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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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Published in:AANA Journal Vol. 85; no. 1; pp. 17 - 28
Main Author: Woersching, Joanna
Format: research systematic review tables/charts Journal Article
Published: American Association of Nurse Anesthetists Feb2017
Online Access:View this record in EBSCOhost
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      dt: Feb2017
      vid: 85
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      pub: American Association of Nurse Anesthetists
      place: Park Ridge, Illinois
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        atl: Postoperative Cognitive Dysfunction after Noncardiac and Nonneurologic Surgery: An Integrative Review.
      aug:
        au: Woersching, Joanna
        affil: Staff nurse anesthetist at NYU Langone Medical Center, New York, New York
      sug:
        subj:
          Postoperative Complications Risk Factors
          Cognition Disorders Risk Factors
          Cognition Disorders Diagnosis
          Postoperative Complications Diagnosis
          Adult
          Human
          Surgery, Operative
          Systematic Review
          Bispectral Index
          Biological Markers
          PubMed
          CINAHL Database
          Embase
          Cochrane Library
          Quantitative Studies
          Prospective Studies
          Randomized Controlled Trials
          Middle Age
          Aged
          Comorbidity
          Anesthetics
          Neuropsychological Tests
          Adult: 19-44 years
          Middle Aged: 45-64 years
          Aged: 65+ years
      ab: 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.
      pubtype: Academic Journal
      doctype:
        research
        systematic review
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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