The Glymphatic System: A Potential Pathophysiological Focus for Perioperative Neurocognitive Disorder

Abstract

Perioperative neurocognitive disorder is a decline in cognitive function of patients after anesthesia and surgery. It seems to be a comprehensive effect of the combination of psychological state before the operation, neurotoxicity of narcotic drugs, inflammation caused by the operation, and sleep deprivation after surgery. The glymphatic pathway is a newly discovered system that clears metabolic waste from the brain. The clearing efficiency of the glymphatic pathway can be influenced by sleep deprivation, some narcotic drugs (like dexmedetomidine and ketamine), and neuroinflammation. We hypothesize that the glymphatic system may play a pivotal role in the occurrence and development of perioperative neurocognitive disorder.