I want to take this podcast episode and talk about surgery.
Might seem like an unusual topic, given that the theme of my podcast is dementia. But actually, there is a connection. It’s not uncommon for seniors who often are the population that has memory impairment, to need some type of surgery, whether it’s a planned surgery or emergency surgery. And so often, after they’ve come out of surgery, we notice that they’ve had a cognitive decline. So let’s talk about that.
Let’s first talk about the surgery that’s a planned surgery, perhaps someone needs to have a hip replaced or a knee replaced. And when you are having that surgical consult, what you need to find out is whether or not it is a general anesthesia type of surgery or, if possibly that same procedure, could be done with a spinal block or local anesthesia.
What we know about general anesthesia is that it takes a while to clear the system. Far beyond after you have woken up in the recovery room. Oftentimes, it takes several weeks for someone to fully have it clear their system. And during that time that lingering anesthesia has a cognitive impact. The person’s memory, just isn’t quite what it was before they had general anesthesia. So what I recommend, especially for planned surgeries, is when you are going in for that surgical consult, either for yourself or with your loved one, regardless of whether or not, there is some type of cognitive impairment involved. Ask what type of anesthesia is required for the procedure. You might be surprised to find out that oftentimes, you can request to have a spinal block. And even though a lot of people just for the sake of convenience, might request to have general anesthesia, maybe they like the idea of going to sleep and waking up and having it be all over. The problem is that general anesthesia lingers. And even after it clears, the person’s baseline may not be quite what it was prior to surgery. Now, unfortunately, there are some surgeries where general anesthesia is the only type that you can have, for example, maybe you’re having bypass surgery. Well, of course, you need to be asleep for that. Or during emergency surgery. If in fact, there’s no time to plan and you just all of a sudden find yourself in a situation where you’re in the OR, or your loved one is. Well then, in that case, there’s really not a lot of time to discuss what type of anesthesia will be given. But so often, these are planned surgeries. And I do really encourage that you have a conversation first with your surgeon about what type of anesthesia you should expect. But you also need to have the conversation with someone else, especially for those planned surgeries. And that’s the anesthesiologist. It’s very important that they understand that the person that they are going to be treating with anesthesia actually has some type of cognitive impairment, because yes it does make a difference in how they administer the medication. Perhaps they won’t give the same dose. And they’ll also understand if the person has a more difficult time waking up in the recovery room. Because it’s metabolized a bit differently, and cognitively that that clarity of thought that we often see in the recovery room, or some variation thereof, Isn’t there with someone who has some type of memory impairment. Now, this is assuming that the person having surgery doesn’t have any type of other issues that might impact the anesthesia. For example, perhaps they have chronic kidney disease. And so the anesthesia will linger even longer because that’s how that medication is cleared from the system, through your kidneys.
It’s also very important to tell everyone involved in either your surgery or your loved ones. Tell the nurses, make sure that they understand that there is a level of cognitive impairment going on because, with that understanding, they won’t be surprised if the person takes a little bit longer to wake up, to have a lucid conversation, or just to help them through the process, in the long after discharge, and after either, you or your loved one is back home. The medication continues to linger. I like to tell my patients and their families. I usually will give it several weeks before I really am concerned about a new norm. It does take that long. It’s very disorienting, so don’t be surprised. I’m not saying that you should not have general anesthesia. Again, that would be a conversation that needs to happen between you, your loved one, and a surgeon, but just understand it’s a risk-benefit, go in with the knowledge so that you’re not surprised if you or your loved one has increased confusion. Afterwards, it’s worth that extra few minutes to understand what if, what if the surgery can be done with a spinal block, or perhaps they say absolutely not, it needs to be done under general anesthesia.
For these reasons, you need to advocate for yourself and for your loved one, because healthcare is a team effort. And you are the most valuable player on that team.
Anyway, I hope that answers some questions about general anesthesia, and the effects it has on cognitive impairment, please go ahead and subscribe to my podcast. I release new episodes every Tuesday. You can follow me on Instagram or you can also check out my website which is compassionateeducation.com. Thanks for listening, and have a great day.