<p>Postoperative cognitive dysfunction (POCD) is a common neurological complication after surgery, with a higher incidence in elderly patients, significantly affecting postoperative recovery and quality of life. This article reviewed the potential mechanisms by which volatile and intravenous anesthetics affected POCD. We discussed mechanisms such as neuroinflammation, oxidative stress, region-specific brain alterations, neurotransmitter imbalances, and synaptic dysfunction, with an analysis of the distinct regulatory effects of both volatile and intravenous anesthetics. By comparing the roles of volatile and intravenous anesthetics, this review investigated the potential of personalized anesthesia strategies to improve cognitive function. Additionally, this review highlighted the use of multi-omics approaches, neuroimaging technologies, and artificial intelligence in POCD research, identified limitations, and promoted further investigation. By clarifying the mechanisms of anesthetic drugs, this review provided a scientific basis for clinical personalized anesthesia decision-making and laid the theoretical foundation for POCD intervention strategies.</p>