A new analysis of 46 randomized controlled trials involving nearly 10,000 patients suggests that certain anesthetic adjuvants and cognitive training may help prevent postoperative cognitive dysfunction (POCD) and delirium (POD) after cardiac surgery. The study compared 20 different strategies, including drugs like intranasal insulin, gastrodin, esketamine, and dexmedetomidine, as well as non-pharmacological approaches like cognitive training.
For preventing delirium, intranasal insulin, gastrodin, and cognitive training ranked highest. For preventing longer-term cognitive problems, gastrodin, esketamine, and dexmedetomidine appeared most effective. However, these rankings are based on a statistical method called SUCRA, which indicates relative effectiveness but does not provide absolute risk reductions.
The findings are exploratory, especially for changes in the Mini-Mental State Examination (MMSE), where results were based on fewer studies and were sensitive to how the data were analyzed. Rankings for strategies supported by only a few studies are uncertain.
This review does not prove that any of these interventions definitively prevent cognitive decline after cardiac surgery. Patients should discuss potential preventive strategies with their healthcare team, as individual risks and benefits vary.
