الفهرس | Only 14 pages are availabe for public view |
Abstract he precise mechanisms for POCD are still far from being clearly elucidated. Due to the pharmacological properties, the application of anesthetics induces acute effects which on one hand blocks learning and memory and on the other hand exerts neuroprotective activities. These in vitro characteristics would exhibit a preferable profile of anesthetics: the patient is protected from undesirable memories and possible neurodegeneration which might be induced during surgery. Unfortunately, there is clear evidence that a considerable proportion of people, dependent on risk factors, suffer from cognitive dysfunction described either as anticholinergic syndrome, delirium or POCD after surgery. At this point it should be stressed that the choice of anesthetic most probably does not influence the incidence of POCD and thus rather speaks in favor of a minor role for anesthesia in contributing to the development of cognitive impairment after surgery. The interpretation of available data on POCD is accompanied by numerous methodological deficits. Overcoming those problems would imply the planning and performance of powerful clinical studies with comparable surgery, standardized neuopsychological tests and defined diagnostic criteria used to classify individuals as having POCD. Concomitantly, the availability of such meaningful data would be useful for the development and application of non-pharmacological and pharmacological neuroprotective strategies. Improvement in surgical technique, anesthesia and intensive care has made it possible for elderly patients to undergo major surgical procedures that successfully prolong life. However, the occurrence of postoperative cognitive decline may affect their quality of life. POCD is multifactorial in origin, with increasing age as the leading risk factor, yet the mechanism is not fully understood. There is no convincing evidence to suggest general anesthesia causes occurrence of POCD, as the incidence of POCD is equivalent between patients receiving general and regional anesthesia. |