At PeopleCare Health Services, we talk a lot about Alzheimer’s, and how to better understand those living with the disease and the disease itself. One of the aspects of Alzheimer’s and other forms of dementia that we don’t often even know to think about, or address, involves the effects of anesthesia. Whether it be for knee replacement or heart surgery, Post-Operative Cognitive Dysfunction (POCD) is a definite risk that should be considered and discussed prior to surgery. Advanced age, accompanying cerebrovascular disease, and extensive surgery all increase the risk of POCD. Meticulous surgical and anesthesiological techniques are important for preventing complications and keeping the risk of POCD to a minimum (Rundshagen, 2014).
Older patients in particular are vulnerable to memory disturbances and other types of cognitive impairment after surgical operations. According to a recent study, about 40% of all persons over age 60 who are hospitalized for surgery have POCD on discharge, and about 10% have POCD three months later. This is an important issue in perioperative care as extensive surgery on older patients becomes more common (Rundshagen, 2014).
When preparing a loved one for surgery, there are a number of things to take into account. First and foremost, carefully weigh the risk versus reward of the procedure in question. If it is not absolutely necessary, patients over 65 should consider other possible options that do not involve anesthetics. Next, consider the cognitive level of your loved one before surgery. Make sure to have noted markers and indicators that you can refer to after the procedure. It is important that a conversation is had with the medical team regarding the type and level of anesthesia being used. Ask plenty of questions; how long will they be “under”? How deep of a sleep will they experience? Will there be a period of premedication? Premedication has been shown to extend the length and degree on post-operative cognitive impairments so this is an important question. During the procedure, will there be a monitoring of electrolytes, blood sugar, and fluids? A deficit in these areas has also been shown to cause additional cognitive impairment. Ask as many question as you need to feel comfortable with the care your loved one will be receiving.
As we prepare our loved one for surgery, it is equally important that we prepare ourselves. If my Aunt is having her hip replaced, I can easily understand that she may not walk quite the same again, but it would never occur to me that she may never think or act the same again. This is POCD. And don’t forget, the only person who will be more confused than you is your loved one.
To find out more about POCD, follow the link below:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959222/
http://www.alzheimersreadingroom.com/2015/11/can-general-anesthesia-cause-dementia.html
Reference:
Rundshagen, I. (2014). Postoperative Cognitive Dysfunction. Deutsches Ärzteblatt International, 111(8),
119–125. http://doi.org/10.3238/arztebl.2014.0119