General Anesthesia: Neurobiological Underpinnings of Individual Cognitive Patient Outcome

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Background

Perioperative neurocognitive disorders (PND) after anesthesia and surgery are a major consequence for the affected patients as well as a major burden for healthcare providers. In societies such as the US or Europe, the number of patients that will develop an adverse outcome postoperatively, e.g., postoperative delirium or neurocognitive disorder, postoperative, may increase as the population ages. Further, given the associations between both postoperative delirium and cognitive decline with increased long term risk of developing dementia, understanding and preventing these disorders is a central goal for both perioperative and geriatric medicine.

To deal with this challenge, we need to understand better the neurobiological mechanisms underlying these disorders, and to develop prevention and treatment strategies.

Recent findings from patient and volunteer investigations have described distinct neurophysiologic activity patterns in the electroencephalogram (EEG) as markers of both specific anesthetic agents (and dosage), and as predictors of neurologic and neurocognitive status (and possible PND risk) in individual patients. For instance, strong alpha oscillatory activity seems to be linked to a positive outcome following an adequate level of general anesthesia, while burst suppression patterns may be associated with a higher risk of adverse outcomes such as delirium.

However, these findings also seem to depend on patient characteristics including age and/or preoperative neuro-cognitive status. Further, both ascending nociceptive stimuli and the use of analgesic drugs and techniques to block/attenuate it, can alter the brain EEG patterns seen in response to anesthetic drugs. Research is thus necessary to understand the relationship between multiple predictor variables ranging from age, preoperative neuro-cognitive status, nociceptive stimuli, analgesic drugs and techniques, anesthetic drugs and dosage, etc; intraoperative EEG activity patterns, and perioperative neurocognitive disorders. This work may help identify patients at the highest risk of these disorders, may help contribute clues towards the etiology of these disorders, and may help identify anesthetic or analgesic drug type or dosage patterns that reduce the risk of perioperative neurocognitive disorders.

Hence, this Research Topic aims to collect research articles, reviews, or opinion articles, that help move towards adequate knowledge to answer these biological questions.

We welcome basic, clinical, cognitive, and behavioral neuroscience research outcomes that can help broaden our knowledge focusing on:

• The description of perioperative brain activity patterns and their correlation with both pre- and post-operative neurocognitive states.
• Evidence from basic research that describes possible mechanisms leading to perioperative EEG signatures.
• Experimental evidence regarding the influence of anesthetic and analgesic drugs on perioperative neurocognitive disorders.
• The description of perioperative treatment and prevention strategies, e.g., using the EEG and other assessments to prevent perioperative neurocognitive disorders.
• Behavioral investigations and neurocognitive assessments in the clinical setting and in animal models to assess cognitive state and/or to translate findings from animal models to humans.


Dr. Berger acknowledges income from legal consulting cases related to postoperative cognition in older adults and material support from Massimo (Massimo is a corporation that makes Clinical monitors, including OR Eeg monitors) for a prior study. Dr. Berger has also taken part in a peer-to-peer consulting session for Massimo, for which his honorarium was donated (at his request) to the Foundation for Anesthesia Education and Research.
Dr. Berger also acknowledges research funding from the National Institute of Aging, the International Anesthesia Research Society, the Foundation for Anesthesia Education and Research, the Alzheimer’s Drug Discovery Foundation, and the American Geriatrics Society.

Dr. Raz is a consultant and receives research support from Medtronic. Dr. Raz acknowledges research support from the American-Israeli Bi-National Science Foundation and from the Clinical Research Institute at Rambam (CRIR).

All other Guest Editors declare no competing interests with regards to the Research Topic subject.

Keywords: Delirium, Electrophysiology, Preventive strategies, CSF, perioperative neurocognitive disorders, postoperative cognition, General anesthesia, AD, Dementia

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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