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Elderly and Anesthesia, Dementia And Other Risks And Side Effects

Elderly and Anesthesia, Dementia And Other Risks And Side Effects

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.

 

anesthesia-in-the-elderly-risks
anesthetizing a patient

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

 

References

3 Responses to Elderly and Anesthesia, Dementia And Other Risks And Side Effects

  1. As long as up to 30% more drugs are being give, the natural consequence of failing to measure the part of the brain behind the forehead, patients will continue to experience POCD & dementia. The historically used heart rate and blood pressure changes only reflect the brain stem or lowest part of the brain. Pain and consciousness are processed at higher levels behind the forehead. The goal of the nonprofit Goldilocks Foundation is getting brain monitoring to be the standard of care for major surgery under anesthesia.

  2. My grandmother had several surgeries in the last years of her life. She would often experience memory loss, and we think she may have developed Altimeters before she passed away. Reading the above information makes me think the effects from the surgeries may have contributed to the disease in the final years of her life.

  3. My Husband is 79 years old he has heart stints, pacemaker, and prostate problems, and he also has been diagnosed with the onset of Dementia. He soon will need a pacemaker change, and a Prostate Surgery. can you give me any suggestions on what anesthesia would not expedite the Dementia further?

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