Regarding postoperative cognitive dysfunction (POCD), which patient population is at highest risk, and which anaesthetic technique has evidence of reduced incidence?
- A Children under 5 years; ketamine-based anaesthesia is protective
- B ASA III–IV patients of any age; high-dose volatile anaesthetics are protective through preconditioning
- C Elderly patients (>65 years), especially after cardiac surgery; regional anaesthesia and avoiding benzodiazepines may reduce risk ✓
- D Obese patients due to altered drug pharmacokinetics; TIVA is the only proven preventive strategy
Explanation
POCD — persistent cognitive impairment detectable on neuropsychological testing after surgery — disproportionately affects elderly patients (>65 years), occurring in 25–40% after major surgery and 50–70% after cardiac surgery (cardiopulmonary bypass). Risk factors include pre-existing cognitive reserve reduction, diabetes, duration of surgery, depth of anaesthesia (BIS-guided anaesthesia may help), and anticholinergic/benzodiazepine burden. Regional anaesthesia reduces systemic anaesthetic exposure and is associated with lower POCD incidence in some studies. Avoiding benzodiazepines and minimising opioids are evidence-based strategies. There is no proven specific anaesthetic agent that prevents POCD.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.