The Effect of Depth of Anesthesia on Postoperative Cognitive Dysfunction in Elderly Patients
Keywords:
Postoperative Cognitive Dysfunction (POCD); Depth of Anesthesia; Elderly Patients; BIS Monitoring; Propofol; Sevoflurane; Neuroinflammation; Cognitive Recovery; Meta-Analysis; General Anesthesia.Abstract
Postoperative cognitive dysfunction (POCD) is a common complication in elderly patients who have undergone surgery and usually leads to slow recovery and poor quality of life. The meta-analysis aimed to assess the impact of the depth of anesthesia on POCD and recovery outcomes. Those papers that were included (1,687 elderly patients) offered 15 studies published in 2021-2025. The monitoring of depth of anesthesia was done using either BIS or Narcotrend and compared with light (BIS 5060) and deep anesthesia (BIS < 40). Combined analysis showed that lighter anesthesia had a big impact to decrease POCD occurrences (SMD = -0.58; 95% CI: -0.84 to -0.31; p < 0.001) and decreased postoperative inflammatory cytokine levels (IL-6, CRP). Propofol-controlled anesthesia and agonists like dexmedetomidine or esketamine better enhanced cognitive function and the time of recovery. These results underscore the fact that having the best, light level of anesthesia is neuroprotective and leads to better recovery, and must be the norm in anesthesia in the elderly.
