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수술전후기 뇌건강관리: 수술전후기 신경인지장애 예방 전략

Perioperative brain health: strategies to prevent perioperative neurocognitive disorders

대한의사협회지 2020년 63권 9호 p.540 ~ 547
홍정민,
소속 상세정보
홍정민 ( Hong Jeong-Min ) - Pusan National University School of Medicine Department of Anesthesia and Pain Medicine

Abstract


Cognitive changes in patients after anesthesia and surgery have been recognized for over 100 years. Research on postoperative cognitive changes accelerated in the 1980s and the term postoperative cognitive dysfunction emerged, which was used until recently. Postoperative cognitive dysfunction has been used in research to describe an objectively measurable decline in cognitive function using neuropsychological tests. This dysfunction had significant heterogeneity in the type, number of tests, timing of tests, and the criteria for change. Therefore, a recent article recommended a new nomenclature for perioperative neurocognitive disorders including neurocognitive disorder, postoperative delirium, delayed neurocognitive recovery, and postoperative neurocognitive disorder. Since old age and baseline cognitive impairment are important risk factors for these perioperative neurocognitive disorders, routine preoperative cognitive assessment in all elderly patients is recommended. A preventive strategy is important, since effective modality for the treatment of perioperative neurocognitive disorders is not yet known. Intraoperative monitoring of ageadjusted end-tidal minimal alveolar concentration fraction, electroencephalography-based anesthetic management, and perioperative non-pharmacological methods are recommended for effective prevention.

키워드

섬망; 인지장애; 수술후합병증
Delirium; Cognition disorders; Postoperative complications

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