title: A new ethical and medico-legal issue: vascular surgery and the postoperative cognitive dysfunction.
abstract: 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.
authors.affiliation: Vascular and Endovascular Surgery Unit, Department of Medicine, Surgery and Neurological Sciences, University of Siena, Siena, Italy - ascaniosirignano@virgilio.it.
authors.forename: C
authors.initials: C
authors.lastname: Setacci
authors.forename: A
authors.initials: A
authors.lastname: Sirignano
authors.forename: G
authors.initials: G
authors.lastname: Ricci
authors.forename: A G
authors.initials: AG
authors.lastname: Spagnolo
authors.forename: F
authors.initials: F
authors.lastname: Pugliese
authors.forename: F
authors.initials: F
authors.lastname: Speziale
mesh_terms: D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control / Q000523:psychology; D003142:Communication; D003661:Decision Support Techniques; D015577:Geriatric Assessment; D006801:Humans; D007258:Informed Consent / Q000941:ethics* / Q000331:legislation & jurisprudence; D009483:Neuropsychological Tests; D010817:Physician-Patient Relations; D011237:Predictive Value of Tests; D011368:Professional-Family Relations; D018570:Risk Assessment; D012307:Risk Factors; D014342:Truth Disclosure; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000941:ethics* / Q000331:legislation & jurisprudence