[The central role of multimodal brain monitoring-guided general anesthesia management in preventing postoperative neurological complications in elderly patients].

With the acceleration of population aging, the proportion of elderly patients undergoing surgical procedures continues to increase. The incidence of postoperative neurological complications, including postoperative delirium and postoperative cognitive dysfunction, has risen significantly. These complications have become major factors affecting patient prognosis and healthcare resource utilization. The aging brain exhibits vulnerability-associated changes across its structural, functional, metabolic, and inflammatory levels. These alterations heighten the sensitivity of elderly patients to anesthetic agents, nociceptive stimuli, and hemodynamic instability. Conventional single-modality monitoring techniques are insufficient to comprehensively assess cerebral functional status. Multimodal brain monitoring-guided general anesthesia management refers to the combined use of techniques that assess sedation depth, analgesia depth, and cerebral oxygen supply-demand balance through brain bioinformatic analysis, in response to anesthesia-related stressors such as noxious stimulation, inflammatory responses, and cerebral ischemia or hypoxia. This approach may be integrated with anti-inflammatory management strategies. Multimodal brain monitoring may help optimize perioperative anesthetic management and potentially reduce the risk of postoperative neurological complications in elderly patients. This article reviews the pathophysiological basis of vulnerable brain function in elderly patients and the clinical value of multimodal brain monitoring-guided general anesthesia management, with the aim of providing references for perioperative neuroprotection in the elderly patients.