Near-infrared spectroscopy-based cerebral oxygen monitoring in perioperative neurocognitive disorders of older adults: current evidence and future perspectives

Perioperative neurocognitive disorders (PNDs) are common pathophysiological states and neurological complications in older adult patients after surgery, which severely restrict the quality of postoperative rehabilitation and increase the social medical burden. Cerebral oxygen saturation monitoring using near-infrared spectroscopy (NIRS) has emerged as a valuable tool for perioperative management. Recently, multiregional NIRS monitoring, an extension of this technology, has gained attention for its potential to detect regional cerebral hypoperfusion in multiple vascular territories and provide more comprehensive guidance for anesthesia interventions. This study comprehensively reviews the definition, classification, and clinical characteristics of different subtypes of PND pathogenesis and risk factors, elaborates on the principles and limitations of NIRS monitoring technology, integrates the research progress of NIRS-based multiregional monitoring, analyzes the clinical value of cerebral oxygen saturation monitoring and its application status in different types of surgery, and focuses on exploring the advantages, application prospects, and current core controversies of multiregional cerebral oxygen saturation monitoring technology to provide a reference for the optimization of perioperative anesthesia management and neuroprotective strategies in older adult patients.