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The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature

Background and objectives: Postoperative cognitive dysfunction (POCD) represents a decreased cognitive performance in patients undergoing general anesthesia for major surgery. Since liver cirrhosis is associated with high mortality and morbidity rates, cirrhotic patients also assemble many risk fact...

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Autores principales: Ingustu, Daiana-Georgiana, Pavel, Bogdan, Paltineanu, Silvia-Ioana, Mihai, Diana-Irene, Cotorogea-Simion, Mihail, Martac, Cristina, Florescu, Madalina-Marieta, Cobilinschi, Cristian, Isac, Sebastian, Droc, Gabriela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10053389/
https://www.ncbi.nlm.nih.gov/pubmed/36984466
http://dx.doi.org/10.3390/medicina59030465
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author Ingustu, Daiana-Georgiana
Pavel, Bogdan
Paltineanu, Silvia-Ioana
Mihai, Diana-Irene
Cotorogea-Simion, Mihail
Martac, Cristina
Florescu, Madalina-Marieta
Cobilinschi, Cristian
Isac, Sebastian
Droc, Gabriela
author_facet Ingustu, Daiana-Georgiana
Pavel, Bogdan
Paltineanu, Silvia-Ioana
Mihai, Diana-Irene
Cotorogea-Simion, Mihail
Martac, Cristina
Florescu, Madalina-Marieta
Cobilinschi, Cristian
Isac, Sebastian
Droc, Gabriela
author_sort Ingustu, Daiana-Georgiana
collection PubMed
description Background and objectives: Postoperative cognitive dysfunction (POCD) represents a decreased cognitive performance in patients undergoing general anesthesia for major surgery. Since liver cirrhosis is associated with high mortality and morbidity rates, cirrhotic patients also assemble many risk factors for POCD. Therefore, preserving cognition after major surgery is a priority, especially in this group of patients. The purpose of this review is to summarize the current knowledge regarding the effectiveness of perioperative therapeutic strategies in terms of cognitive dysfunction reduction. Data Collection: Using medical search engines such as PubMed, Google Scholar, and Cochrane library, we analyzed articles on topics such as: POCD, perioperative management in patients with cirrhosis, hepatic encephalopathy, general anesthesia in patients with liver cirrhosis, depth of anesthesia, virtual reality in perioperative settings. We included 115 relevant original articles, reviews and meta-analyses, and other article types such as case reports, guidelines, editorials, and medical books. Results: According to the reviewed literature, the predictive capacity of the common clinical tools used to quantify cognitive dysfunction in cirrhotic settings is reduced in perioperative settings; however, novel neuropsychological tools could manage to better identify the subclinical forms of perioperative cognitive impairments in cirrhotic patients. Moreover, patients with preoperative hepatic encephalopathy could benefit from specific preventive strategies aimed to reduce the risk of further neurocognitive deterioration. Intraoperatively, the adequate monitoring of the anesthesia depth, appropriate anesthetics use, and an opioid-sparing technique have shown favorable results in terms of POCD. Early recovery after surgery (ERAS) protocols should be implemented in the postoperative setting. Other pharmacological strategies provided conflicting results in reducing POCD in cirrhotic patients. Conclusions: The perioperative management of the cognitive function of cirrhotic patients is challenging for anesthesia providers, with specific and targeted therapies for POCD still sparse. Therefore, the implementation of preventive strategies appears to remain the optimal attitude. Further research is needed for a better understanding of POCD, especially in cirrhotic patients.
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spelling pubmed-100533892023-03-30 The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature Ingustu, Daiana-Georgiana Pavel, Bogdan Paltineanu, Silvia-Ioana Mihai, Diana-Irene Cotorogea-Simion, Mihail Martac, Cristina Florescu, Madalina-Marieta Cobilinschi, Cristian Isac, Sebastian Droc, Gabriela Medicina (Kaunas) Review Background and objectives: Postoperative cognitive dysfunction (POCD) represents a decreased cognitive performance in patients undergoing general anesthesia for major surgery. Since liver cirrhosis is associated with high mortality and morbidity rates, cirrhotic patients also assemble many risk factors for POCD. Therefore, preserving cognition after major surgery is a priority, especially in this group of patients. The purpose of this review is to summarize the current knowledge regarding the effectiveness of perioperative therapeutic strategies in terms of cognitive dysfunction reduction. Data Collection: Using medical search engines such as PubMed, Google Scholar, and Cochrane library, we analyzed articles on topics such as: POCD, perioperative management in patients with cirrhosis, hepatic encephalopathy, general anesthesia in patients with liver cirrhosis, depth of anesthesia, virtual reality in perioperative settings. We included 115 relevant original articles, reviews and meta-analyses, and other article types such as case reports, guidelines, editorials, and medical books. Results: According to the reviewed literature, the predictive capacity of the common clinical tools used to quantify cognitive dysfunction in cirrhotic settings is reduced in perioperative settings; however, novel neuropsychological tools could manage to better identify the subclinical forms of perioperative cognitive impairments in cirrhotic patients. Moreover, patients with preoperative hepatic encephalopathy could benefit from specific preventive strategies aimed to reduce the risk of further neurocognitive deterioration. Intraoperatively, the adequate monitoring of the anesthesia depth, appropriate anesthetics use, and an opioid-sparing technique have shown favorable results in terms of POCD. Early recovery after surgery (ERAS) protocols should be implemented in the postoperative setting. Other pharmacological strategies provided conflicting results in reducing POCD in cirrhotic patients. Conclusions: The perioperative management of the cognitive function of cirrhotic patients is challenging for anesthesia providers, with specific and targeted therapies for POCD still sparse. Therefore, the implementation of preventive strategies appears to remain the optimal attitude. Further research is needed for a better understanding of POCD, especially in cirrhotic patients. MDPI 2023-02-26 /pmc/articles/PMC10053389/ /pubmed/36984466 http://dx.doi.org/10.3390/medicina59030465 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Ingustu, Daiana-Georgiana
Pavel, Bogdan
Paltineanu, Silvia-Ioana
Mihai, Diana-Irene
Cotorogea-Simion, Mihail
Martac, Cristina
Florescu, Madalina-Marieta
Cobilinschi, Cristian
Isac, Sebastian
Droc, Gabriela
The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature
title The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature
title_full The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature
title_fullStr The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature
title_full_unstemmed The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature
title_short The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature
title_sort management of postoperative cognitive dysfunction in cirrhotic patients: an overview of the literature
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10053389/
https://www.ncbi.nlm.nih.gov/pubmed/36984466
http://dx.doi.org/10.3390/medicina59030465
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