Neurophysiological and Systemic Mechanisms of Anesthesia: Contemporary Perspectives on Perioperative Outcomes and Brain Health

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Abstract
Anesthesia is a complex physiological intervention capable of producing significant neurophysiological and systemic alterations that influence perioperative and postoperative patient outcomes. Contemporary evidence suggests that anesthetic agents affect cortical connectivity, thalamocortical communication, neurotransmitter regulation, cardiovascular stability, respiratory physiology, inflammatory pathways, and metabolic homeostasis. The objective of this review was to analyze the neurophysiological and systemic effects of anesthesia and evaluate their implications for perioperative recovery, postoperative complications, and patient-centered outcomes. A narrative review methodology supported by the Scientific Method framework was employed. Scientific literature indexed in internationally recognized databases including PubMed, Scopus, ScienceDirect, and specialized anesthesiology journals was analyzed. The review focused on studies published between 2015 and 2025 involving neurophysiological mechanisms of anesthesia, postoperative neurocognitive disorders, hemodynamic instability, systemic physiological alterations, perioperative brain health, and individualized anesthetic management strategies. The analyzed evidence demonstrated that anesthesia produces coordinated alterations involving neural networks, organ perfusion, inflammatory activation, respiratory dynamics, and metabolic regulation. Excessive anesthetic depth was associated with increased postoperative delirium and cognitive dysfunction, particularly among elderly and vulnerable patients. Intraoperative hypotension demonstrated a strong relationship with postoperative organ dysfunction and perioperative morbidity. Furthermore, individualized strategies such as electroencephalography-guided anesthesia, regional anesthesia, multimodal analgesia, and precision-based hemodynamic management were associated with improved recovery profiles and better postoperative outcomes.