
35. KokL, Slooter AJ, Hillegers MH,van Dijk D, Veldhuijzen DS. Benzodiazepine use and neuropsychiatric outcomes in the ICU:asystematicreview. Crit Care Med 2018;46:1673-80.
36. Mansouri N, Nasrollahi K, Shetabi H. Preventionofcognitive dysfunction after cataract surgery with intravenous administrationofmidazolamand dexmedetomidineinelderly patientsundergoing cataractsurgery.AdvBiomedRes2019;8:6.
37. Wang Y, Han R, Zuo Z. Dexmedetomidine-induced neuroprotection: isit translational?Transl Perioper Pain Med 2016;1:15-9.
38. Yang W, Kong LS, Zhu XX, Wang RX,Liu Y, ChenLR. Effect of dexmedetomidineon postoperativecognitive dysfunction and inflammation in patients after general anaesthesia: A PRISMA-compliant systematic review and meta-analysis. Medicine(Baltimore)2019;98:e15383.
39. Zhang Y, Shan GJ, Zhang YX,etal. Propofolcompared with sevoflurane general anaesthesia is associated with decreased delayed neurocognitiverecoveryinolderadults. Br J Anaesth2018;121:595-604.
40. Tang S, Huang W, Zhang K, Chen W, Xie T. Comparison of effectsof propofolversussevofluranefor patientsundergoing cardiopulmonary bypass cardiac surgery. Pak J Med Sci 2019;35:1072-5.
41. Kletecka J, Holeckova I, Brenkus P, Pouska J, Benes J, ChytraI. Propofol versus sevofluraneanaesthesia:effecton cognitive decline and event-related potentials. J Clin Monit Comput2019;33:665-73.
42. Guo L, Lin F, Dai H, et al. Impact of sevoflurane versus propofolanesthesiaon post-operativecognitive dysfunction in elderly cancer patients: A double-blinded randomized controlled trial. Med Sci Monit2020;26.
43. Miller D, Lewis SR, Pritchard MW, et al. Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitiveoutcomesinelderly peopleundergoing non-cardiac surgery. Cochrane Database Syst Rev2018;8:Cd012317.
44. Hovaguimian F, Tschopp C, Beck-Schimmer B, Puhan M. Intraoperativeketamineadministrationto prevent delirium or postoperative cognitive dysfunction: A systematic review andmeta-analysis.ActaAnaesthesiolScand2018;62:1182-93.
45. DeKockM,Loix S,Lavand’homme P.Ketamineand peripheral inflammation. CNS NeurosciTher2013;19:403-10.
46. ChenG, Zhou Y, ShiQ, Zhou H. Comparisonofearlyrecovery and cognitive function after desflurane and sevoflurane anaesthesia in elderly patients: A meta-analysis of randomized controlled trials.JInt Med Res2015;43:619-28.
47. Davis N,LeeM,Lin AY,etal. Postoperativecognitivefunction following general versus regional anesthesia: a systematic review. J Neurosurg Anesthesiol2014;26:369-76.
48. BocskaiT, KovácsM, Szakács Z,etal. Isthe bispectral index monitoring protective against postoperative cognitive decline? A systematicreview with meta-analysis. PLoS ONE 2020;15(2).
49. Punjasawadwong Y, Chau-InW,LaopaiboonM, Punjasawadwong S, Pin-On P. Processed electroencephalogram and evoked potential techniquesforameliorationof postoperative deliriumand cognitive dysfunctionfollowing non-cardiacand non-neurosurgical proceduresinadults. Cochrane Database
Syst Rev2018;5(5):Cd011283.
50. HouR,WangH,ChenL,Qiu Y,Li S. POCDin patientsreceiving total knee replacement under deep vs light anesthesia: A randomized controlled trial. Brain Behav2018;8:e00910.
51. Quan C, Chen J, Luo Y, et al. BIS-guided deep anesthesia decreases short-term postoperative cognitive dysfunction and peripheral inflammation in elderly patients undergoing abdominal surgery. Brain Behav2019;9:e01238.
52. Farag E, Chelune GJ, Schubert A, Mascha EJ. Is depth of anesthesia,asassessed by the Bispectral Index, related to postoperative cognitive dysfunction and recovery? Anesth Analg 2006;103:633-40.
53. Kristek G, RadošI, Kristek D,etal. Influenceof postoperative analgesiaonsystemicinflammatoryresponseandpostoperative cognitive dysfunction after femoral fractures surgery: A randomized controlled trial. Reg Anesth Pain Med 2019; 44:59-68.
54. YanW, Mao H, Qiu P. Effectsof differentanalgesiaregimens on early post-operative cognitive dysfunction in elderly patientsundergoing radical resectionofcervicalcarcinoma. Exp Ther Med 2019;18:1465-9.
55. Mei B, Zha H, Lu X, et al. Peripheral nerve block as a supplement to light or deep general anesthesia in elderly patients receiving total hip arthroplasty. Clin J Pain 2017; 33:1053-9.
56. Liang L. Intercostalnerve blockimproves postoperative pain and cognitiveimpairment inelderly patients withesophageal cancer.WorldChineseJournalofDigestology2018;26:609-15.
57. Awada HN, Luna IE, Kehlet H, Wede HR, Hoevsgaard SJ, Aasvang EK. Postoperative cognitive dysfunction is rare after fast-track hip- and knee arthroplasty - but potentially related toopioid use. J Clin Anesth2019;57:80-6.
58. Wang Y, Sands LP, Vaurio L, Mullen EA, Leung JM. The effects of postoperative pain and its management on postoperativecognitive dysfunction. Am J Geriatr Psychiatry 2007;15:50-9.
59. Rasmussen LA, Ryhammer PK, Greisen J, Bhavsar RR, Lorentzen AG, Jakobsen CJ. Ultrashort acting remifentanil isnotsuperior tolong-acting sufentanil in preserving cognitive function- A randomized study.J Clin Anesth2016;33:127-34.
60. Huang S, Hu H, Cai YH, Hua F. Effect of parecoxib in the treatmentof postoperativecognitive dysfunction:asystematic review and meta-analysis. Medicine2019;98:e13812.
61. Ortega-Loubon C, Herrera-Gomez F, Bernuy-Guevara C, etal. Near-infrared spectroscopy monitoring incardiacand noncardiac surgery: Pairwise and Network Meta-Analyses. J Clin Med 2019;8(12).
62. PappaM,Theodosiadis N,Tsounis A, Sarafis P. Pathogenesis and treatment of post-operative cognitive dysfunction. Electron Physician2017;9:3768-75.
63. Brady K, Hogue CW. Intraoperativehypotensionand patient outcome: does “one size fit all?”. Anesthesiology 2013; 119:495-7.
64. Krzych ŁJ, Pluta MP, Putowski Z, Czok M. Investigating association between intraoperative hypotension and postoperative neurocognitive disorders in non-cardiac surgery: A comprehensivereview. J Clin Med 2020;9:1-24.
65. Feng X, HuJ, HuaF, Zhang J, Zhang L, Xu G.Thecorrelation of intraoperative hypotension and postoperative cognitive impairment:a meta-analysisof randomized controlled trials. BMC Anesthesiology.2020;20(1).
66. Gold JP, Charlson ME,Williams-Russo P,etal. Improvement of outcomes after coronary artery bypass. A randomized trialcomparing intraoperativehighversus low meanarterial pressure. J Thorac Cardiovasc Surg 1995;110:1302-11; discussion11-4.
67. LangerT, Santini A, ZadekF,etal. Intraoperativehypotension is not associated with postoperative cognitive dysfunction in elderly patients undergoing general anesthesia for surgery: results of a randomized controlled pilot trial. J Clin Anesth2019;52:111-8.
68. Vedel AG, Holmgaard F, Rasmussen LS, et al. High-target versus low-target blood pressure management during cardiopulmonary bypassto preventcerebral injuryincardiac surgery patients: a randomized controlled trial. Circulation 2018;137:1770-80.
69. Williams-RussoP,SharrockNigel E,MattisS,etal.Randomized trial of hypotensive epidural anesthesia in older adults. Anesthesiology1999;91:926.
70. Evered L, Scott DA, Silbert B, Maruff P. Postoperative cognitive dysfunctionisindependentof typeofsurgeryand anesthetic. Anesth Analg 2011;112:1179-85.
71. Newman S, StygallJ,Hirani S, Shaefi S,MazeM. Postoperative cognitive dysfunctionafternoncardiacsurgery:asystematic review. Anesthesiology2007;106:572-90.
72. FranckM,NerlichK,NeunerB,etal.Noconvincing association between post-operative deliriumand post-operativecognitive dysfunction:asecondaryanalysis. Acta Anaesthesiol Scand 2016;60:1404-14.
73. Tan CB, Ng J, Jeganathan R,etal. Cognitivechangesafter surgery in the elderly: does minimally invasive surgery influencetheincidenceof postoperativecognitivechanges compared to open colon surgery? Dement Geriatr Cogn Disord 2015;39:125-31.
74. Zhu SH,JiMH, Gao DP,LiWY, Yang JJ. Association between perioperative blood transfusion and early postoperative cognitive dysfunction in aged patients following total hip replacement surgery. Ups J Med Sci2014;119:262-7.
75. Krenk L, Rasmussen LS, Kehlet H. Postoperative cognitive dysfunctionafter fast-trackhip and kneearthroplasty. Anesth Analg 2012;114:S290.
function. Acta Anaesthesiol Scand 2001;45:275-89.
2. Bedford PD. Adversecerebraleffectsofanaesthesiaonold people.Lancet1955;269:259-63.
3. Norkiene I, Samalavicius R, Misiuriene I, Paulauskiene K, Budrys V, Ivaskevicius J. Incidence and risk factors for early postoperative cognitive decline after coronary artery bypass grafting. Medicina(Kaunas)2010;46:460-4.
4. CanetJ, RaederJ, RasmussenLS,etal.Cognitive dysfunction after minor surgery in the elderly. Acta Anaesthesiologica Scandinavica2003;47:1204-10.
5. Daiello LA, Racine AM, Yun Gou R, et al. Postoperative delirium and postoperative cognitive dysfunction: overlap and divergence. Anesthesiology2019;131:477-91.
6. HudetzJA, Iqbal Z, Gandhi SD,etal. Postoperativecognitive dysfunctioninolder patients withahistoryofalcoholabuse. Anesthesiology2007;106:423-30.
7. Evered L, Silbert B, Knopman DS, et al. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Acta Anaesthesiol Scand 2018;62:1473-80.
8. TerrandoN, ErikssonLI, RyuJK,etal. Resolving postoperative neuroinflammation and cognitive decline. Ann Neurol 2011;70:986-95.
9. Li Y, He R, Chen S, Qu Y. Effect of dexmedetomidine on early postoperativecognitive dysfunctionand peri-operative inflammation in elderly patients undergoing laparoscopic cholecystectomy. Exp Ther Med 2015;10:1635-42.
10. Zhang H, Wu Z, Zhao X, Qiao Y. Role of dexmedetomidine inreducingtheincidenceofpostoperativecognitivedysfunction caused bysevofluraneinhalationanesthesiainelderly patients with esophageal carcinoma. J Cancer Res Ther 2018;14: 1497-502.
11. Peng L, Xu L, Ouyang W. Role of peripheral inflammatory markers in postoperative cognitive dysfunction (POCD): a meta-analysis. PLoS One2013;8:e79624.
12. NeedhamMJ,Webb CE, Bryden DC. Postoperativecognitive dysfunction and dementia: what we need to know and do. Br J Anaesth2017;119(suppl_1):i115-i25.
13. Vizcaychipi MP. Post-operative cognitive dysfunction: pre-operative risk assessment and peri-operative risk minimization: A pragmaticreview of theliterature.JIntensive & Crit Care2016;02(02).
14. Feinkohl I, Winterer G, Spies CD, Pischon T. Cognitive reserveand theriskof postoperativecognitive dysfunction. Dtsch Arztebl Int2017;114:110-7.
15. Shoair OA, Grasso Ii MP, Lahaye LA, Daniel R, Biddle CJ, Slattum PW. Incidence and risk factors for postoperative cognitive dysfunction in older adults undergoing major noncardiacsurgery: A prospectivestudy.J Anaesthesiol Clin Pharmacol2015;31:30-6.
16. American Geriatrics Society. American Geriatrics Society updatedBeersCriteriafor potentiallyinappropriatemedication useinolderadults. J Am Geriatr Soc2012;60:616-31.
17. Silbert B, Evered L, Scott DA, et al. Preexisting cognitive impairment is associated with postoperative cognitive dysfunctionafterhipjointreplacementsurgery.Anesthesiology 2015;122:1224-34.
18. Knaak C, BrockhausWR, Spies C,etal. Presurgicalcognitive impairment is associated with postoperative delirium and postoperative cognitive dysfunction. Minerva Anestesiol 2020;86:394-403.
19. Monk TG, Weldon BC, Garvan CW, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology2008;108:18-30.
20. MonkTG, Price CC. Postoperativecognitive disorders. Curr Opin Crit Care2011;17:376-81.
21. Yeh YC, Kuo YT, Huang MF,etal. Associationof brain white matter lesionsand atrophy withcognitivefunctioninchronic kidney disease. Int J Geriatr Psychiatry2019;34:1826-32.
22. Kadoi Y, Goto F. Factors associated with postoperative cognitive dysfunctionin patientsundergoing cardiacsurgery. SurgeryToday2006;36:1053-7.
23. Miyagawa N, Baba T, Maekawa K, et al. Chronic kidney diseaseand postoperativecognitive dysfunctionincoronary surgical patients. Cardiovascular Anesthesia2017;21:123-9.
24. Feinkohl I, Winterer G, Pischon T. Diabetes is associated withriskofpostoperativecognitivedysfunction:Ameta-analysis. Diabetes Metab Res Rev2017;33(5).
25. Kadoi Y, Saito S, Fujita N, Goto F. Risk factors for cognitive dysfunction after coronary artery bypass graft surgery in patients with type 2 diabetes. J Thorac Cardiovasc Surg 2005;129:576-83.
26. He X,Long G, Quan C, Zhang B, ChenJ, Ouyang W. Insulin resistance predicts postoperative cognitive dysfunction in elderly gastrointestinal patients. Front Aging Neurosci 2019;11:197.
27. Nakao S, Yamamoto T, Kimura S, Mino T, Iwamoto T. Brain whitematter lesionsand postoperativecognitive dysfunction: areview. J Anesth2019;33:336-40.
28. Feinkohl I, Winterer G, Pischon T. Hypertension and risk of post-operative cognitive dysfunction (POCD): A systematic review and meta-analysis. Clin Pract Epidemiol Ment Health 2017;13:27-42.
29. Cao L, Wang K, Gu T, Du B, Song J. Association between APOE epsilon4alleleand postoperativecognitive dysfunction: A meta-analysis. Int J Neurosci2014;124:478-85.
30. BickelH,Gradinger R, Kochs E,FörstlH. Highriskofcognitive and functional decline after postoperative delirium: A three-year prospectivestudy. Dement Geriatr Cogn Disord 2008;26:26-31.
31. Goldberg TE, Chen C, Wang Y,etal. Associationof delirium with long-term cognitive decline: A meta-analysis. JAMA Neurology2020.
32. Ge Y, Ma Z, Shi H, Zhao Y, Gu X, Wei H. Incidenceand risk factors of postoperative cognitive dysfunction in patients underwent coronary artery bypass grafting surgery. Zhong nan da xue xue bao Yi xue ban = Journal of Central South University Medical sciences2014;39:1049-55.
33. Safavynia SA, Goldstein PA. The role of neuroinflammation inpostoperativecognitivedysfunction:movingfromhypothesis totreatment.Front Psychiatry2019;9:752.
34. RousselJKS. Postoperativecognitive dysfunction:anupdated review.JournalofNeurology &Neurophysiology.2015;06(03).
35. KokL, Slooter AJ, Hillegers MH,van Dijk D, Veldhuijzen DS. Benzodiazepine use and neuropsychiatric outcomes in the ICU:asystematicreview. Crit Care Med 2018;46:1673-80.
36. Mansouri N, Nasrollahi K, Shetabi H. Preventionofcognitive dysfunction after cataract surgery with intravenous administrationofmidazolamand dexmedetomidineinelderly patientsundergoing cataractsurgery.AdvBiomedRes2019;8:6.
37. Wang Y, Han R, Zuo Z. Dexmedetomidine-induced neuroprotection: isit translational?Transl Perioper Pain Med 2016;1:15-9.
38. Yang W, Kong LS, Zhu XX, Wang RX,Liu Y, ChenLR. Effect of dexmedetomidineon postoperativecognitive dysfunction and inflammation in patients after general anaesthesia: A PRISMA-compliant systematic review and meta-analysis. Medicine(Baltimore)2019;98:e15383.
39. Zhang Y, Shan GJ, Zhang YX,etal. Propofolcompared with sevoflurane general anaesthesia is associated with decreased delayed neurocognitiverecoveryinolderadults. Br J Anaesth2018;121:595-604.
40. Tang S, Huang W, Zhang K, Chen W, Xie T. Comparison of effectsof propofolversussevofluranefor patientsundergoing cardiopulmonary bypass cardiac surgery. Pak J Med Sci 2019;35:1072-5.
41. Kletecka J, Holeckova I, Brenkus P, Pouska J, Benes J, ChytraI. Propofol versus sevofluraneanaesthesia:effecton cognitive decline and event-related potentials. J Clin Monit Comput2019;33:665-73.
42. Guo L, Lin F, Dai H, et al. Impact of sevoflurane versus propofolanesthesiaon post-operativecognitive dysfunction in elderly cancer patients: A double-blinded randomized controlled trial. Med Sci Monit2020;26.
43. Miller D, Lewis SR, Pritchard MW, et al. Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitiveoutcomesinelderly peopleundergoing non-cardiac surgery. Cochrane Database Syst Rev2018;8:Cd012317.
44. Hovaguimian F, Tschopp C, Beck-Schimmer B, Puhan M. Intraoperativeketamineadministrationto prevent delirium or postoperative cognitive dysfunction: A systematic review andmeta-analysis.ActaAnaesthesiolScand2018;62:1182-93.
45. DeKockM,Loix S,Lavand’homme P.Ketamineand peripheral inflammation. CNS NeurosciTher2013;19:403-10.
46. ChenG, Zhou Y, ShiQ, Zhou H. Comparisonofearlyrecovery and cognitive function after desflurane and sevoflurane anaesthesia in elderly patients: A meta-analysis of randomized controlled trials.JInt Med Res2015;43:619-28.
47. Davis N,LeeM,Lin AY,etal. Postoperativecognitivefunction following general versus regional anesthesia: a systematic review. J Neurosurg Anesthesiol2014;26:369-76.
48. BocskaiT, KovácsM, Szakács Z,etal. Isthe bispectral index monitoring protective against postoperative cognitive decline? A systematicreview with meta-analysis. PLoS ONE 2020;15(2).
49. Punjasawadwong Y, Chau-InW,LaopaiboonM, Punjasawadwong S, Pin-On P. Processed electroencephalogram and evoked potential techniquesforameliorationof postoperative deliriumand cognitive dysfunctionfollowing non-cardiacand non-neurosurgical proceduresinadults. Cochrane Database
Syst Rev2018;5(5):Cd011283.
50. HouR,WangH,ChenL,Qiu Y,Li S. POCDin patientsreceiving total knee replacement under deep vs light anesthesia: A randomized controlled trial. Brain Behav2018;8:e00910.
51. Quan C, Chen J, Luo Y, et al. BIS-guided deep anesthesia decreases short-term postoperative cognitive dysfunction and peripheral inflammation in elderly patients undergoing abdominal surgery. Brain Behav2019;9:e01238.
52. Farag E, Chelune GJ, Schubert A, Mascha EJ. Is depth of anesthesia,asassessed by the Bispectral Index, related to postoperative cognitive dysfunction and recovery? Anesth Analg 2006;103:633-40.
53. Kristek G, RadošI, Kristek D,etal. Influenceof postoperative analgesiaonsystemicinflammatoryresponseandpostoperative cognitive dysfunction after femoral fractures surgery: A randomized controlled trial. Reg Anesth Pain Med 2019; 44:59-68.
54. YanW, Mao H, Qiu P. Effectsof differentanalgesiaregimens on early post-operative cognitive dysfunction in elderly patientsundergoing radical resectionofcervicalcarcinoma. Exp Ther Med 2019;18:1465-9.
55. Mei B, Zha H, Lu X, et al. Peripheral nerve block as a supplement to light or deep general anesthesia in elderly patients receiving total hip arthroplasty. Clin J Pain 2017; 33:1053-9.
56. Liang L. Intercostalnerve blockimproves postoperative pain and cognitiveimpairment inelderly patients withesophageal cancer.WorldChineseJournalofDigestology2018;26:609-15.
57. Awada HN, Luna IE, Kehlet H, Wede HR, Hoevsgaard SJ, Aasvang EK. Postoperative cognitive dysfunction is rare after fast-track hip- and knee arthroplasty - but potentially related toopioid use. J Clin Anesth2019;57:80-6.
58. Wang Y, Sands LP, Vaurio L, Mullen EA, Leung JM. The effects of postoperative pain and its management on postoperativecognitive dysfunction. Am J Geriatr Psychiatry 2007;15:50-9.
59. Rasmussen LA, Ryhammer PK, Greisen J, Bhavsar RR, Lorentzen AG, Jakobsen CJ. Ultrashort acting remifentanil isnotsuperior tolong-acting sufentanil in preserving cognitive function- A randomized study.J Clin Anesth2016;33:127-34.
60. Huang S, Hu H, Cai YH, Hua F. Effect of parecoxib in the treatmentof postoperativecognitive dysfunction:asystematic review and meta-analysis. Medicine2019;98:e13812.
61. Ortega-Loubon C, Herrera-Gomez F, Bernuy-Guevara C, etal. Near-infrared spectroscopy monitoring incardiacand noncardiac surgery: Pairwise and Network Meta-Analyses. J Clin Med 2019;8(12).
62. PappaM,Theodosiadis N,Tsounis A, Sarafis P. Pathogenesis and treatment of post-operative cognitive dysfunction. Electron Physician2017;9:3768-75.
63. Brady K, Hogue CW. Intraoperativehypotensionand patient outcome: does “one size fit all?”. Anesthesiology 2013; 119:495-7.
64. Krzych ŁJ, Pluta MP, Putowski Z, Czok M. Investigating association between intraoperative hypotension and postoperative neurocognitive disorders in non-cardiac surgery: A comprehensivereview. J Clin Med 2020;9:1-24.
65. Feng X, HuJ, HuaF, Zhang J, Zhang L, Xu G.Thecorrelation of intraoperative hypotension and postoperative cognitive impairment:a meta-analysisof randomized controlled trials. BMC Anesthesiology.2020;20(1).
66. Gold JP, Charlson ME,Williams-Russo P,etal. Improvement of outcomes after coronary artery bypass. A randomized trialcomparing intraoperativehighversus low meanarterial pressure. J Thorac Cardiovasc Surg 1995;110:1302-11; discussion11-4.
67. LangerT, Santini A, ZadekF,etal. Intraoperativehypotension is not associated with postoperative cognitive dysfunction in elderly patients undergoing general anesthesia for surgery: results of a randomized controlled pilot trial. J Clin Anesth2019;52:111-8.
68. Vedel AG, Holmgaard F, Rasmussen LS, et al. High-target versus low-target blood pressure management during cardiopulmonary bypassto preventcerebral injuryincardiac surgery patients: a randomized controlled trial. Circulation 2018;137:1770-80.
69. Williams-RussoP,SharrockNigel E,MattisS,etal.Randomized trial of hypotensive epidural anesthesia in older adults. Anesthesiology1999;91:926.
70. Evered L, Scott DA, Silbert B, Maruff P. Postoperative cognitive dysfunctionisindependentof typeofsurgeryand anesthetic. Anesth Analg 2011;112:1179-85.
71. Newman S, StygallJ,Hirani S, Shaefi S,MazeM. Postoperative cognitive dysfunctionafternoncardiacsurgery:asystematic review. Anesthesiology2007;106:572-90.
72. FranckM,NerlichK,NeunerB,etal.Noconvincing association between post-operative deliriumand post-operativecognitive dysfunction:asecondaryanalysis. Acta Anaesthesiol Scand 2016;60:1404-14.
73. Tan CB, Ng J, Jeganathan R,etal. Cognitivechangesafter surgery in the elderly: does minimally invasive surgery influencetheincidenceof postoperativecognitivechanges compared to open colon surgery? Dement Geriatr Cogn Disord 2015;39:125-31.
74. Zhu SH,JiMH, Gao DP,LiWY, Yang JJ. Association between perioperative blood transfusion and early postoperative cognitive dysfunction in aged patients following total hip replacement surgery. Ups J Med Sci2014;119:262-7.
75. Krenk L, Rasmussen LS, Kehlet H. Postoperative cognitive dysfunctionafter fast-trackhip and kneearthroplasty. Anesth Analg 2012;114:S290.