The ASA’s Perioperative Brain Health Initiative is an important undertaking aimed at minimizing perioperative cognitive and psychiatric dysfunction. Most attention is focused on maintaining cognition and avoiding delirium postoperatively in elderly surgical patients, who are most at risk for clinically-obvious deterioration in brain function. A broader vision of physician anesthesiologists’ role in brain health would be optimizing brain function for all those receiving anesthetic and analgesic drugs, during all episodes of care involving an anesthesiologist, intensivist or pain medicine physician.

The human brain is, arguably, the most complex system in the known universe, with an estimated 120 billion neurons that make approximately 1,000 times more synaptic connections with one another. Most anesthetics and analgesics have known receptor pharmacology that interacts with this vast neural network, but the full impact of these medications on complex cognitive functions is...

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