From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
Anesth Analg. 2022 Aug 1;135(2):316-328. doi: 10.1213/ANE.0000000000006090. Epub 2022 May 18.
While people 65 years of age and older represent 16% of the population in the United States, they account for >40% of surgical procedures performed each year. Maintaining brain health after anesthesia and surgery is not only important to our patients, but it is also an increasingly important patient safety imperative for the specialty of anesthesiology. Aging is a complex process that diminishes the reserve of every organ system and often results in a patient who is vulnerable to the stress of surgery. The brain is no exception, and many older patients present with preoperative cognitive impairment that is undiagnosed. As we age, a number of changes occur in the human brain, resulting in a patient who is less resilient to perioperative stress, making older adults more susceptible to the phenotypic expression of perioperative neurocognitive disorders. This review summarizes the current scientific and clinical understanding of perioperative neurocognitive disorders and recommends patient-centered, age-focused interventions that can better mitigate risk, prevent harm, and improve outcomes for our patients. Finally, it discusses the emerging topic of sleep and cognitive health and other future frontiers of scientific inquiry that might inform clinical best practices.
在美国，65 岁及以上的人口占总人口的 16%，但他们占每年实施的手术的>40%。在麻醉和手术后保持大脑健康不仅对我们的患者很重要，而且对麻醉学这一专业的患者安全也越来越重要。衰老是一个复杂的过程，会削弱每个器官系统的储备能力，使患者容易受到手术压力的影响。大脑也不例外，许多老年患者在术前就存在未被诊断出的认知障碍。随着年龄的增长，人类大脑会发生许多变化，导致患者对围手术期压力的抵抗力下降，使老年人更容易出现围手术期神经认知障碍的表型表达。这篇综述总结了围手术期神经认知障碍的当前科学和临床认识，并推荐了以患者为中心、以年龄为重点的干预措施，可以更好地降低风险、预防伤害，并改善我们患者的预后。最后，它讨论了睡眠和认知健康等新兴话题以及可能为临床最佳实践提供信息的其他未来科学研究前沿。
