General anesthesia is a combination of medications that are given to patients during surgery to reduce pain, paralyze muscles, block memory, and reduce anxiety.
Milder forms are local and regional anesthesia.
It is given through a needle in a vein or through a breathing mask by an anesthesiologist. An anesthesiologist is a doctor who has completed advanced studies in anesthesiology after completing medical school.
While generally safe, anesthesia can create complications for the average patient. For the elderly, there is an increased risk of complications.
In some cases a desired procedure may not be worth the risk. Patients and families should discuss the possible risks with their doctor and determine if the benefit outweighs the risk.
Most complications from anesthesia in the elderly are due to existing medical conditions rather than from age alone.
- Severe heart disease and any disease causing poor heart or lung function put patients at higher risk.
- The lower functional level of some elderly patients may put them at risk for postoperative delirium and a prolonged recovery.
- Studies have shown that elderly patients exposed to anesthesia have a 35% higher risk of developing dementia.
The 2 most common side effects of anesthesia in elderly
The two most common complications of anesthesia given to the elderly are:
- postoperative delirium and
- postoperative cognitive dysfunction (POCD).
Postoperative delirium occurs in up to 40% of elderly patients who have received anesthesia. It is characterized by confusion, visual hallucinations, anxiety, distress, aggression, and withdrawal which can last up to several weeks after surgery.
It is more common with major or emergency surgeries and in patients with significant medical problems, particularly Alzheimer’s, Parkinson’s, and prior strokes.
POCD is not as obvious as delirium. It may not even be immediately obvious to family and caregivers. For those aged 60 and over there is a 10% risk of developing POCD.
For those patients over age 80 there is a 33% risk. It is diagnosed through neuropsychological testing. POCD is a long-term disabling deterioration in cognitive function and can be permanent. POCD is characterized by several complaints:
- Easily tired.
- Inability to concentrate.
- Problems with memory.
- Problems performing math.
In an effort to reduce the incidence of postoperative delirium, POCD, and the possibility of future dementia some facilities are offering the use of a brain monitor during surgery to better gauge how much anesthesia is needed and prevent giving too much.
A brain monitor can be a reasonable option if there is a significant concern about the effects of anesthesia on an elderly patient.
- A healthy, independent patient age 60 or over has a greater chance of successful anesthesia and surgery than one who has medical, mobility, or cognitive problems.
- Advanced age (80+) leads to increased risk no matter the patient’s condition.
It is important for patients and families to discuss the risks and possible outcomes of anesthesia and surgery. There are facilities and anesthesiologists that are trained to specifically handle elderly patients.
by Anna Coss, RN, BSN, MSN