As the brain and cognitive functions are particularly vulnerable to the effects of anesthesia and surgical stress, postoperative delirium remains the most common complication in patients aged 65 and older. This journal course explores the pathophysiology of postoperative neurocognitive dysfunction and delirium, examining how surgical trauma triggers the release of proinflammatory cytokines (including interleukin-1β, interleukin-6, and tumor necrosis factor-α) that compromise the blood-brain barrier. Aging adults, with their reduced brain volume, cerebrospinal fluid, and dendritic synapses, are particularly susceptible to these neuroinflammatory changes.
The course delves into the role of anesthetic techniques in influencing these processes, with a focus on dexmedetomidine, a nonspecific α2-adrenergic receptor agonist known for its anti-inflammatory properties. Dexmedetomidine’s effects, including mimicking natural sleep pathways and reducing opioid requirements, contribute to cognitive preservation. Current literature on its efficacy in reducing postoperative delirium and cognitive dysfunction in older adults is reviewed, highlighting how certified registered nurse anesthetists (CRNAs) can incorporate these insights into their practice. This course aims to equip CRNAs with an understanding of dexmedetomidine’s potential benefits as an adjunct therapy and its implications for improving postoperative cognitive outcomes in older patients.
Learning Outcome:
- Define postoperative delirium (POD) and postoperative cognitive dysfunction (POCD).
- Discuss the pathophysiology related to neurocognitive dysfunction.
- Describe dexmedetomidine’s mechanism of action, its influence on neurocognitive dysfunction, and common dosing described in the literature.
- Acknowledge additional benefits and limitations of dexmedetomidine for older adults.
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This program has been prior approved by the American Association of Nurse Anesthesiology for 1.0 Class A CE credits; Code Number 1044960; Expiration Date 10/7/2025.
AANA designates this program as meeting the criteria for up to 1.0 CE Credits in pharmacology/therapeutics.