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 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 humans that prove a causative effect on the brain from anesthesia or provide recommendations on specific choices of anesthesia. Despite this, we hope to be able to identify information that may help our patients with cognitive problems evaluate the 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 have your hearing aids and glasses in the recovery room so that you can wake up and be 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 think about usual sleep habits like listening to music or reading that may assist you in falling asleep. You can consider trying eyeshades or earplugs to make the environment quieter and more conducive. It is good to avoid the use of 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 have help with things that may 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 being able to plan for it will prevent you from worrying during your hospitalization.

Here are some more tips to prepare for surgery and an article on the risk of postoperative delirium in older adults by the American Society of Anesthesiologists.