This course unpacks the subtle but serious problem of postoperative cognitive decline, especially in older surgical patients. You’ll review incidence, risk factors, and diagnostic approaches, then dive into how different anesthetic techniques (volatile agents, TIVA, BIS-guided dosing) and inflammatory pathways shape POCD risk. Finally, you’ll explore the evidence for pharmacologic strategies—including dexmedetomidine, ketamine, steroids, NSAIDs, and lidocaine—to help you design anesthetics that better protect the brain and support long-term cognitive outcomes.