Exploring the gut microbiome-Postoperative Cognitive Dysfunction connection: Mechanisms, clinical implications, and future directions

Abstract

Postoperative Cognitive Dysfunction (POCD) is a common yet poorly understood complication of surgery that can lead to long-term cognitive decline. The gut-brain axis, a bidirectional communication system between the central nervous system and the gut microbiota, plays a significant role in maintaining cognitive health. The potential for anesthetic agents and perioperative medications to modulate the gut microbiota and influence the trajectory of POCD suggests the need for a more integrated approach in perioperative care. Perioperative medications, including opioids and antibiotics, further compound these disruptions, leading to dysbiosis and consequent systemic and neuroinflammation implicated in cognitive impairment. Understanding how surgical interventions and associated treatments affect this relationship is crucial for developing strategies to reduce the incidence of POCD. Strategies to preserve and promote a healthy gut microbiome may mitigate the risk and severity of POCD. Future research should aim to clarify the mechanisms linking gut flora alterations to cognitive outcomes and explore targeted interventions, such as probiotic supplementation and microbiota-friendly prescription practices, to safeguard cognitive function postoperatively.

Keywords: Anesthesia; Dysbiosis; Gut microbiota; Gut-brain axis; Perioperative medications; Postoperative cognitive dysfunction.

Fig. 1

The dysbiosis of intestinal flora induced postoperative cognitive dysfunction. Multiple neuro-transmitters/modulators were synthesized by intestinal flora, absorbed into the blood and cross the BBB, which modulate the activity of glial cells and neurons. Dysbiosis of intestinal flora affect the levels of these neurotransmitters within the CNS, influencing cognition. The impacr factors include but not limited surgery procedure, antibiotics, anesthetics, hemodynamic instability and hyoxemia during the operation, which induce the dysbiosis of intestinal flora and lead to the postoperative cognitive dysfunction. The figure was Created with BioRender.com.