2025-08-22
Anesthesia and the brain: mere sleep or true disruption?
Anesthesia and Intensive Care Neurology
By Ana Espino | Published on August 22, 2025 | 2 min read
#POCD #Neurology #Anesthesia #Surgery
Postoperative cognitive decline (POCD) is a frequent and concerning complication, particularly among elderly patients undergoing major surgery. This condition manifests as impairments in memory, attention, or processing speed, which may durably impact quality of life, delay recovery, and increase the risk of dependency.
A major limitation in managing this condition lies not only in the absence of a standardized definition, but also in the wide methodological variability across studies and the lack of specific diagnostic tools. These gaps hinder comparison of results and slow the development of targeted prevention strategies. A central challenge is to disentangle the respective contributions of anesthesia and surgery to the onset of these impairments, while identifying patients at highest risk through clinical or biological criteria.
Against this background, this study was undertaken to evaluate the association between anesthesia, surgery, and cognitive alterations, in order to better understand the underlying mechanisms and inform future preventive and therapeutic strategies.
The methodology is based on the selection of numerous clinical and experimental studies that assessed cognitive function in patients before and after surgery. These works used standardized neuropsychological batteries to measure memory, attention, and processing speed. In some cases, advanced brain imaging techniques were also employed to objectify structural or functional changes.
Results show that postoperative cognitive decline is more common in elderly patients, particularly those with cardiovascular comorbidities or prior cognitive frailty. General anesthesia is frequently implicated, but evidence suggests that systemic inflammation induced by surgery, oxidative stress, and cerebral micro-injuries play equally critical roles. Anesthetic agents (e.g., propofol, inhaled agents) may exert variable effects on neuronal plasticity, with no clear consensus. Finally, some studies report partial recovery of cognitive functions, while others describe persistent sequelae—underscoring the importance of individual and contextual factors.
Postoperative cognitive decline remains a common complication, especially in older patients, and represents a significant public health concern. Recent evidence suggests that anesthesia and surgical stress are both strong contributors to the development of this condition in vulnerable individuals.
The aim of this review was to evaluate the links between anesthesia, surgery, and cognitive alterations, and to shed light on the underlying mechanisms. Findings suggest that POCD arises from a multifactorial process involving anesthetic effects, systemic inflammation, oxidative stress, and preexisting frailty, highlighting the complexity of its etiology. However, the analysis is limited by the absence of a standardized definition of POCD, methodological heterogeneity across studies, and a lack of long-term follow-up data. Future research should focus on multicenter studies with standardized protocols, identification of predictive biomarkers, exploration of the impact of different anesthetic agents, and the development of personalized strategies to optimize perioperative management and postoperative cognitive monitoring.
About the author – Ana Espino
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions through impactful communication.
#POCD #Neurology #Anesthesia #Surgery
Postoperative cognitive decline (POCD) is a frequent and concerning complication, particularly among elderly patients undergoing major surgery. This condition manifests as impairments in memory, attention, or processing speed, which may durably impact quality of life, delay recovery, and increase the risk of dependency.
A major limitation in managing this condition lies not only in the absence of a standardized definition, but also in the wide methodological variability across studies and the lack of specific diagnostic tools. These gaps hinder comparison of results and slow the development of targeted prevention strategies. A central challenge is to disentangle the respective contributions of anesthesia and surgery to the onset of these impairments, while identifying patients at highest risk through clinical or biological criteria.
Against this background, this study was undertaken to evaluate the association between anesthesia, surgery, and cognitive alterations, in order to better understand the underlying mechanisms and inform future preventive and therapeutic strategies.
Anesthesia: guilty or merely an accomplice?
The methodology is based on the selection of numerous clinical and experimental studies that assessed cognitive function in patients before and after surgery. These works used standardized neuropsychological batteries to measure memory, attention, and processing speed. In some cases, advanced brain imaging techniques were also employed to objectify structural or functional changes.
Results show that postoperative cognitive decline is more common in elderly patients, particularly those with cardiovascular comorbidities or prior cognitive frailty. General anesthesia is frequently implicated, but evidence suggests that systemic inflammation induced by surgery, oxidative stress, and cerebral micro-injuries play equally critical roles. Anesthetic agents (e.g., propofol, inhaled agents) may exert variable effects on neuronal plasticity, with no clear consensus. Finally, some studies report partial recovery of cognitive functions, while others describe persistent sequelae—underscoring the importance of individual and contextual factors.
POCD: inevitable fate or preventable condition?
Postoperative cognitive decline remains a common complication, especially in older patients, and represents a significant public health concern. Recent evidence suggests that anesthesia and surgical stress are both strong contributors to the development of this condition in vulnerable individuals.
The aim of this review was to evaluate the links between anesthesia, surgery, and cognitive alterations, and to shed light on the underlying mechanisms. Findings suggest that POCD arises from a multifactorial process involving anesthetic effects, systemic inflammation, oxidative stress, and preexisting frailty, highlighting the complexity of its etiology. However, the analysis is limited by the absence of a standardized definition of POCD, methodological heterogeneity across studies, and a lack of long-term follow-up data. Future research should focus on multicenter studies with standardized protocols, identification of predictive biomarkers, exploration of the impact of different anesthetic agents, and the development of personalized strategies to optimize perioperative management and postoperative cognitive monitoring.
Read next: Postoperative delirium: does melatonin really work?
About the author – Ana Espino
PhD in Immunology, specialized in Virology
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