Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 2 2026 02 22 187 191 Sogol Asgari Department of Anesthesiology, Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hasanali Ahmadi Department of Anesthesiology, Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohammad Hallajnejad Department of Neurosurgery, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Faranak Behnaz Department of Anesthesiology, Shohada-e-Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2025 06 01 2025 06 30 Background: Postoperative cognitive dysfunction (POCD) is a relatively common and troubling issue, especially in older adults undergoing surgery. Bispectral index (BIS) monitoring enables anesthesiologists to assess anesthetic depth in real time and adjust dosing accordingly. In this article, we summarize the current evidence on BIS-guided anesthesia in reducing the incidence and severity of POCD in adult surgical patients. Methods: A structured search was conducted in PubMed and Scopus databases to identify randomized controlled trials, observational studies, and meta-analyses published between 2000 and 2024. Results: Clinical trials and meta-analyses suggest that BIS monitoring reduces anesthetic exposure, shortens recovery time, and is associated with lower POCD rates. Mechanisms may include optimized drug titration, improved hemodynamic control, and reduced neuroinflammation. Conclusion: BIS monitoring may represent an effective approach to mitigate POCD, especially in high-risk patients. Further large-scale trials are needed to confirm these findings and refine guidelines. https://aacc.tums.ac.ir/index.php/aacc/article/view/1300