Dear editor
Fathy et alCitation1 rightfully emphasize the importance of postoperative cognitive dysfunction (POCD) as it is associated with longer length of in-hospital stay and an increased mortality in the first year after surgery.Citation2,Citation3 However, in contrast to the conclusion made by Fathy et al, it is not anesthesia and surgery that are risk factors for the development of POCD.Citation4 Baseline patient characteristics (education level, age, frailty) and in-hospital delirium are major contributors for the development of POCD.Citation2–Citation4 Subsequently there were no differences found in the incidence of POCD between regional vs general anesthesia.Citation5 Although Fathy et al target a very vulnerable patient group with respect to risk factors of developing POCD, it is very unlikely, in relation to the aforementioned, that there will be a difference in incidence between two local anesthetics. Fathy et al confirm this in their own study;Citation1 there is a similar (nonsignificant) incidence of POCD in patients receiving lidocaine and in patients receiving bupivacaine during cataract surgery. So, the challenge in the prevention of POCD is not in the anesthetic technique or drug, but in the identification and treatment of modifiable risk factors and postoperative delirium.
Disclosure
The authors report no conflicts of interest in this communication.
References
- FathyWHusseinMKhalilHEffect of local anesthesia (with lidocaine vs bupivacaine) on cognitive function in patients undergoing elective cataract surgeryLocal Reg Anesth2019121630643450
- O’ BrienHMohanHHareCOReynoldsJVKennyRAMind over matter? The hidden epidemic of cognitive dysfunction in the older surgical patientAnn Surg2017265467769127537541
- MonkTGWeldonBCGarvanCWPredictors of cognitive dysfunction after major noncardiac surgeryAnesthesiology20081081183018156878
- HughesCGPatelMBJacksonJCSurgery and anesthesia exposure is not a risk factor for cognitive impairment after major noncardiac surgery and critical illnessAnn Surg201726561126113327433893
- BergerMSchenningKJBrownCHBest practices for postoperative brain health: recommendations from the Fifth International Perioperative Neurotoxicity Working GroupAnesth Analg201812761406141330303868