Authors: van Zundert AJ, Cylinder DM, van Swinderen B
Anesthesia & Analgesia ():10.1213/ANE.0000000000007695, August 08, 2025.
This perspective explores the complexities of cognitive recovery following general anesthesia (GA), emphasizing that emergence from anesthesia does not equate to full cognitive restoration. Recovery trajectories can be unpredictable, especially in patients with comorbidities or preexisting cognitive or psychiatric conditions. Common measures, such as the bispectral index (BIS), have limitations, and no universal threshold exists for defining full consciousness.
The authors highlight that delayed emergence may predict poor cognitive outcomes and that postoperative delirium could be linked to long-term cognitive decline. They suggest that anesthetic action involves multiple neural processes working in parallel, potentially making presynaptic neurotransmission a rate-limiting step in recovery. Understanding these mechanisms may improve perioperative cognitive outcomes and guide anesthetic choices, especially for vulnerable patient populations.
Thank you to Anesthesia & Analgesia for allowing the use of this article.