Anesthesia and cognitive changes in the postoperative period. What do we know so far? A literature review

Abstract

Introduction: Postoperative cognitive changes represent an important concern in anesthesiology, particularly in the context of population aging and the increasing number of surgical procedures. These changes may involve memory, attention, orientation, concentration, and processing speed, with variable duration and clinical impact. Postoperative delirium and persistent cognitive changes are relevant manifestations and should be differentiated according to their characteristics and clinical course. Objective: To discuss current knowledge regarding the relationship between anesthesia and postoperative cognitive changes, addressing pathophysiological mechanisms, risk factors, clinical manifestations, and prevention strategies. Methods: This is a narrative review of the literature, of a qualitative and descriptive nature. The search was carried out between 2005 and 2026 in the PubMed/MEDLINE, SciELO, LILACS, Virtual Health Library (VHL), and Scopus databases, using descriptors related to postoperative cognitive changes, delirium, cognitive dysfunction, general anesthesia, regional anesthesia, cognitive function, and surgical procedures, combined by the Boolean operators AND and OR. Studies published in Portuguese, English, and Spanish, including original articles, observational studies, clinical studies, literature reviews, systematic reviews, and guidelines, were considered. Duplicate studies, publications without direct relation to the theme, editorials, letters to the editor, abstracts of events, theses, and dissertations were excluded. Selection occurred by analyzing titles and abstracts, followed by reading the eligible studies in full. The data were organized according to the characteristics of the studies, main findings and conclusions, and were analyzed in a descriptive and qualitative way, focusing on cognitive manifestations, delirium, risk factors and the relationship between anesthetic techniques and neurocognitive outcomes. Results: The evidence analyzed indicates that postoperative cognitive changes have a multifactorial origin. Although anesthetic agents may contribute to this process, factors such as the inflammatory response to surgery, advanced age, preexisting cognitive impairment, frailty, hemodynamic and metabolic alterations, pain, sleep disturbances, and the use of certain medications are also relevant. The choice between general and regional anesthesia alone does not determine the occurrence of these complications. Conclusion: Prevention of cognitive changes requires an individualized perioperative approach, including baseline cognitive assessment, physiological stability, adequate pain control, rational use of medications, sleep preservation, and early mobilization. Understanding the mechanisms involved may contribute to the development of more effective cognitive protection strategies.