During my (MH) medical school rotation in anesthesiology, the importance of optimizing specific organ systems prior to surgery was a fundamental aspect of what I was taught. If a patient had congestive heart failure, diuresis would be considered; for reactive airway disease, inhalers would be administered; and appropriately timed dialysis was key for end-stage renal disease patients. But no one ever talked about optimizing the brain! I may have been biased as I was fresh off a long stint in graduate school studying neuronal aging in the hippocampus, an important brain structure for learning and memory; but this seemed like an obvious gap. At that time, it was recognized that patients may experience alterations in thinking and behavior after surgery, but this was largely dismissed as an accepted response to anesthesia medications. I was disappointed, but what an opportunity...

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