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Some of these can be attributed to the changes that occur in the process of aging, but many are also caused by diseases that accompany seniority. The distinction between so-called normal aging and pathological changes is critical to the care of elderly people. Anesthesia and surgery has become more common as the population survives longer.
Its causes are under investigation and occurs commonly in older patients and those with pre-existing cognitive impairment. [2] The causes of POCD are not understood. It does not appear to be caused by lack of oxygen or impaired blood flow to the brain [3] and is equally likely under regional and general anesthesia.
The authors of this review were uncertain whether maintenance of anaesthesia with propofol-based total intravenous anaesthesia (TIVA) or with inhalational agents can affect incidences of postoperative delirium. [7] Emergence delirium has been associated long-term changes neurocognitive dysfunction after cardiac surgery. [8]
Total intravenous anesthesia (TIVA) refers to the intravenous administration of anesthetic agents to induce a temporary loss of sensation or awareness. The first study of TIVA was done in 1872 using chloral hydrate , [ 1 ] and the common anesthetic agent propofol was licensed in 1986.
Conscious sedation and monitored anesthesia care (MAC) refer to an awareness somewhere in the middle of the spectrum, depending on the degree to which a patient is sedated. Monitored anesthesia care involves titration of local anesthesia along with sedation and analgesia. [18] Awareness/wakefulness does not necessarily imply pain or discomfort.
The effects of early-life exposures to anesthesia on the brain in humans are controversial. Evidence from nonhuman primate research suggests significant developmental neurotoxicity and long-term social impairment, with a dose–response relationship where repeated exposures cause a more severe impact than single ones.
The Meyer-Overton correlation for anaesthetics. A nonspecific mechanism of general anaesthetic action was first proposed by Emil Harless and Ernst von Bibra in 1847. [9] They suggested that general anaesthetics may act by dissolving in the fatty fraction of brain cells and removing fatty constituents from them, thus changing activity of brain cells and inducing anaesthesia.
Anticholinergics can be used as a long-acting patch placed behind the patient's ear. Adverse effects include dry mouth and blurry vision. Care must be taken when handling the patch, as transfer of medication to the eye can induce pupillary dilation. Avoid use in elderly patients. Medications include scopolamine.