Postoperative Cognitive Dysfunction after Noncardiac and Nonneurologic Surgery: An Integrative Review.

Postoperative cognitive dysfunction (POCD), a subtle change in patients' cognition that occurs after anesthesia and surgery, is a major concern for the growing, elderly population. The purpose of this integrative review was to examine the state of the science of POCD after noncardiac surgery. Englis...

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Detalles Bibliográficos
Publicado en:AANA Journal Vol. 85; no. 1; pp. 17 - 28
Autor principal: Woersching, Joanna
Formato: research systematic review tables/charts Journal Article
Publicado: American Association of Nurse Anesthetists Feb2017
Acceso en línea:Ver este registro en EBSCOhost
Descripción
Sumario:Postoperative cognitive dysfunction (POCD), a subtle change in patients' cognition that occurs after anesthesia and surgery, is a major concern for the growing, elderly population. The purpose of this integrative review was to examine the state of the science of POCD after noncardiac surgery. English-language research articles published from 2004 until May 2015 in adults were reviewed. A literature search revealed 587 studies with 16 articles meeting inclusion criteria. Six research domains were identified; 2 areas--anesthetic technique and biomarkers -- were the focus of this review because there were more than 3 studies in each area. Bispectral index monitoring, as an anesthetic technique to decrease the incidence rate of POCD, was a major focus of research studies (n = 4). Based on the quality appraisal and study findings, the reviewer recommends that higher bispectral index levels of 40 to 60 be maintained to decrease short-term POCD. Further research is needed for the use of bio-markers as risk factors in POCD prevention research. Overall, the review was limited by methodologic weaknesses and a lack of standardized neuropsychological testing in studies. Further research is needed for the use of other anesthetic techniques and biomarkers in the study of POCD.