Exploring nurses' perceptions of cross-border mobility based on the cultural homology background: a qualitative descriptive study.

Older patients increasingly undergo complex cardiac surgeries, putting them at risk for serious complications, of which postoperative delirium (POD), an acute brain dysfunction with fluctuating consciousness and cognition, has a reported incidence of 50%. POD correlates with adverse postoperative outcomes. Delirium is rooted in many causes, including age, pre-existing cognitive dysfunction, pain, sedatives, and inflammation. The burden of preoperative cognitive dysfunction is prevalent in this vulnerable elderly demographic yet remains vastly underrecognized. Systematic preoperative cognitive screening is not yet a part of formal pre-anesthesia evaluation. Identifying these cases holds potential for predicting perioperative neurocognitive disorders (PND) that encompass POD and enabling targeted interventions to mitigate these morbid conditions. Cognitively impaired patients exhibit modified Electroencephalogram (EEG) patterns with diminished awake alpha activity, offering insights into the underlying neural circuitry. Systematic neural oscillations change intraoperatively based on age, drug type, and dosage. Advances in perioperative EEG analysis highlight burst suppression (BS) pattern occurrence and duration (BSD), along with specific spectral dynamics including spectral edge frequency (SEF) as predictive indicators for POD. Recent studies show links between cognitive dysfunction and decreased intraoperative measurements of alpha band power, alpha peak frequency, and coherence, revealing heightened sensitivities to similar anesthetic depth in this cohort. Cerebral oxygenation (CO), a surrogate marker for cerebral blood flow, also varies based on the cerebral vasculature. These factors have been used to predict PND with variable reliability. Nonetheless, conflicting data on their effectiveness, cost-efficiency, and anesthesiologists’ familiarity limit the widespread adoption of noninvasive, clinical neuromonitoring. In a fast-paced cardiac OR, integrating comprehensive neuromonitoring with interpretable metrics to identify patients with cognitive dysfunction remains a challenge, especially without defined thresholds to distinguish them. Thus, our study seeks to examine whether readily available, real-time EEG and CO metrics differ in older cardiac surgery patients with normal cognition vs cognitive dysfunction.