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Best Practices for Postoperative Brain Health: Recommendations From the Fifth International Perioperative Neurotoxicity Working Group.

Publication ,  Journal Article
Berger, M; Schenning, KJ; Brown, CH; Deiner, SG; Whittington, RA; Eckenhoff, RG; Angst, MS; Avramescu, S; Bekker, A; Brzezinski, M; Crosby, G ...
Published in: Anesth Analg
December 2018

As part of the American Society of Anesthesiology Brain Health Initiative goal of improving perioperative brain health for older patients, over 30 experts met at the fifth International Perioperative Neurotoxicity Workshop in San Francisco, CA, in May 2016, to discuss best practices for optimizing perioperative brain health in older adults (ie, >65 years of age). The objective of this workshop was to discuss and develop consensus solutions to improve patient management and outcomes and to discuss what older adults should be told (and by whom) about postoperative brain health risks. Thus, the workshop was provider and patient oriented as well as solution focused rather than etiology focused. For those areas in which we determined that there were limited evidence-based recommendations, we identified knowledge gaps and the types of scientific knowledge and investigations needed to direct future best practice. Because concerns about perioperative neurocognitive injury in pediatric patients are already being addressed by the SmartTots initiative, our workshop discussion (and thus this article) focuses specifically on perioperative cognition in older adults. The 2 main perioperative cognitive disorders that have been studied to date are postoperative delirium and cognitive dysfunction. Postoperative delirium is a syndrome of fluctuating changes in attention and level of consciousness that occurs in 20%-40% of patients >60 years of age after major surgery and inpatient hospitalization. Many older surgical patients also develop postoperative cognitive deficits that typically last for weeks to months, thus referred to as postoperative cognitive dysfunction. Because of the heterogeneity of different tools and thresholds used to assess and define these disorders at varying points in time after anesthesia and surgery, a recent article has proposed a new recommended nomenclature for these perioperative neurocognitive disorders. Our discussion about this topic was organized around 4 key issues: preprocedure consent, preoperative cognitive assessment, intraoperative management, and postoperative follow-up. These 4 issues also form the structure of this document. Multiple viewpoints were presented by participants and discussed at this in-person meeting, and the overall group consensus from these discussions was then drafted by a smaller writing group (the 6 primary authors of this article) into this manuscript. Of course, further studies have appeared since the workshop, which the writing group has incorporated where appropriate. All participants from this in-person meeting then had the opportunity to review, edit, and approve this final manuscript; 1 participant did not approve the final manuscript and asked for his/her name to be removed.

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Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

December 2018

Volume

127

Issue

6

Start / End Page

1406 / 1413

Location

United States

Related Subject Headings

  • United States
  • Societies, Medical
  • Risk Factors
  • Postoperative Period
  • Postoperative Complications
  • Perioperative Period
  • Perioperative Care
  • Neurotoxicity Syndromes
  • Neuropsychological Tests
  • Humans
 

Citation

APA
Chicago
ICMJE
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Berger, M., Schenning, K. J., Brown, C. H., Deiner, S. G., Whittington, R. A., Eckenhoff, R. G., … Perioperative Neurotoxicity Working Group, . (2018). Best Practices for Postoperative Brain Health: Recommendations From the Fifth International Perioperative Neurotoxicity Working Group. Anesth Analg, 127(6), 1406–1413. https://doi.org/10.1213/ANE.0000000000003841
Berger, Miles, Katie J. Schenning, Charles H. Brown, Stacie G. Deiner, Robert A. Whittington, Roderic G. Eckenhoff, Martin S. Angst, et al. “Best Practices for Postoperative Brain Health: Recommendations From the Fifth International Perioperative Neurotoxicity Working Group.Anesth Analg 127, no. 6 (December 2018): 1406–13. https://doi.org/10.1213/ANE.0000000000003841.
Berger M, Schenning KJ, Brown CH, Deiner SG, Whittington RA, Eckenhoff RG, et al. Best Practices for Postoperative Brain Health: Recommendations From the Fifth International Perioperative Neurotoxicity Working Group. Anesth Analg. 2018 Dec;127(6):1406–13.
Berger, Miles, et al. “Best Practices for Postoperative Brain Health: Recommendations From the Fifth International Perioperative Neurotoxicity Working Group.Anesth Analg, vol. 127, no. 6, Dec. 2018, pp. 1406–13. Pubmed, doi:10.1213/ANE.0000000000003841.
Berger M, Schenning KJ, Brown CH, Deiner SG, Whittington RA, Eckenhoff RG, Angst MS, Avramescu S, Bekker A, Brzezinski M, Crosby G, Culley DJ, Eckenhoff M, Eriksson LI, Evered L, Ibinson J, Kline RP, Kofke A, Ma D, Mathew JP, Maze M, Orser BA, Price CC, Scott DA, Silbert B, Su D, Terrando N, Wang D-S, Wei H, Xie Z, Zuo Z, Perioperative Neurotoxicity Working Group. Best Practices for Postoperative Brain Health: Recommendations From the Fifth International Perioperative Neurotoxicity Working Group. Anesth Analg. 2018 Dec;127(6):1406–1413.

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

December 2018

Volume

127

Issue

6

Start / End Page

1406 / 1413

Location

United States

Related Subject Headings

  • United States
  • Societies, Medical
  • Risk Factors
  • Postoperative Period
  • Postoperative Complications
  • Perioperative Period
  • Perioperative Care
  • Neurotoxicity Syndromes
  • Neuropsychological Tests
  • Humans