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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2015 August;56(4):607-15

lingua: Inglese

A new ethical and medico-legal issue: vascular surgery and the postoperative cognitive dysfunction

Setacci C. 1, Sirignano A. 2, Ricci G. 2, Spagnolo A. G. 3, Pugliese F. 4, Speziale F. 5

1 Vascular and Endovascular Surgery Unit, Department of Medicine, Surgery and Neurological Sciences, University of Siena, Siena, Italy;
2 Institute of Medical Law, School of Law, University of Camerino, Camerino, Macerata, Italy;
3 Institute of Bioethics, School of Medicine “A. Gemelli”, Università Cattolica del Sacro Cuore, Rome, Italy;
4 Intensive Care Unit, Department of Anesthesiology, Policlinico Umberto I, “Sapienza” University, Rome, Italy;
5 Vascular and Endovascular Surgery Division, Department of Surgery “P. Stefanini”, Policlinico Umberto I, “Sapienza” University, Rome, Italy


Patients undergoing major surgery are at risk for postoperative cognitive dysfunction (POCD). The consciousness of the POCD arises new ethical and medico-legal issues that should be identified, managed and, if possible, prevented. Elderly patients still represent a real challenge for physicians and medical science. This challenge can be surmounted not only through technical progress but also by safeguarding the correct ethical behavior at the base of each relationship between a patient and his physician. Effective communication with the elderly patient is a prerequisite for clear and complete information, involving family members and caregivers when necessary. In every case, the identification of patients with pre-existing risk factors of POCD, shortening the period of time preceding the surgery and a proper technique of the procedure as well as physical and intellectual exercises, nutrition and medication play an important role in decreasing the incidence of neurocognitive deficits in the elderly.

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