Impact of pharmacological and non-pharmacological strategies on postoperative cognitive disfunction (POCD) in cardiac surgery
Juan P. Alzate-Granados 1, Betty G. Valencia-Angarita 2, Santiago González-González 3, Carlos A. Corona-Arias 4, Gabriela V. Torres-Menjura 5
1 Department of Pathology, Faculty of Medicine, National University of Colombia, Bogotá, Colombia; 2 Department of Medicine, Universidad Metropolitana, Barranquilla, Colombia; 3 Department of Medicine, Universidad de Antioquia, Medellín, Colombia; 4 Department of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia; 5 Department of Medicine, National University of Colombia, Bogotá, Colombia
*Correspondencia: Betty G. Valencia-Angarita, Email no disponible
Resumen
Postoperative cognitive dysfunction (POCD) is a common complication following cardiac surgery, particularly in elderly patients, and is characterized by deficits in memory, attention, and executive function. Its etiology involves neuroinflammation, cerebral hypoperfusion, embolism, and oxidative stress. A systematic review of randomized controlled trials (RCTs) and observational studies was conducted. The databases consulted included PubMed, EMBASE, Scopus, CENTRAL, and Web of Science (last search: March 2024). Studies included adult patients undergoing cardiac surgery who received either pharmacological interventions (e.g., dexmedetomidine, ketamine) or non-pharmacological interventions, with cognitive outcomes measured. Sixteen studies were included. Perioperative dexmedetomidine reduced the incidence of early POCD by 40% to 60%. Low-dose ketamine (0.5 mg/kg) decreased POCD from 81% to 27% one week after surgery (p < 0.001). Melatonin improved early cognitive scores and sleep quality. Cognitive training significantly reduced the risk of POCD (relative risk ~0.35), while NIRS monitoring showed short-term benefits (POCD: 28% vs. 52%, p = 0.002). Off-pump surgery and remote ischemic preconditioning demonstrated transient benefits with no long-term effects. Lidocaine and donepezil did not show significant cognitive improvement. Dexmedetomidine and ketamine provide the strongest evidence among pharmacological strategies.
