Should General Anesthesia Be Avoided In The Elderly
As a caregiver, it can be hard to know what to do when a doctor says your loved one needs surgery. The link between dementia and anesthesia remains fuzzy, but there is no doubt that going under can cause lingering physical and cognitive issues for some older adults. Many seniors bounce back after procedures like hip replacements and open heart surgery, but some never return to their preoperative cognitive baseline.
It is crucial to communicate with all members of a seniors health care team to weigh the risks and benefits of every medical treatment, especially surgical procedures. When making this decision, consider the patients age, physical and mental health status, and the anticipated effects on their quality of life. For example, if a senior is still very active and in decent shape but suffers from excruciating arthritis, joint replacement surgery could significantly enhance their quality of life, mobility and functional ability.
A seniors ability to participate in post-op rehabilitation is also an important factor in this decision. Older adults with new or worsening cognitive decline often struggle to understand and comply with prescribed physical and occupational therapy sessions in senior rehab.
Anesthesia And Dementia Wheres The Connection
Post-surgery memory loss is acommon phenomenon. It is not unusual for the patients to appear disoriented andlost as they recover from the effects of anesthesia. This general observationhas led to many studies that try to figure out the connection between anesthesia and dementia.
So far, the results are mixed.While some studies prove there is a risk of dementia after anesthesia, otherspin it on the surgery itself.
The elderlies are most likely tosuffer from the impact of general anesthesia on memory. Today, we will exploreif there really is a connection between anesthesia and dementia in that demographic.
Surgery And General Anesthesia
A cocktail of drugs called General Anesthesia is administered to the patients that render them unconscious, prevents them from moving and blocks any memories of the surgery. The state of anesthesia is more of a carefully controlled coma. Elderly patients achieve this state with as little as half the dose of anesthesia that is required for a younger adult, owing to their age-related declines in cardiovascular, respiratory, liver and kidney function, but primarily in the brain and central nervous system. After GA, short term impairment of cognitive and psychomotor performance is common and expected.
Although anesthetic drugs have been around since 1846, doubts about their mechanism of action remain. Evidences from research suggest that the drugs are only partly effective because they bind to and incapacitate the proteins on the neuron surface that are essential for regulating sleep, attention, learning, and memory. It also seems that interrupting the usual activity of neurons may disrupt communication between far-flung regions of the brain, triggering unconsciousness.
In older people, there are three particular anesthesia-related surgery risks:
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Surgery Performed Under Propofol Anesthesia Induces Cognitive Impairment And Amyloid Pathology In Apoe4 Knock
- 1Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
- 2Institute of New Frontier Research, College of Medicine, Hallym University, Chuncheon, South Korea
- 3Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
Background: Postoperative cognitive dysfunction following anesthesia and surgery is a common and severe complication, especially in elderly patients. A pre-existing cognitive impairment may impart susceptibility to further cognitive dysfunction the mechanism remains unclear. We hypothesized that the specific impacts of anesthesia and surgery on individuals with preclinical Alzheimers disease may render them more susceptible to an increase in the risk of cognitive impairment. The aim of this study was to compare the cognitive impairment between normal adult mice and those with preclinical AD after propofol anesthesia and surgery.
Propofol anesthesia followed by surgery induced persistent changes in cognition, and pathological hippocampal changes in pre-symptomatic, but vulnerable AD mice. It would be appropriate to explore whether preclinical AD patients are more vulnerable to POCD development.
Does General Anesthesia Increase Dementia Risk
- There are concerns that exposure to general anesthesia during surgery may contribute to an increased risk of Alzheimer’s disease. To investigate, researchers compared exposure to general anesthesia versus regional anesthesia during elective surgery, looking for potential links to the development of dementia.
There are concerns that exposure to general anesthesia during surgery may contribute to an increased risk of Alzheimer’s disease. To investigate, researchers compared exposure to general anesthesia versus regional anesthesia during elective surgery, looking for potential links to the development of dementia.
The Journal of the American Geriatrics Society study included 7,499 matched pairs of community-dwelling individuals aged 66 years or older who underwent surgery between 2007 and 2011 and were followed for up to 5 years.
The investigators found no difference in risk of being diagnosed with dementia for individuals who received general anesthesia when compared with those who received regional anesthesia.
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Does Anesthesia Cause Dementia In The Elderly
Which is true:
No Link Between Anesthesia, Dementia in Elderly, Science Daily, May 1, 2013
This is so annoying. Two studies published exactly one month apart in the same publication have completely opposite claims. The source for the first story is research presented at Euroanaesthesia, the annual congress of the European Society of Anesthesiology . The second story is from The Mayo Clinic. Both are reputable sources. Both seem to be good studies. So whats an average person to do?
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When my father had surgery about five years ago, he was in his late-70s. No one had warned us that he might have cognitive difficulties after the operation. Its called POCD Post Operational Cognitive Disorder. My mother was very concerned until her friends clued her in they told her it was so common it had a name anesthesia brain. Fortunately my fathers confusion cleared up after a few months.
Some of the confusion about study results for the general consumer comes from the exaggerated headlines. The Mayo Clinics own article on its study was the same as above. No Link Between Anesthesia, Dementia in Elderly, Mayo Clinic Study Finds. In my opinion, that headline is an exaggeration the study absolutely found a link between anesthesia and dementia in the elderly. Researchers found it was not permanent, but that didnt mean it didnt exist.
Suzanne B. Robotti
General Anesthesia Can Make The Elderly 15% More Likely To Develop Alzheimer’s Disease
There’s no denying that our bodies deteriorate as we age. First to go are usually joints, followed by vision and memory. And often, the elderly will undergo major surgeries on joints or organs to improve their quality of life.
But can the general anesthesia they’re put under ultimately speed the decline of their brains and cognitive functions?
During anesthesia, drugs are administered to block surgery patients’ pain receptors and dull their awareness to the point where they are reversible sedated. This ensures that patients will not experience discomfort during surgery. The general anesthetics tend to work mainly on the brain to allow for a reversible loss of consciousness. Local anesthetics may also be used they do not act on the brain but rather the local pain receptors, such as one’s arm or leg, to shut them off and stop uncomfortable sensations in the patient.
While anesthesia is reversible and harmless in most surgery patients, the elderly, whose bodies are deteriorating due to age, may have difficulty recovering afterward.
A new study has found that general anesthesia, when used on the elderly, can increase the risk of dementia and the development of neurodegenerative disorders like Parkinson’s or Alzheimer’s disease.
Source: Sztark F, Le Goff ML, Andre D, et al. Exposure to general anesthesia could increase the risk of dementia in the elderly. European Society of Anesthesiology. 2013.
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Anesthesia Surgery Linked To Subtle Decline In Memory And Thinking In Older Adults Mayo Study Finds
ROCHESTER, Minn. In adults over 70, exposure to general anesthesia and surgery is associated with a subtle decline in memory and thinking skills, according to new Mayo Clinic research. The study analyzed nearly 2,000 participants in the Mayo Clinic Study of Aging and found that exposure to anesthesia after age 70 was linked to long-term changes in brain function. The results appear in the British Journal of Anaesthesia.
Although the decline in brain function was small, it could be meaningful for individuals with already low cognitive function or pre-existing mild cognitive impairment who are considering surgery with general anesthesia, the researchers note. In older adults with borderline cognitive reserve that is not yet clinically obvious, exposure to anesthesia and surgery may unmask underlying problems with memory and thinking.
The link between exposure to anesthesia and surgery, and cognitive decline in older adults has been debated for many years. Animal studies have suggested that exposure to inhaled anesthetics may be related to brain changes linked to Alzheimers disease however, most previous studies in humans have not consistently shown association between anesthesia and impaired brain function.
The authors emphasized that it is not possible to determine whether anesthesia, surgery or the underlying conditions necessitating surgery caused the decline.
Do Anesthesia Risks Increase In Older Adults
One concern for older patients is that the aging brain is more vulnerable to anesthesia, medication that prevents you from feeling pain during surgery often by sedating you or making you lose consciousness. Here are two anesthesia-related surgery risks that are more common in older people:
- Postoperative delirium â This is a temporary condition that causes the patient to be confused, disoriented, and unaware of surroundings, and have problems with memory and paying attention. It may not start until a few days after surgery, may come and go, and usually disappears after about a week.
- Postoperative cognitive dysfunction â This is a more serious condition that can lead to long-term memory loss and make it difficult to learn, concentrate, and think. Because some of these problems are already common in elderly people, the only way to determine if a patient actually has POCD is to conduct a mental test before surgery. Certain conditions, including heart disease , lung disease, Alzheimerâs disease, Parkinsonâs disease, and having had a stroke in the past, increase your risk for POCD. Researchers in anesthesia care continue to study and learn more about these conditions and how to prevent or reduce the effects.
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Will A General Anaesthetic Increase My Risk Of Developing Dementia
Whilst there is a known short-term effect of anaesthesia on memory , studies that have investigated a link between dementia risk and general anaesthetics have found mixed results.
These inconsistent findings make it difficult to definitively say whether or not general anaesthesia increases risk of dementia.
Research About Memory Loss And Anesthesia
Have you ever heard someone talk about a loved one not being quite the same after general anesthesia? General anesthesia has been periodically connected to worsened cognitive functioning, but is this connection real or just a coincidence? Does research support this association?
The short answer? It depends which research study you read.
A handful of studies have found some connection, including the following:
- One study concluded that there was an increased risk of dementia after participants received general anesthesia.
- A second study found that people who had received anesthesia during surgery had a significantly greater risk of developing dementia specifically in the time frame of three to seven years after surgery.
- A third research study noted that a specific medication and type of surgerysevoflurane during spinal surgerywas associated with a decline in cognition in people who had been diagnosed with mild cognitive impairment. Mild cognitive impairment is a condition that increases the risk of Alzheimer’s disease, although some people with MCI remain stable and others even return to normal cognitive functioning.
However, other research contradicts those findings:
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Does Anesthesia Kill Brain Cells
It has long been known that a single exposure to anesthesia leads to widespread neuronal cell death throughout the brain in very young animals. The results confirm their previous findings that isoflurane exposure greatly increases caspase expression and cell death in these immature, developing neurons .
What Are The Results Of This Research
Studying the effect of general anaesthetics in the brain is difficult. Dementia can have a very slow development and there is a lack of studies that follow people for a long enough period of time.
Looking in-depth at the mechanisms underlying the effects of general anaesthetics on brain cells would require very invasive procedures and are not possible to do in people. Many studies have looked at these mechanisms in mouse and fly brains.
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Cognitive Decline After Surgery Tied To Brains Own Immune Cells
In Mouse Study, Experimental Drug Blocks Post-Operative Memory Loss
After undergoing surgery, elderly patients often experience cloudy thinking that can last for weeks or even months. At one time researchers thought this cognitive decline might be caused by anesthesia, but mounting evidence suggests that heightened inflammation in the brain following surgery is the more likely cause.
Now a new study in mice by UC San Francisco researchers suggests that brain inflammation and cognitive decline following surgery are triggered by the brains own specialized immune cells, called microglia. Mice given an experimental oral drug that temporarily depletes microglia ahead of an operation were much less likely to fail memory tests several days after surgery, the UCSF team found, suggesting a possible new approach to preventing the condition in humans.
The study, published April 6 in JCI Insight, an online, open-access companion publication to the Journal of Clinical Investigation, was led by collaborators Suneil Koliwad, MD, PhD, assistant professor of medicine, and Mervyn Maze, MD, professor of anesthesia and perioperative care at UCSF. Koliwad has been studying microglia for several years, and Maze developed the mouse model that was used to investigate cognitive effects of surgery.
The Known Effects Of Anesthesia On Brain Cell
The frailty factor is unignorably real, but it doesnt completely rule out anesthesia as the reason behind memory loss or its connection to degenerative diseases such as Alzheimers.
General anesthesia used during most surgical procedures can increase the level of toxic clumps on amyloid and tau proteins. These toxins inside the brain cell are indicative of Alzheimers disease. They can cause severe damage to the brain cells over time.
Anesthesia can also prevent braincells from sending signals to the repair cell. This is one of the most importantsteps of cell repair and regenerationafter surgery. Due to the inability tosend signals, the repair is delayed to the point where inflammation gets worse.Prolonged damage can have long term and short-term impact on the patientscognitive ability.
Another study revealed that connection between anesthesia and dementia is more profound among patients with an increased genetic risk. It may not necessarily trigger dementia on its own, but it can bring the underlying symptoms to the surface. Since it lowers the body temperature and levels of oxygen in the blood, it can speed up cell degeneration in such patients.
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Anaesthetic Technique And Postoperative Cognitive Impairment
Good perioperative anaesthetic care is regarded as one of the key means of reducing postoperative complications in any group of patients, and it seems reasonable to assume that this also applies to POCD in elderly patients. Therefore, it is surprising and disappointing that fundamental parameters such as oxygenation and blood pressure do not seem to influence the incidence. Nevertheless, there are important considerations for the anaesthetist which can affect postoperative cognitive function.
Effects Of Anesthesia On Elderly Patients
General anesthesia does carry a higher risk for the elderly population, admits Damon Raskin, MD, a board-certified internist and medical director for a hospice provider and two nursing homes in the Santa Monica, CA, area. According to Dr. Raskin, it takes longer for an older persons body to rid itself of the chemicals involved in anesthesia, which can prolong the negative effects of these drugs. Because of this, many seniors report feeling foggy, slow or downright confused for days, weeks or even months after a surgical procedure.
The situation becomes increasingly complex if a patient also suffers from other health conditions, such as diabetes or heart disease. For example, people with Parkinsons disease are more prone to experiencing bouts of confusion and hallucinations that may not present until days after having surgery. Not only is this distressing for patients , but experts from the Parkinsons Foundation caution that this can also have a negative effect on the type and quality of post-operative care they receive.
When it comes to seniors with cognitive conditions like Alzheimers disease and other types of dementia, it can be difficult for doctors and family caregivers to weigh the benefits and potential drawbacks of surgery. Anecdotes often point to a direct connection between anesthesia and dementia, but this cause-and-effect relationship is far more complex than it seems.
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Intraoperative Care And Anesthetic Management
Advancing age is not a contradiction for either general or regional anesthesia.
Some aspects of regional anesthesia may provide benefit for the patient. It affects the coagulation system by preventing postoperative inhibition of fibrinolysis. Furthermore, it decreases the incidence of deep vein thrombosis after total hip arthroplasty.
The hemodynamic effects of regional anesthesia may be associated with reduced blood loss in pelvic and lower extremity operations. More important, the patient maintains his airway and pulmonary function.
Advanced age and general anesthesia are associated with hypothermia. Maintenance of normothermia is important as hypothermia is related to myocardial ischemia, and hypoxemia in the early postoperative period.
In case of general anesthesia it is of major importance to titrate drug doses and it would be prudent to use short-acting drugs.
The use of peripheral blocks in the elderly promises favorable outcomes without compromising the safety of the airway or risking major hemodynamic effects. However, it should always be kept in mind that there are some anatomic changes in geriatric patients and that peripheral blocks have shown to last longer in these cases.
The optimal physiological management is required to produce the best surgical outcome.