TABLE 1.
Studies concerning perioperative neurocognitive disorders (PNDs)
| References | Type of study | Method | Type of PNDs | Main findings | Conclusions |
|---|---|---|---|---|---|
| MacKenzie et al (2018) | Meta‐analysis | Anesthesia depth | POD | POD (38.0% reduction) | Electroencephalogram‐guided anesthesia is associated with decreased POD |
| Bocskai et al (2020) | Meta‐analysis | Anesthesia depth |
POD POND |
POD (6.7% reduction) PND (3.0% reduction) |
BIS‐guided anesthesia reduced rate of POD at 1 day and PND at 12 weeks after anesthesia and surgery |
| Yang et al (2021) | RCT | Anesthesia depth | POD | MoCA score (average 1.24 higher, first 7 days) | Multi‐modal brain monitoring improves postoperative neurocognition. |
| Zhao et al (2020) | RCT | Dexmedetomidine |
POD Delayed Neurocognitive Recovery |
POD (decreased on day 1–3, p < 0.05) Delayed neurocognitive recovery (decreased on day 7, p < 0.05) |
Intraoperative use of dexmedetomidine significantly attenuated the rate of POD and delayed neurocognitive recovery |
| Su, et al, 2016 | RCT | Dexmedetomidine | POD | POD (14.0% reduction, first 7 days) | Use of dexmedetomidine decreases the incidence of POD in ICU in patients >65 yrs undergoing non‐cardiac surgery. |
| Deiner et al (2017) | RCT | Dexmedetomidine | POD | POD (increased for 0.8%, p > 0.94) | Use of dexmedetomidine cannot prevent POD from happening. |
| Zhang et al (2018) | RCT | Intravenous anesthesia | Delayed Neurocognitive Recovery | Delayed neurocognitive recovery (8.4% reduction, first 7 days) | Propofol reduced the rate of delayed neurocognitive recovery as compared with sevoflurane. |
| Konishi et al (2018) | RCT | Intravenous anesthesia |
Delayed Neurocognitive Recovery POND |
Delayed neurocognitive recovery (p = 0.26) PND (p = 0.61 and 0.23, 3 and 12 months after surgery) |
No difference was found between propofol and sevoflurane for inducing cognitive impairment |
| Sun et al (2019) | Meta‐analysis | Intravenous anesthesia | POD | MMSE score (significantly lower in patients using propofol until 7 days) | Propofol had great adverse effect as compared with sevoflurane |
| Kristek et al (2019) | RCT | Multi‐modal analgesia | POD | POD (22.0% reduction, first 72 hours) | Multi‐modal analgesia significantly reduced the rate of POD. |
| Subramaniam et al (2019) | RCT | Multi‐modal analgesia | POD | POD length (1 day reduced, first 48 hours) | Acetaminophen reduced the length of POD in elderly patients |
| Mu et al (2017) | RCT | Multi‐modal analgesia | POD | POD (4.8% reduction, first 5 days) | Multi‐dose of parecoxib supplemented to intravenous morphine decreased the rate of POD without increasing side effects. |
| Rudiger et al (2016) | Observational | Temperature | POD | Hypothermia (34.5℃ vs. 35.1℃) | Low body temperature is one of the major risks for POD in ICU. |
| Wagner et al (2021) |
Retrospective Exploratory |
Temperature | POD | Hypothermia (χ2 = 54.94, df = 4) | A significant relationship was found between hypothermia and POD |
| Maheshwari et al (2020) | Observational | Blood Pressure | POD | Hypotension (p = 0.009, 95% CI: 1.03–1.20) | Intraoperative hypotension is moderately associated with POD within 5 days after surgery. |
| Feng, et al (2020) | Meta‐analysis | Blood Pressure |
POD POND |
Hypotension (p = 0.10 for POD: p = 0.37 for POCD) | No significant correlations between intraoperative hypotension and POD / PND. |
The type of PNDs were adjusted according to the latest diagnostic criteria.
Abbreviations: ICU, intensive care unit; MoCA, Montreal Cognitive Assessment; POD, postoperative delirium; POND, postoperative neurocognitive disorder; RCT, randomized controlled trial.