General Anesthesia, Cognition, and Neurological Comorbidities
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Published
Oct 31, 2023
Abstract
General anesthesia is a frequently employed medical intervention that facilitates the induction of a temporary state of unconsciousness, hence facilitating the execution of surgical procedures in patients. Nevertheless, the cognitive capabilities of patients with neurological comorbidities, such as epilepsy or dementia, may be a subject of worry when contemplating the impact of general anesthesia. Studies have indicated that individuals who have pre-existing neurological diseases may encounter negative consequences on their brain function when exposed to anesthesia. These consequences can manifest as a reduction in cognitive abilities or a worsening of their current coexisting medical conditions. Hence, it is imperative for healthcare practitioners to thoroughly assess the potential advantages and disadvantages of general anesthesia in individuals with neurological comorbidities. This evaluation should encompass exploring alternative methodologies or tailoring anesthetic management strategies to mitigate potential complications and enhance patients’ overall results.
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Keywords
General anesthesia, Neurological Comorbidities, Central Nervous System, Cognition, Prevention
References
1. Rabinstein AA, Keegan MT. Neurologic complica-tions of anesthesia: A practical approach. Neurol Clin Pract 2013 Aug; 3(4):295-304. DOI: https://doi.org/10.1212/CPJ.0b013e3182a1b9bd
2. Steadman J, Catalani B, Sharp C, Cooper L. Life-threatening perioperative anesthetic complica-tions: Major issues surrounding perioperative mor-bidity and mortality. Trauma Surg Acute Care Open 2017; 2(1):e000113. DOI: https://doi.org/10.1136/tsaco-2017-000113
3. Gerritsen JKW, Rizopoulos D, Schouten JW, Haitsma IK, Eralp I, Klimek M, Dirven CMF, Vincent AJPE. Impact of dedicated neuro-anesthesia management on clinical outcomes in glioblastoma patients: A single-institution cohort study. PLoS One 2022; 17(12):e0278864. DOI: https://doi.org/10.1371/journal.pone.0278864
4. Son Y. Molecular mechanisms of general anesthesia. Korean J Anesthesiol 2010; 59(1):3-8. DOI: https://doi.org/10.4097/kjae.2010.59.1.3
5. Slupe AM, Kirsch JR. Effects of anesthesia on cerebral blood flow, metabolism, and neuroprotec-tion. J Cereb Blood Flow Metab 2018; 38(12):2192-2208. DOI: https://doi.org/10.1177/0271678X18789273
6. Yeh HW, Yeh LT, Chou YH, Yang SF, Ho SW, Yeh YT, Yeh YT, Wang YH, Chan CH, Yeh CB. Risk of cardiovascular disease due to general anesthesia and neuraxial anesthesia in lower-limb fracture pa-tients: A retrospective population-based cohort study. Int J Environ Res Public Health 2019; 17(1):33. DOI: https://doi.org/10.3390/ijerph17010033
7. Meng T, Ren X, Chen X, Yu J, Agrimi J, Paolocci N, Gao WD. Anesthetic agents isoflurane and propofol decrease maximal Ca2+-activated force and thus contractility in the failing myocardium. J Pharmacol Exp Ther 2019; 371(3):615-623. DOI: https://doi.org/10.1124/jpet.119.259556
8. Saraswat V. Effects of anaesthesia techniques and drugs on pulmonary function. Indian J Anaesth 2015; 59(9):557-564. DOI: https://doi.org/10.4103/0019-5049.165850
9. Brinkman JE, Toro F, Sharma S. Physiology, Res-piratory Drive. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Pub-lishing; 2023 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK482414/
10. Doo AR, Kang S, Kim YS, Lee TW, Lee JR, Kim DC. The effect of the type of anesthesia on the quality of postoperative recovery after orthopedic forearm surgery. Korean J Anesthesiol 2020; 73(1):58-66. DOI: https://doi.org/10.4097/kja.19352
11. Brown EN, Pavone KJ, Naranjo M. Multimodal general anesthesia: Theory and practice. Anesth Analg. 2018 Nov;127(5):1246-1258. DOI: https://doi.org/10.1213/ANE.0000000000003668
12. Wu L, Zhao H, Weng H, Ma D. Lasting effects of general anesthetics on the brain in the young and elderly: “Mixed picture” of neurotoxicity, neuropro-tection and cognitive impairment. J Anesth 2019; 33(2):321-335. DOI: https://doi.org/10.1007/s00540-019-02623-7
13. Belrose JC, Noppens RR. Anesthesiology and cognitive impairment: A narrative review of current clinical literature. BMC Anesthesiol 2019; 19(1):241. DOI: https://doi.org/10.1186/s12871-019-0903-7
14. Alam A, Hana Z, Jin Z, Suen KC, Ma D. Surgery, neuroinflammation and cognitive impairment. EBioMedicine 2018; 37:547-556. DOI: https://doi.org/10.1016/j.ebiom.2018.10.021
15. Zuo C, Ma J, Pan Y, Zheng D, Chen C, Ruan N, Su Y, Nan H, Lian Q, Lin H. Isoflurane and sevoflurane induce cognitive impairment in neonatal rats by in-hibiting neural stem cell development through mi-croglial activation, neuroinflammation, and sup-pression of VEGFR2 signaling pathway. Neurotox Res 2022; 40(3):775-790. DOI: https://doi.org/10.1007/s12640-022-00511-9
16. Henschel O, Gipson KE, Bordey A. GABAA re-ceptors, anesthetics and anticonvulsants in brain development. CNS Neurol Disord Drug Targets 2008; 7(2):211-224. DOI: https://doi.org/10.2174/187152708784083812
17. Newcomer JW, Farber NB, Olney JW. NMDA receptor function, memory, and brain aging. Dia-logues Clin Neurosci 2000; 2(3):219-232. DOI: https://doi.org/10.31887/DCNS.2000.2.3/jnewcomer
18. Gao Y, Hong Y, Huang L, Zheng S, Zhang H, Wang S, Yao Y, Zhao Y, Zhu L, Xu Q, Chai X, Zeng Y, Zeng Y, Zheng L, Zhou Y, Luo H, Zhang X, Zhang H, Zhou Y, Fu G, Sun H, Huang TY, Zheng Q, Xu H, Wang X. β2-microglobulin functions as an endogenous NMDAR antagonist to impair synaptic function. Cell 2023; 186(5):1026-1038.e20. DOI: https://doi.org/10.1016/j.cell.2023.01.021
19. Ntalouka MP, Arnaoutoglou E, Tzimas P. Postop-erative cognitive disorders: An update. Hippokratia 2018; 22(4):147-154.
20. Tang CY, Wang VX, Lun MY, Mincer JS, Ng JC, Brallier JW, Schwartz AE, Ahn H, McCormick PJ, Nir T, Delman B, Sano M, Deiner SG, Baxter MG. Transient changes in white matter microstructure during general anesthesia. PLoS One 2021; 16(3):e0247678. DOI: https://doi.org/10.1371/journal.pone.0247678. Er-ratum in: PLoS One 2021; 16(4):e0250449
21. Jia X, Wang Z, Huang F, Su C, Du W, Jiang H, Wang H, Wang J, Wang F, Su W, Xiao H, Wang Y, Zhang B. A comparison of the Mini-Mental State Examination (MMSE) with the Montreal Cognitive Assessment (MoCA) for mild cognitive impairment screening in Chinese middle-aged and older popu-lation: A cross-sectional study. BMC Psychiatry 2021; 21(1):485. DOI: https://doi.org/10.1186/s12888-021-03495-6
22. Ishizawa Y. Does preoperative cognitive optimiza-tion improve postoperative outcomes in the elderly? J Clin Med 2022; 11(2):445. DOI: https://doi.org/10.3390/jcm11020445
23. Davis N, Lee M, Lin AY, Lynch L, Monteleone M, Falzon L, Ispahany N, Lei S. Postoperative cogni-tive function following general versus regional an-esthesia: A systematic review. J Neurosurg An-esthesiol. 2014; 26(4):369-376. DOI: https://doi.org/10.1097/ANA.0000000000000120
24. Chen PL, Yang CW, Tseng YK, Sun WZ, Wang JL, Wang SJ, Oyang YJ, Fuh JL. Risk of dementia after anaesthesia and surgery. Br J Psychiatry 2014; 204(3):188-193. DOI: https://doi.org/10.1192/bjp.bp.112.119610
25. Prabhakar H, Singh GP, Mahajan C, Kapoor I, Kalaivani M, Anand V. Intravenous versus inhala-tional techniques for rapid emergence from an-aesthesia in patients undergoing brain tumour surgery. Cochrane Database Syst Rev 2016; 9(9):CD010467. DOI: https://doi.org/10.1002/14651858.CD010467.pub2
26. Tamagno E, Guglielmotto M, Vasciaveo V, Tabaton M. Oxidative stress and beta amyloid in Alzheimer’s disease. Which comes first: The chicken or the egg? Antioxidants (Basel) 2021; 10(9):1479. DOI: https://doi.org/10.3390/antiox10091479
27. Ancelin ML, de Roquefeuil G, Scali J, Bonnel F, Adam JF, Cheminal JC, Cristol JP, Dupuy AM, Carrière I, Ritchie K. Long-term post-operative cognitive decline in the elderly: the effects of an-esthesia type, apolipoprotein E genotype, and clinical antecedents. J Alzheimers Dis 2010; 22 Suppl 3:105-113. DOI: https://doi.org/10.3233/JAD-2010-100807
28. Patel D, Lunn AD, Smith AD, Lehmann DJ, Dor-rington KL. Cognitive decline in the elderly after surgery and anaesthesia: Results from the Oxford Project to Investigate Memory and Ageing (OPTIMA) cohort. Anaesthesia 2016; 71(10):1144-1152. DOI: https://doi.org/10.1111/anae.13571
29. Yang X, Huang X, Li M, Jiang Y, Zhang H. Identi-fication of individuals at risk for postoperative cog-nitive dysfunction (POCD). Ther Adv Neurol Disord 2022; 15:17562864221114356. DOI: https://doi.org/10.1177/17562864221114356
30. Riehl JR, Palanca BJ, Ching S. High-energy brain dynamics during anesthesia-induced uncon-sciousness. Netw Neurosci 2017; 1(4):431-445. DOI: https://doi.org/10.1162/NETN_a_00023
31. Benish SM, Cascino GD, Warner ME, Worrell GA, Wass CT. Effect of general anesthesia in patients with epilepsy: A population-based study. Epilepsy Behav 2010; 17(1):87-89. DOI: https://doi.org/10.1016/j.yebeh.2009.10.015
32. Aytuluk HG, Simsek T, Yilmaz M, Turan AZ, Sar-acoglu KT. Can Propofol Lead to an Increase in Seizure Threshold Over the Course of Electro-convulsive Therapy? Clin Psychopharmacol Neu-rosci 2019; 17(4):523-530. DOI: https://doi.org/10.9758/cpn.2019.17.4.523
33. Jindal S, Sidhu GK, Kumari S, Kamboj P, Chauhan R. Etomidate versus propofol for motor seizure dura-tion during modified electroconvulsive therapy. Anesth Essays Res 2020; 14(1):62-67. DOI: https://doi.org/10.4103/aer.AER_5_20
34. Kulkarni LM, Sanikop C, Shilpa H, Vinayan A. An-aesthetic management in a patient with multiple sclerosis. Indian J Anaesth 2011; 55(1):64-67. DOI: https://doi.org/10.4103/0019-5049.76598
35. Razi O, Tartibian B, Teixeira AM, Zamani N, Go-vindasamy K, Suzuki K, Laher I, Zouhal H. Thermal dysregulation in patients with multiple sclerosis during SARS-CoV-2 infection. The potential thera-peutic role of exercise. Mult Scler Relat Disord 2022; 59:103557. DOI: https://doi.org/10.1016/j.msard.2022.103557
36. Woodruff BC, Garcia D, Chaudhari S. Preoperative evaluation of Parkinson’s disease. Cureus 2021; 13(6):e15933. DOI: https://doi.org/10.7759/cureus.15933
37. Liao PJ, Mao CT, Chen TL, Deng ST, Hsu KH. Factors associated with adverse drug reaction occurrence and prognosis, and their economic impacts in older inpatients in Taiwan: A nested case-control study. BMJ Open 2019; 9(5):e026771. DOI: https://doi.org/10.1136/bmjopen-2018-026771
38. Guerriero F. Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults. World J Clin Cases 2017; 5(3):73-81. DOI: https://doi.org/10.12998/wjcc.v5.i3.73
39. Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population; Board on Health Care Services; Institute of Medi-cine; Levit L, Balogh E, Nass S, et al., editors. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Washington (DC): National Academies Press (US); 2013 Dec 27. 3, Patient-Centered Communication and Shared Decision Making. Available at: https://www.ncbi.nlm.nih.gov/books/NBK202146/
40. Cottrell JE, Hartung J. Anesthesia and cognitive outcome in elderly patients: A narrative viewpoint. J Neurosurg Anesthesiol 2020; 32(1):9-17. DOI: https://doi.org/10.1097/ANA.0000000000000640
41. Laaksonen M, Rinne J, Rahi M, Posti JP, Laitio R, Kivelev J, Saarenpää I, Laukka D, Frösen J, Ronkainen A, Bendel S, Långsjö J, Ala-Peijari M, Saunavaara J, Parkkola R, Nyman M, Martikainen IK, Dickens AM, Rinne J, Valtonen M, Saari TI, Koivisto T, Bendel P, Roine T, Saraste A, Vahlberg T, Tanttari J, Laitio T. Effect of xenon on brain injury, neurological outcome, and survival in patients after aneurysmal subarachnoid hemorrhage-study pro-tocol for a randomized clinical trial. Trials 2023; 24(1):417. DOI: https://doi.org/10.1186/s13063-023-07432-8
42. Singh M, Nath G. Artificial intelligence and anes-thesia: A narrative review. Saudi J Anaesth 2022; 16(1):86-93. DOI: https://doi.org/10.4103/sja.sja_669_21
43. Armstrong R, Riaz S, Hasan S, Iqbal F, Rice T, Syed N. Mechanisms of anesthetic action and neurotoxicity: Lessons from molluscs. Front Physiol 2018; 8:1138. DOI: https://doi.org/10.3389/fphys.2017.01138
2. Steadman J, Catalani B, Sharp C, Cooper L. Life-threatening perioperative anesthetic complica-tions: Major issues surrounding perioperative mor-bidity and mortality. Trauma Surg Acute Care Open 2017; 2(1):e000113. DOI: https://doi.org/10.1136/tsaco-2017-000113
3. Gerritsen JKW, Rizopoulos D, Schouten JW, Haitsma IK, Eralp I, Klimek M, Dirven CMF, Vincent AJPE. Impact of dedicated neuro-anesthesia management on clinical outcomes in glioblastoma patients: A single-institution cohort study. PLoS One 2022; 17(12):e0278864. DOI: https://doi.org/10.1371/journal.pone.0278864
4. Son Y. Molecular mechanisms of general anesthesia. Korean J Anesthesiol 2010; 59(1):3-8. DOI: https://doi.org/10.4097/kjae.2010.59.1.3
5. Slupe AM, Kirsch JR. Effects of anesthesia on cerebral blood flow, metabolism, and neuroprotec-tion. J Cereb Blood Flow Metab 2018; 38(12):2192-2208. DOI: https://doi.org/10.1177/0271678X18789273
6. Yeh HW, Yeh LT, Chou YH, Yang SF, Ho SW, Yeh YT, Yeh YT, Wang YH, Chan CH, Yeh CB. Risk of cardiovascular disease due to general anesthesia and neuraxial anesthesia in lower-limb fracture pa-tients: A retrospective population-based cohort study. Int J Environ Res Public Health 2019; 17(1):33. DOI: https://doi.org/10.3390/ijerph17010033
7. Meng T, Ren X, Chen X, Yu J, Agrimi J, Paolocci N, Gao WD. Anesthetic agents isoflurane and propofol decrease maximal Ca2+-activated force and thus contractility in the failing myocardium. J Pharmacol Exp Ther 2019; 371(3):615-623. DOI: https://doi.org/10.1124/jpet.119.259556
8. Saraswat V. Effects of anaesthesia techniques and drugs on pulmonary function. Indian J Anaesth 2015; 59(9):557-564. DOI: https://doi.org/10.4103/0019-5049.165850
9. Brinkman JE, Toro F, Sharma S. Physiology, Res-piratory Drive. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Pub-lishing; 2023 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK482414/
10. Doo AR, Kang S, Kim YS, Lee TW, Lee JR, Kim DC. The effect of the type of anesthesia on the quality of postoperative recovery after orthopedic forearm surgery. Korean J Anesthesiol 2020; 73(1):58-66. DOI: https://doi.org/10.4097/kja.19352
11. Brown EN, Pavone KJ, Naranjo M. Multimodal general anesthesia: Theory and practice. Anesth Analg. 2018 Nov;127(5):1246-1258. DOI: https://doi.org/10.1213/ANE.0000000000003668
12. Wu L, Zhao H, Weng H, Ma D. Lasting effects of general anesthetics on the brain in the young and elderly: “Mixed picture” of neurotoxicity, neuropro-tection and cognitive impairment. J Anesth 2019; 33(2):321-335. DOI: https://doi.org/10.1007/s00540-019-02623-7
13. Belrose JC, Noppens RR. Anesthesiology and cognitive impairment: A narrative review of current clinical literature. BMC Anesthesiol 2019; 19(1):241. DOI: https://doi.org/10.1186/s12871-019-0903-7
14. Alam A, Hana Z, Jin Z, Suen KC, Ma D. Surgery, neuroinflammation and cognitive impairment. EBioMedicine 2018; 37:547-556. DOI: https://doi.org/10.1016/j.ebiom.2018.10.021
15. Zuo C, Ma J, Pan Y, Zheng D, Chen C, Ruan N, Su Y, Nan H, Lian Q, Lin H. Isoflurane and sevoflurane induce cognitive impairment in neonatal rats by in-hibiting neural stem cell development through mi-croglial activation, neuroinflammation, and sup-pression of VEGFR2 signaling pathway. Neurotox Res 2022; 40(3):775-790. DOI: https://doi.org/10.1007/s12640-022-00511-9
16. Henschel O, Gipson KE, Bordey A. GABAA re-ceptors, anesthetics and anticonvulsants in brain development. CNS Neurol Disord Drug Targets 2008; 7(2):211-224. DOI: https://doi.org/10.2174/187152708784083812
17. Newcomer JW, Farber NB, Olney JW. NMDA receptor function, memory, and brain aging. Dia-logues Clin Neurosci 2000; 2(3):219-232. DOI: https://doi.org/10.31887/DCNS.2000.2.3/jnewcomer
18. Gao Y, Hong Y, Huang L, Zheng S, Zhang H, Wang S, Yao Y, Zhao Y, Zhu L, Xu Q, Chai X, Zeng Y, Zeng Y, Zheng L, Zhou Y, Luo H, Zhang X, Zhang H, Zhou Y, Fu G, Sun H, Huang TY, Zheng Q, Xu H, Wang X. β2-microglobulin functions as an endogenous NMDAR antagonist to impair synaptic function. Cell 2023; 186(5):1026-1038.e20. DOI: https://doi.org/10.1016/j.cell.2023.01.021
19. Ntalouka MP, Arnaoutoglou E, Tzimas P. Postop-erative cognitive disorders: An update. Hippokratia 2018; 22(4):147-154.
20. Tang CY, Wang VX, Lun MY, Mincer JS, Ng JC, Brallier JW, Schwartz AE, Ahn H, McCormick PJ, Nir T, Delman B, Sano M, Deiner SG, Baxter MG. Transient changes in white matter microstructure during general anesthesia. PLoS One 2021; 16(3):e0247678. DOI: https://doi.org/10.1371/journal.pone.0247678. Er-ratum in: PLoS One 2021; 16(4):e0250449
21. Jia X, Wang Z, Huang F, Su C, Du W, Jiang H, Wang H, Wang J, Wang F, Su W, Xiao H, Wang Y, Zhang B. A comparison of the Mini-Mental State Examination (MMSE) with the Montreal Cognitive Assessment (MoCA) for mild cognitive impairment screening in Chinese middle-aged and older popu-lation: A cross-sectional study. BMC Psychiatry 2021; 21(1):485. DOI: https://doi.org/10.1186/s12888-021-03495-6
22. Ishizawa Y. Does preoperative cognitive optimiza-tion improve postoperative outcomes in the elderly? J Clin Med 2022; 11(2):445. DOI: https://doi.org/10.3390/jcm11020445
23. Davis N, Lee M, Lin AY, Lynch L, Monteleone M, Falzon L, Ispahany N, Lei S. Postoperative cogni-tive function following general versus regional an-esthesia: A systematic review. J Neurosurg An-esthesiol. 2014; 26(4):369-376. DOI: https://doi.org/10.1097/ANA.0000000000000120
24. Chen PL, Yang CW, Tseng YK, Sun WZ, Wang JL, Wang SJ, Oyang YJ, Fuh JL. Risk of dementia after anaesthesia and surgery. Br J Psychiatry 2014; 204(3):188-193. DOI: https://doi.org/10.1192/bjp.bp.112.119610
25. Prabhakar H, Singh GP, Mahajan C, Kapoor I, Kalaivani M, Anand V. Intravenous versus inhala-tional techniques for rapid emergence from an-aesthesia in patients undergoing brain tumour surgery. Cochrane Database Syst Rev 2016; 9(9):CD010467. DOI: https://doi.org/10.1002/14651858.CD010467.pub2
26. Tamagno E, Guglielmotto M, Vasciaveo V, Tabaton M. Oxidative stress and beta amyloid in Alzheimer’s disease. Which comes first: The chicken or the egg? Antioxidants (Basel) 2021; 10(9):1479. DOI: https://doi.org/10.3390/antiox10091479
27. Ancelin ML, de Roquefeuil G, Scali J, Bonnel F, Adam JF, Cheminal JC, Cristol JP, Dupuy AM, Carrière I, Ritchie K. Long-term post-operative cognitive decline in the elderly: the effects of an-esthesia type, apolipoprotein E genotype, and clinical antecedents. J Alzheimers Dis 2010; 22 Suppl 3:105-113. DOI: https://doi.org/10.3233/JAD-2010-100807
28. Patel D, Lunn AD, Smith AD, Lehmann DJ, Dor-rington KL. Cognitive decline in the elderly after surgery and anaesthesia: Results from the Oxford Project to Investigate Memory and Ageing (OPTIMA) cohort. Anaesthesia 2016; 71(10):1144-1152. DOI: https://doi.org/10.1111/anae.13571
29. Yang X, Huang X, Li M, Jiang Y, Zhang H. Identi-fication of individuals at risk for postoperative cog-nitive dysfunction (POCD). Ther Adv Neurol Disord 2022; 15:17562864221114356. DOI: https://doi.org/10.1177/17562864221114356
30. Riehl JR, Palanca BJ, Ching S. High-energy brain dynamics during anesthesia-induced uncon-sciousness. Netw Neurosci 2017; 1(4):431-445. DOI: https://doi.org/10.1162/NETN_a_00023
31. Benish SM, Cascino GD, Warner ME, Worrell GA, Wass CT. Effect of general anesthesia in patients with epilepsy: A population-based study. Epilepsy Behav 2010; 17(1):87-89. DOI: https://doi.org/10.1016/j.yebeh.2009.10.015
32. Aytuluk HG, Simsek T, Yilmaz M, Turan AZ, Sar-acoglu KT. Can Propofol Lead to an Increase in Seizure Threshold Over the Course of Electro-convulsive Therapy? Clin Psychopharmacol Neu-rosci 2019; 17(4):523-530. DOI: https://doi.org/10.9758/cpn.2019.17.4.523
33. Jindal S, Sidhu GK, Kumari S, Kamboj P, Chauhan R. Etomidate versus propofol for motor seizure dura-tion during modified electroconvulsive therapy. Anesth Essays Res 2020; 14(1):62-67. DOI: https://doi.org/10.4103/aer.AER_5_20
34. Kulkarni LM, Sanikop C, Shilpa H, Vinayan A. An-aesthetic management in a patient with multiple sclerosis. Indian J Anaesth 2011; 55(1):64-67. DOI: https://doi.org/10.4103/0019-5049.76598
35. Razi O, Tartibian B, Teixeira AM, Zamani N, Go-vindasamy K, Suzuki K, Laher I, Zouhal H. Thermal dysregulation in patients with multiple sclerosis during SARS-CoV-2 infection. The potential thera-peutic role of exercise. Mult Scler Relat Disord 2022; 59:103557. DOI: https://doi.org/10.1016/j.msard.2022.103557
36. Woodruff BC, Garcia D, Chaudhari S. Preoperative evaluation of Parkinson’s disease. Cureus 2021; 13(6):e15933. DOI: https://doi.org/10.7759/cureus.15933
37. Liao PJ, Mao CT, Chen TL, Deng ST, Hsu KH. Factors associated with adverse drug reaction occurrence and prognosis, and their economic impacts in older inpatients in Taiwan: A nested case-control study. BMJ Open 2019; 9(5):e026771. DOI: https://doi.org/10.1136/bmjopen-2018-026771
38. Guerriero F. Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults. World J Clin Cases 2017; 5(3):73-81. DOI: https://doi.org/10.12998/wjcc.v5.i3.73
39. Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population; Board on Health Care Services; Institute of Medi-cine; Levit L, Balogh E, Nass S, et al., editors. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Washington (DC): National Academies Press (US); 2013 Dec 27. 3, Patient-Centered Communication and Shared Decision Making. Available at: https://www.ncbi.nlm.nih.gov/books/NBK202146/
40. Cottrell JE, Hartung J. Anesthesia and cognitive outcome in elderly patients: A narrative viewpoint. J Neurosurg Anesthesiol 2020; 32(1):9-17. DOI: https://doi.org/10.1097/ANA.0000000000000640
41. Laaksonen M, Rinne J, Rahi M, Posti JP, Laitio R, Kivelev J, Saarenpää I, Laukka D, Frösen J, Ronkainen A, Bendel S, Långsjö J, Ala-Peijari M, Saunavaara J, Parkkola R, Nyman M, Martikainen IK, Dickens AM, Rinne J, Valtonen M, Saari TI, Koivisto T, Bendel P, Roine T, Saraste A, Vahlberg T, Tanttari J, Laitio T. Effect of xenon on brain injury, neurological outcome, and survival in patients after aneurysmal subarachnoid hemorrhage-study pro-tocol for a randomized clinical trial. Trials 2023; 24(1):417. DOI: https://doi.org/10.1186/s13063-023-07432-8
42. Singh M, Nath G. Artificial intelligence and anes-thesia: A narrative review. Saudi J Anaesth 2022; 16(1):86-93. DOI: https://doi.org/10.4103/sja.sja_669_21
43. Armstrong R, Riaz S, Hasan S, Iqbal F, Rice T, Syed N. Mechanisms of anesthetic action and neurotoxicity: Lessons from molluscs. Front Physiol 2018; 8:1138. DOI: https://doi.org/10.3389/fphys.2017.01138
How to Cite
Jung Nho, M. (2023). General Anesthesia, Cognition, and Neurological Comorbidities. Science Insights, 43(4), 1097–1104. https://doi.org/10.15354/si.23.re815
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