Postoperative
neurocognitive
impairments
following
surgery
are
a
growing
concern,
especially
in
the
elderly
population,
since
it
is
associated
with
significantly
increased
risk
of
morbi-mortality
postoperative
period.
Among
them,
delirium
or
early
cognitive
decline
further
prolonged
dysfunction
and
may
quicken
long-term
impairment
(POCD).
The
current
knowledge
regarding
preventive
strategies
for
not
focused
anymore
only
on
pharmacological
behavioral
management
period,
but
also
supports
preoperative
training
programs.
Since
evaluation
proactive
interventions
to
optimize
surgical
patient
outcomes
rather
impossible
emergency
setting,
what
appropriate
that
can
be
implemented
day-to-day
practice?
In
this
review,
we
try
highlight
most
recent
experimental
clinical
strategies,
outline
relevant
recommendations
clinicial
practicioners
based
available
data.
BMC Pharmacology and Toxicology,
Год журнала:
2025,
Номер
26(1)
Опубликована: Янв. 17, 2025
We
conducted
a
meta-analysis
to
investigate
the
effect
of
dexmedetomidine
on
postoperative
delirium
in
elderly
orthopedic
surgery
patients.
A
was
identify
randomized
controlled
trials
patients
undergoing
surgery.
The
data
published
October
25,
2024.
PubMed,
Embase,
and
Cochrane
Library
databases
were
searched.
Outcome
measures
included
incidence
delirium,
length
hospital
stay,
visual
analogue
scale,
complications.
Estimates
are
expressed
as
relative
risk
(RR)
or
mean
difference
(MD)
with
95%
confidence
interval
(CI).
publications
reviewed
according
guidelines
Handbook
Preferred
Reporting
Items
for
Systematic
Reviews
Meta-Analyses
(PRISMA).
This
study
registered
INPLASY
(number
INPLASY2024110004).
total
3159
9
trials.
results
showed
that
exhibited
preventive
compared
control
group
after
(RR:
0.55,
CI:
0.45–0.66,
P
<
0.01,
I2
=
0%).
Subgroup
analysis
suggested
significantly
different
from
saline(RR:
0.56;
0.44–0.73,
P<0.01,
I²=31%)
propofol(RR:
0.52;
0.39–0.70,
I²=0%)
reducing
fracture
No
statistically
significant
differences
observed
complications
(P
>
0.05).
Certainty
evidence
moderate.
Dexmedetomidine
has
been
shown
have
protective
following
Biomedicines,
Год журнала:
2025,
Номер
13(2), С. 506 - 506
Опубликована: Фев. 18, 2025
Perioperative
neurocognitive
disorders
(PNDs),
including
postoperative
delirium,
delayed
recovery,
and
long-term
disorders,
present
significant
challenges
for
older
patients
undergoing
surgery.
Inflammation
is
a
protective
mechanism
triggered
in
response
to
external
pathogens
or
cellular
damage.
Historically,
the
central
nervous
system
(CNS)
was
considered
immunoprivileged
due
presence
of
blood-brain
barrier
(BBB),
which
serves
as
physical
preventing
systemic
inflammatory
changes
from
influencing
CNS.
However,
aseptic
surgical
trauma
now
recognized
induce
localized
inflammation
at
site,
further
exacerbated
by
release
peripheral
pro-inflammatory
cytokines,
can
compromise
BBB
integrity.
This
breakdown
facilitates
activation
microglia,
initiating
cascade
neuroinflammatory
responses
that
may
contribute
onset
PNDs.
review
explores
mechanisms
underlying
neuroinflammation,
with
particular
focus
on
pivotal
role
cytokines
pathogenesis
Hitit Medical Journal,
Год журнала:
2025,
Номер
7(1), С. 20 - 28
Опубликована: Фев. 25, 2025
Objective:
It
is
aimed
to
evaluate
the
neuroprotective
effects
of
Dexmedetomidine
(DEX),
which
has
antioxidant,
antiapoptotic,
anti-inflammatory
properties,
in
acute
carbon
monoxide
toxicity.
Material
and
Method:
28
Wistar-Albino
female
rats
were
randomly
divided
into
four
groups
as
control,
Carbon
(CO)
poisoning,
CO
poisoning
+
DEX
only.
The
study
exposed
3000
ppm
for
30
minutes.
was
administered
half
an
hour
after
onset
exposure.
At
end
experiment,
blood
tissue
samples
taken
from
sacrificed
rats.
Bcl-2
Immunopositively
cell
values
prefrontal
hippocampal
areas
scored
by
examining
immune
expressions
antibodies
obtained
immunohistochemical
method
under
light
microscope.
Malondialdehyde
(MDA),
nitric
oxide
(NO),
asymmetric
dimethylarginine
ADMA
levels,
superoxide
dismutase
(SOD),
catalase
(CAT)
activity
measured
right
hemisphere
brain
biochemical
methods.
Results:
CAT,
SOD,
MDA,
NO
statistically
different
between
experimental
(p0.05).
SOD
NO,
immunosuppressive
levels
decreased
group
compared
control
(p
Advances in medical education, research, and ethics (AMERE) book series,
Год журнала:
2025,
Номер
unknown, С. 489 - 524
Опубликована: Янв. 10, 2025
IASP
defines
pain
as
“an
unpleasant
sensory
and
emotional
experience
associated
with
actual
or
potential
tissue
damage.”
In
the
present
chapter,
it
attempts
to
explore
interrelations
between
nervous
systems
clinical
approaches
in
anesthesia.
It
further
discriminates
among
nociceptive,
neuropathic,
psychogenic
pain.
describes
functions
of
receptors
neural
pathways
determining
perception
covers
mechanisms
relevant
referred
pain,
including
Biopsychosocial
Model
Gate
Control
Theory.
The
chapter
also
contrasts
general
regional
anesthesia,
discussing
their
pharmacological
effects.
Recent
advances
understanding
descending
emphasize
role
neuroscience
improving
patient
care,
leading
development
innovative
management
strategies.
These
findings
have
high
value
fine-tuning
treatment
strategies
maximizing
success
various
applications.
Keywords:
Neuroscience,
Pain
Modulation,
Mechanisms
Anesthesia,
Neurophysiology,
Neural
Pathways.
Anesthesiology and Pain Medicine,
Год журнала:
2025,
Номер
15(2)
Опубликована: Март 11, 2025
Background:
Postoperative
delirium
is
a
significant
problem
that
deteriorates
the
cognitive
state
of
patients
after
cardiac
surgery,
which
can
be
short-
or
long-term
complication.
Objectives:
This
study
was
conducted
to
evaluate
efficacy
dexmedetomidine,
commenced
simultaneously
with
anesthesia
induction
and
continued
throughout
surgical
operation,
on
postoperative
surgery
cardiopulmonary
bypass.
Methods:
randomized,
double-blind,
case-control
trial
sixty-one
undergoing
surgery.
The
were
randomly
divided
into
dexmedetomidine
(case)
normal
saline
(control)
groups.
primary
outcome
incidence
delirium,
as
screened
by
Confusion
Assessment
Method
for
ICU
(CAM-ICU).
Results:
There
no
distinction
in
CAM-ICU
outcomes
between
two
groups
at
6
24
hours
postoperatively.
However,
difference
non-positive
results
statistically
+1
-1
Richmond
Agitation-Sedation
Scale
scores.
Conclusions:
Starting
before
bypass
did
not
significantly
affect
rate
based
assessments.
Further
research
examining
larger
necessary
clarify
perioperative
delirium.
Carotid
stenosis
(CS)
is
closely
associated
with
cognitive
decline,
primarily
affecting
memory,
attention,
and
executive
function.
This
relationship
explained
by
mechanisms
such
as
chronic
cerebral
hypoperfusion
asymptomatic
microembolism.
Interventions
like
carotid
endarterectomy
(CEA)
artery
stenting
(CAS)
have
demonstrated
potential
benefits
in
restoring
perfusion;
however,
outcomes
are
variable,
particularly
domains
These
differences
may
be
attributed
to
patient
characteristics,
the
degree
of
stenosis,
technique
employed.
Revascularization
more
commonly
stabilization
decline
rather
than
active
improvement
CEA
has
shown
superiority
over
CAS
promoting
recovery
connectivity
hemodynamic
stability.
Improvements
been
documented
using
instruments
Montreal
Cognitive
Assessment
(MoCA),
especially
patients
baseline
impairment.
Complications
postoperative
dysfunction
(POCD)
hyperperfusion
syndrome
underscore
importance
appropriate
selection,
taking
into
account
factors
advanced
age,
hypertension,
bilateral
stenosis.
Biomarkers
neutrophil-to-lymphocyte
platelet-to-lymphocyte
ratios
a
higher
risk
deterioration.
Imaging
modalities,
including
functional
magnetic
resonance
imaging,
support
evidence
following
CEA.
Questions
remain
regarding
long-term
benefits,
optimal
selection
criteria,
predictive
value
biomarkers,
all
which
represent
key
areas
for
future
research.
