State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018

Abstract

Cognitive recovery after anaesthesia and surgery is a concern for older adults, their families, and caregivers. Reports of patients who were 'never the same' prompted a scientific inquiry into the nature of what patients have experienced. In June 2018, the ASA Brain Health Initiative held a summit to discuss the state of the science on perioperative cognition, and to create an implementation plan for patients and providers leveraging the current evidence. This group included representatives from the AARP (Area. This paper summarises the state of the relevant clinical science, including risk factors, identification and diagnosis, prognosis, disparities, outcomes, and treatment of perioperative neurocognitive disorders. Finally, we discuss gaps in current knowledge with suggestions for future directions and opportunities for clinical and translational projects.

Microemboli on Cardiopulmonary Bypass: Should We Care?

“…Patients with lower baseline cognitive function may benefit most from modified perioperative strategies, including establishing optimal MAP, glucose control, temperature management, and surgical approach. 14 Finally, based on the current evidence, it may not be surprising that Wiberg et al 3 did not find any association among the cumulative gaseous microemboli burden, cerebral infarcts, and POCD. It is likely that the exclusion of high-risk patients with a history of stroke and preexisting neurocognitive dysfunction may have rendered their findings inconsequential.…”

Economic Burden of Postoperative Neurocognitive Disorders Among US Medicare Patients

“…As PNDs are often considered the most common postoperative complication in older patients, focusing on efforts to prevent or reduce duration of symptoms may result in significant cost savings. 1,36 Future research is needed to determine whether measures to decrease the risk of PND are associated with cost savings.…”

“…Cognitive impairment is the most common complication experienced by older adults after surgical treatment. 1 The incidence of cognitive impairment ranges from 10% to 65% and varies depending on a variety of factors, such as age, level of education, sex, comorbidities, surgery type, and assessment methods. 2,3 Although delirium is often most apparent in the hospital setting and has been rigorously studied in the immediate postoperative phase, other distinct yet potentially connected forms of postoperative cognitive dysfunction continue through, and often past, discharge.…”

Preoperative assessment of cognitive function and risk assessment of cognitive impairment in elderly patients with orthopedics: A cross-sectional study.

“…[9] Mini-mental state examination (MMSE) is the most commonly used cognitive function test scale, and could be used as a screening for epidemiological investigations, and recommended to evaluate the preoperative cognitive status of elderly patients. [10] Moreover, Chinese Medical Association Geriatrics Branch recommended MMSE to evaluate the preoperative cognitive status of elderly patients in 2016. [11] The aim of this study was, therefore, to explore the incidence of cognitive impairment in patients ≥ 65 years old with MMSE, and examine the association of delirium with preoperative risk factors in an older scheduled for orthopedic surgery population.…”