General Anesthetics and Perioperative Management of the Geriatric Patients: What We Know and Do Not Know

Jing Xu , Qiang Wang
Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
J Anesth Perioper Med 2017; 4(6): 266- 273 . Published on Nov 28, 2017 . doi:10.24015/JAPM.2017.0092
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Aim of review: The main purpose of this review is to gather the historical evolution on why people pay more and more concerns about postoperative cognitive dysfunction (POCD) and the postoperative management of the old people, and provide a synopsis of the available clinical and preclinical data and summarizes current research that is relevant to the occurrence of POCD due to anesthetics we are now commonly using. As the whole world is becoming an aging society, POCD and the physiological and pathological changes caused by aging have a great impact on and the further postoperative outcomes. 
Methods: To have a complete understanding of anesthetics and their effects on POCD in elderly, certain keywords have been used to identify the relevance to anesthesia. The terms, Isoflurane, Sevoflurane, Desflurane, Ketamine, Propofol, and Dexmedetomidine, were searched to identify correlations between POCD as postoperative cognitive dysfunction, cognitive disabilities and elderly. The search consisted of all possible combinations of one anesthesia term and one cognitive term. This review mainly focused on the results published in the past 5 years and summarized the entire story in a structured way. 
Recent findings: Aging is one of the top risk factors of POCD, and it is mainly connected to the postoperative brain damage and cognitive deficiency. POCD is associated with numerous of postoperative complications, and anesthetic drugs may play a very important role in these changes. Though many opinions came out as both volatile and intravenous anesthetics might affect and increase the brain damage, the results vary as the different criteria they use. Anesthetics are not the only cause of the onset of POCD, surgery itself may cause the cognitive dysfunction as well. Dexmedetomidine can contribute to prevent and reduce the occurrence of POCD, and additional measures were taken during the whole perioperative period and early postoperative recovery would also help keep the patients from suffering from POCD.
Conclusion: POCD occurs frequently in patients older than 65 years, and it is clearly related to some postoperative complications. The core mechanism is the aging immune system and inflammation. There is plenty to do both in clinically preventing its occurrence in old patients, and determining its original mechanism in basic science. (Funded by the National Natural Science Foundation of China, the Overseas, Hong Kong & Macao Scholars Collaborated Researching Fund, and the Natural Science Foundation of Shaanxi Province, China.) 
Citation: Jing Xu, Qiang Wang. General Anesthetics and Perioperative Management of the Geriatric Patients: What We Know and Do Not Know. J Anesth Perioper Med 2017;4:266-73. doi: 10.24015/JAPM.2017.0092
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