PERIOPERASTIVE NEUROLOGICAL COMPLICATIONS AND COGNITIVE DYSFUNCTION

Abstract

Perioperative neurological complications and cognitive dysfunctions are common in elderly patients. Neurological complications are often seen in the perioperative period and these complications are damaging to patients’ well-being. Neurophysiological dysfunction in the perioperative period is the result of hypotension, hypoperfusion and brain hypoxia. Cytokine inflammatory response to operative trauma can damage neurological function at subcellular level. 

Neurological complications can be acute, or de novo events such as stroke, nerve injury and delirium. Also, neurological complications can occur as decompensation of chronic neurological disease. In acute and chronic neurological impairment, patients can suffer from health problems that are affecting their social and medicolegal wellbeing. Most common neurological complications are delirium, stroke, postoperative cognitive disorder, neuroleptic malignant-like syndrome. Delirium is a devastating life-threatening disorder that has a great impact on the brain cell metabolism. Stroke is a rare complication, however it is 20 times more frequent among patients who had a stroke before surgery. In the perioperative period we can witness aggravation of a significant number of diseases, including Parkinson’s disease, myasthenia gravis, epilepsy. We also have to mention the perioperative peripheral neuro injuries. Local anesthetics that are used as painkillers, such as lidocaine, can cause central nervous system toxicity. The interaction of the medications, such as beta blocker antiarrhythmics, should be considered a factor for enhancing the neurotoxicity of the local anesthetics. Cognitive postoperative disorder includes a wide spectrum of symptoms during the perioperative period. They can manifest preoperatively as acute preoperative delirium, postoperative delirium – an event that can manifest hours to days after surgery, delayed cognitive dysfunction- an event that can occur within 30 days after surgery and postoperative neurocognitive dysfunction, which can occur between 30 days to 1 year after surgery.