With the acceleration of global population aging, the proportion of elderly patients undergoing surgical procedures has been increasing year by year. Postoperative cognitive dysfunction (POCD) caused by sevoflurane in elderly patients has become a major clinical challenge affecting postoperative rehabilitation and quality of life. Sevoflurane, as a widely used inhaled anesthetic in clinical practice, is closely related to the occurrence and development of postoperative cognitive dysfunction in elderly patients. This article systematically reviews the epidemiological characteristics, chemical properties, and clinical advantages of sevoflurane induced cognitive dysfunction in elderly patients after surgery, and focuses on exploring its possible mechanisms of action, including neuroinflammatory response, oxidative stress damage, hormone imbalance, and neuronal pyroptosis. At the same time, this article summarizes the potential intervention targets and drug research progress for these mechanism links, and looks forward to future research directions, in order to provide theoretical basis for clinical prevention and treatment.