Authors: Brenna et al.
The Daily Dose, IARS, Friday, May 8, 2026
Key Points
Perioperative neurocognitive disorders are common after anesthesia and surgery and are expected to become more common as the surgical population ages.
The article reviews a 2026 IARS and SOCCA Annual Meeting session focused on improving post-anesthetic cognitive recovery.
Current clinical strategies emphasize prevention, risk identification, early delirium screening, medication review, pain control, mobility, hydration, and sleep hygiene.
New research suggests that sleep, attention, arousal pathways, and dopamine circuits may play important roles in postoperative delirium and delayed recovery.
Animal models may help identify therapeutic targets, including dopaminergic arousal circuits that could potentially accelerate emergence from anesthesia.
Summary
This IARS Daily Dose article reviewed a session from the 2026 IARS and SOCCA Annual Meeting titled “Clearing the Fog: Emerging Strategies to Improve Post-Anesthetic Cognitive Recovery.” The session focused on perioperative neurocognitive disorders and how clinical research, sleep science, and animal models may help identify future strategies to improve recovery after anesthesia and surgery.
The article begins by noting that perioperative neurocognitive disorders are among the most common complications after anesthesia and surgery. These disorders are especially important because the surgical population is aging, and older adults are at higher risk for postoperative cognitive decline, delirium, and delayed recovery. The session framed these complications as both a clinical challenge and a translational neuroscience opportunity, since anesthesia, surgery, inflammation, illness, sleep, and brain vulnerability may all contribute to postoperative cognitive dysfunction.
The first presentation was delivered by Stacie Deiner, MD, MS, who reviewed current clinical approaches to cognitive recovery after surgery. She explained that the older term postoperative cognitive dysfunction, or POCD, has been replaced by more precise terminology aligned with DSM-5 concepts. The newer framework distinguishes postoperative delirium, delayed neurocognitive recovery, and longer-term postoperative neurocognitive disorders. This nomenclature helps clinicians and researchers better define what they are measuring and when cognitive changes occur.
Dr. Deiner also emphasized that diagnosis remains challenging. Subjective cognitive complaints can be important but are nonspecific, and longer-term studies must distinguish true postoperative neurocognitive decline from the normal cognitive changes that occur with aging. At present, there are no targeted therapies that reliably treat perioperative neurocognitive disorders. For that reason, best practices focus on prevention, early recognition, and risk reduction.
Important preventive strategies include identifying high-risk patients before surgery, screening for baseline cognitive impairment, reviewing medications that may increase risk, and recognizing frailty. Intraoperative and postoperative approaches may include considering dexmedetomidine or regional anesthetic techniques when appropriate, screening early for postoperative delirium, controlling pain, and using nonpharmacologic measures such as early mobilization, hydration, and sleep support.
The second presentation, by Michael Devinney, MD, PhD, explored the relationship between sleep, attention, and postoperative delirium. Preoperative sleep disorders have been associated with increased delirium risk, and sleep deprivation can impair attention, which is one of the hallmark features of delirium. However, the findings discussed in this session challenged the simple idea that more postoperative sleep is always protective.
Dr. Devinney presented a secondary analysis of the REPOSE Trial that included cognitive assessments, psychomotor vigilance testing, and EEG-derived sleep data in postoperative patients. Unexpectedly, patients who developed postoperative delirium had increased sleep duration and fewer sleep disruptions during the first two postoperative days compared with patients who did not develop delirium. Automated EEG staging suggested that much of the increase involved N2-stage sleep, with possible REM sleep contribution.
These findings suggest that sleep may not function in a straightforward restorative or protective way after surgery. Instead, postoperative delirium may involve altered arousal pathways, meaning that patients who appear to sleep more may still have abnormal brain recovery. This could make arousal regulation an important area for future therapeutic research.
The final presentation, by Kathleen Vincent, PhD, focused on animal models and circuit-based approaches to cognitive recovery. Rodent models allow researchers to isolate the effects of anesthesia from surgery, study genetically vulnerable animals, and investigate specific neural circuits involved in attention and arousal. These models are especially useful for understanding why some patients may be more vulnerable to delayed emergence or postoperative cognitive problems.
Dr. Vincent’s work has shown that transgenic mouse models of Alzheimer’s disease recover more slowly from anesthesia and demonstrate attention deficits and reduced behavioral activity. Her team investigated whether impaired arousal circuitry might contribute to delayed emergence. Using DREADD chemogenetic tools, they selectively activated dopaminergic neurons in the ventral tegmental area, which accelerated recovery even in cognitively vulnerable mice. Similar effects were seen with methylphenidate, suggesting that dopamine arousal circuits may be a clinically relevant target for improving emergence after anesthesia.
What You Should Know
This article highlights how perioperative brain health is moving from broad clinical observation toward more precise neuroscience. The field is no longer focused only on identifying delirium or cognitive decline after surgery. It is increasingly trying to understand the underlying mechanisms that affect arousal, attention, sleep, emergence, and long-term recovery.
For anesthesia providers, the practical message is that prevention remains the current standard. Preoperative cognitive screening, frailty assessment, medication review, delirium screening, pain control, hydration, mobilization, and sleep support remain important because no targeted treatment currently exists for perioperative neurocognitive disorders.
At the same time, the research discussed in this article points toward future therapies. Sleep patterns, EEG markers, attention testing, and dopaminergic arousal circuits may help identify vulnerable patients and guide interventions. The possibility that drugs targeting arousal systems could improve recovery after anesthesia is especially important for future research.
Overall, the article shows that post-anesthetic cognitive recovery is both a clinical priority and a promising area of translational neuroscience. Understanding how the brain emerges from anesthesia may eventually help clinicians reduce delirium, speed recovery, and protect cognitive function in vulnerable surgical patients.
ASA status:
This is not an ASA article. It is from IARS The Daily Dose. It does mention that Stacie Deiner is chair of the American Society of Anesthesiology Brain Health Initiative, but that does not make the article an ASA publication.
Thank you to IARS and The Daily Dose for allowing us to summarize and share this article.