Perioperative Cardiopulmonary Optimization, Cerebral Oximetry, and Recovery Focused Anesthesia: A Narrative Review

Abstract

Modern anesthesia practice extends beyond intraoperative unconsciousness and analgesia. It requires protection of cerebral, cardiovascular, pulmonary, and functional recovery outcomes across the perioperative continuum. Patients undergoing cardiac surgery, laparoscopic abdominal surgery, or surgery after coronavirus disease 2019 (COVID-19) may present with unique physiologic risks that require individualized anesthetic planning. This narrative review discusses perioperative cardiopulmonary optimization, cerebral oximetry, pulmonary function assessment, postoperative nausea and vomiting prevention, opioid-sparing analgesia, and recovery-focused anesthesia strategies. A narrative review was conducted using anesthesia, perioperative medicine, and enhanced recovery literature. Emphasis was placed on clinically relevant evidence applicable to anesthesiologists, perioperative physicians, and surgical teams. Cerebral oximetry using near-infrared spectroscopy may help identify cerebral desaturation during cardiac surgery, although its effect on hard clinical outcomes remains uncertain. Cardiopulmonary reserve, stress-induced blood pressure responses, post-COVID pulmonary dysfunction, and procedure-specific surgical recovery all influence anesthetic risk. Multimodal analgesia, regional anesthesia, nausea prevention, and enhanced recovery pathways are central to improving postoperative outcomes. Perioperative anesthesia should be individualized according to neurologic risk, cardiopulmonary reserve, surgical stress, and expected postoperative recovery needs. Cerebral oximetry, pulmonary assessment, opioid-sparing analgesia, and enhanced recovery protocols may improve patient-centered care when applied selectively and thoughtfully.