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Comment on Does anesthesia “fry” the elderly brain? by surgiprep

surgiprep — Sat, 14 Jul 2012 12:58:32 +0000

I’m sorry about your dad. I hope he recovers; many patients are back to normal in 6 months or so.
POCD is not “anesthesia fog” – it is much more complex than that.
We now know the phenomenon is as common in medical as in surgical patients.

Comment on Does anesthesia “fry” the elderly brain? by surgiprep

surgiprep — Sat, 14 Jul 2012 12:52:48 +0000

So far, we don’t have evidence that regional anesthesia is less risky. It also isn’t clear what role anesthesia has in the development of POCD. Many factors seem to be involved:
Surgery involves anesthesia but also the deliberate injury of tissues (trauma), hospitalisation and many other drugs. There is evidence that medical patients (i.s. those wo do not have surgery) have a similar rate of POCD to surgical patients. No anesthesia there!
The peripheral systemic response to trauma, hospitalisation and drugs includes cellular damage, inflammatory mediators and so on.
What happens in the brain that causes POCD is not known exactly but may involve inflammation also, direct toxicity to brain cells, and laying down of abnormal protein.
Complicated!

There seems to be an association between postoperative delirium i.e. acute brain injury, and long term cognitive problems. If we can prevent the delirium maybe the chances of POCD will decrease. This means:
Treating pain – round the clock analgesia; avoid pethidine; avoid catheters
Avoid sedatives whenever possible – benzodiazepines, anticholinergics, antihistamines
Maintain orientation – glasses, hearing aids, clock/calendar, radio
Ensuring sleep – non-pharmacologic sleep aids (music, massage)
Prevent/detect severe complications of surgery including infection and heart attack
Mobilisation – avoid physical restraints
Nutrition – e.g. preoperative carbohydrate drink

Comment on Does anesthesia “fry” the elderly brain? by Lisa Riegel

Lisa Riegel — Sat, 14 Jul 2012 04:15:56 +0000

My mother is due to have major (spinal fusion, laminectomy) non-cardiac surgery – maybe a 5 or 6 hr surgery. She is 79 and works stil. Her father never recovered from severe POCD after a simple hernia operation. She seems genetically a lot like him and we’re all petrified. How genetic is POCD? Is there anything the anasthesiologists/staff can do to minimize her risk? Is regional anasthesia less risky? If we opt to only do the laminectomy, we might be able to find a surgeon to do it with regional.

Comment on Does anesthesia “fry” the elderly brain? by Susan Brandt

Susan Brandt — Wed, 11 Jul 2012 19:46:16 +0000

Our 90 year old father had knee replacement surgery on June 8th. He was sent home two days later to my mother who has had a stroke. Her cognition is excellent though she is compromised physically. Unable to care for Dad completely, I went to stay with them for two weeks. During that time, Dad fell on his new knee, breaking the knee cap. This was discovered a week after the fall. I had gone home (1500 miles away) and had to return to take care of them. Another surgery ensued. He is currently two weeks post-op from the knee cap surgery. We’ve had a visiting nurse who has 34 years experience with geriatric patients. Her observation is twofold: The elderly rarely come out of the anesthesia “fog,” and issues that may have been on the surface previously will present themselves with a vengeance post-op. My father, who is educated and ran a corporation, can’t even put sentences or complete thoughts together. This is not the man who went to the hospital for his surgery. He is now frail and confused. I do hope he gets better but we can’t be sure.

Comment on Does anesthesia “fry” the elderly brain? by surgiprep

surgiprep — Sun, 10 Jun 2012 12:33:31 +0000

There is a high rate of temporary cognitive decline in the elderly who have surgery. This decline is common also in patients who have hospital admissions without surgery. We probably don’t do enough to tell patients and their families about this risk but it is hard to assess the risk for an individual – some people do well from the start, others have a temporary setback and get back to baseline within 3 months or so.

You don’t say whether your mother had a fall and a hip fracture, as is common in women of that age. What you have to realise is that failure to perform this surgery, and to repair the fracture early, condemns these patients to spend the rest of their lives in bed, and, very often, an early death from pneumonia.

Comment on Does anesthesia “fry” the elderly brain? by surgiprep

surgiprep — Sun, 10 Jun 2012 12:28:35 +0000

POCD is a syndrome and there are no specific findings on MRI. An MRI may however reveal other findings that could explain your mother’s cognitive deterioration. Even patients who don’t have surgery can experience a cognitive decline after hospital admission. We don’t know what the relative contributions to POCD are of surgery, anesthesia, other drugs, infection, pain, metabolic changes, sensory deprivation, bedrest, etc.

It is a big challenge but don’t lose hope for you mother’s recovery. Even patients with severe strokes can recover function if they have enough self-motivation, and intensive support and encouragement. In the mean time however it sounds like it will be difficult for her to take care both of herself and your father.

Comment on Does anesthesia “fry” the elderly brain? by diann

diann — Sun, 10 Jun 2012 05:14:17 +0000

My mother is 73, and 2 months ago had hernia surgery, since then she describes her brain as “not being able to make the right connections” She could knit and crochet b4 surgery with her eyes closed or practically in her sleep, when asked if she can now she says no, not even a crochet chain. She goes in the refrigerator looking for her cereal and once you ask her what she is looking for and tell her it’s not in there she then is able to figure it out. My father has Parkinson’s and she has been his care taker. We live 8 hours away. At first I thought maybe it was her potassium level and maybe going into renal failure but the Dr said those levels were good. The next step is a brain MRI, will POCD show in an MRI? Do they recover from this , this far out?

Comment on Does anesthesia cause sleep disturbance? by surgiprep

surgiprep — Wed, 15 Feb 2012 10:50:20 +0000

You’ve misunderstood. The volunteer study is trying to separate the effect of anesthesia from the effect of surgery. The purpose is to find the truth, and having found it, to “do good” by applying improved understanding to the care of patients. If volunteers who get only anesthesia have no sleep disturbance this implies that it might not be the anesthesia but the surgery (or some interaction of the two) that leads to sleep disturbance. This blog post was not a systematic review of the literature and there may be other studies with different findings.

Comment on Does anesthesia cause sleep disturbance? by julie

julie — Thu, 09 Feb 2012 19:43:12 +0000

Everything was accurate until you got to the part about a volunteer study. How can you possibly come to any conclusions using people who went under, but didn’t have surgery? That’s comparing apples to oranges. You did more harm than good. I only pray doctors are smarter than this. I mean, were you amazed that these people were in no pain also???!!!!! What a complete joke. If you want to do a real study follow up with those that went under the knife….. Sheesh!!!!!

Comment on Does anesthesia “fry” the elderly brain? by joycebarb

joycebarb — Mon, 14 Nov 2011 14:58:39 +0000

i just found this article, my Mom had surgery last monday. She is 86 and is frail with failing memory, but lives with me and can stay home alone, read, etc. Her deterioration after hip surgery has been shocking. She has been tormented by hallucinations, both visual and auditory, and delusions. Those abate a little, but her cognition is shot, i.e. she does not know where she is physically despite being told many times and has no idea what month it is, etc. I had never heard of POCD, was not warned about it, and am very upset. The nursing staff has no idea what her mental state was before the surgery, they think she was like this all the time. I tell them my concerns, they are currently telling me it is urinary track infection, which can cause confusion in eldery women. But her fever is gone, she has been on antibiotics for3 days, and she still has the unfortunate and sad delusion that she has died, is crying and very distressed. Wish this risk had been explained to us ahead of time, it is very difficult to see. Hard to believe she could go in for a hip pin and lose her mind as a result.