The risk of cognitive decline related to surgery and anesthesia continues to be debated in the scientific literature. Some animal studies suggest that anesthesia may worsen the development of the plaques and tangles associated with Alzheimer’s disease, while others identify the surgical procedure itself to be a problem by causing inflammation and the release of harmful proteins. Others attribute temporary or permanent cognitive changes to the medications used to manage pain or other complications of being hospitalized. Ultimately, although this is a very active area of research, there are no definitive studies in older adults that demonstrate a causal effect of anesthesia on the brain or provide recommendations on specific anesthesia choices. Despite this, we hope to identify information that may help our patients with cognitive impairments evaluate risk and make informed choices about surgery and anesthesia.
Are there things I should tell my anesthesiologist or surgeon about my memory and thinking?
If you have any concerns about your memory or thinking, or you have a diagnosis of a cognitive problem, you may be more at risk for a slower recovery. It is important that the doctors know so they can anticipate and accurately interpret your responses after surgery. Also, if you’ve had any previous episode of difficulty after surgery with your thinking or memory, it will alert them to the possibility that you may be more likely to have these symptoms recur.
Is there a particular anesthetic that I should consider?
There are no conclusive human studies that prove the advantage of any particular anesthetic. There are some trends in research that regional or local anesthesia may be better, but those studies are not final.
What other things should I consider in the hospital?
Remind your anesthesiologist to bring your hearing aids and glasses to the recovery room so you can wake up as aware of your surroundings as possible.
What should I think about for managing pain during the period after surgery?
Ask the surgeon and anesthesiologist about options for pain management that avoid opiates such as morphine or dilaudid. These non-opioid medications avoid some of the more dramatic effects on the brain and thinking. They may include analgesics like acetaminophen, anti-inflammatories like celecoxib, or neuropathic pain medications like gabapentin. These may be used alone or in combination to provide pain relief while avoiding the side effects of sedation and confusion.
What should I think about if I have difficulty sleeping after surgery?
The best strategy is to consider usual sleep habits, such as listening to music or reading, that may help you fall asleep. You can consider trying eyeshades or earplugs to make the environment quieter and more conducive. It is best to avoid sleep aids that may increase the risk of confusion or falls, such as zolpidem or diphenhydramine.
What should I do to plan for discharge?
Ask your doctor before the surgery to provide details about the care required after surgery. You may need to plan to stay with friends or arrange help for tasks that require assistance. This can include new short-term medications such as those to prevent blood clots, antibiotics, complex wound care, or restrictions on mobility that may interfere with your ability to manage alone. You may even want to consider a short stay at a facility that offers rehabilitation or skilled nursing care. Talking about this ahead of time and planning for it will help you avoid worrying during your hospitalization.
Here are some tips to prepare for surgery and an article on the risk of postoperative delirium in older adults by the American Society of Anesthesiologists.