Lower Brain Risk During Surgery

Eleven Ways to Achieve the Best Outcome When Anesthesia Is Used

World Anesthesia Day is October 16th and commemorates the delivery of the world’s first successful general anesthetic with ether at Massachusetts General Hospital in 1846.
While this is only of interest to an anesthesiologist/nerd like me, anyone with a 50+ brain might find anesthesia’s impact on the brain of great interest. Our likelihood of surgery climbs as hips and knees wear out, and eyes get cataracts.
Though research on the effects of anesthesia on aging brains is ongoing, we already have some results. Anesthesia and surgery can cause postoperative delirium (see sidebar) and memory loss for up to three months. With longer-term memory loss or postoperative cognitive dysfunction, the case isn’t so clear: Anesthesia and surgery might be uncovering underlying impairment rather than causing it.
Here are 11 ways to reduce risks to your brain during anesthesia and surgery:

  1. Get your blood pressure under control with the help of your primary care physician. Wild swings in blood pressure, both during and after surgery, may increase your chance of having a stroke.
  2. If you have diabetes, aim for normal blood sugars and ask which of your diabetes medications to take the evening before and the morning of your surgery. Under anesthesia, you won’t have low blood sugar symptoms, a risky condition for your brain, so your anesthesiologist will be monitoring your blood sugar.
  3. Have your spouse, a family member, friend, or caregiver keep a close eye on you for 24 hours after surgery. Ask them to re-orient you to the day, time, and circumstances if you forget.
  4. Bring your glasses and hearing aids with you. Ask them to be given back to you in the recovery room. Seeing and hearing can speed recovery.
  5. Ask to be in a room with a window as you recover. Under anesthesia, you lose track of time. With a window, you’ll know whether it’s day or night.
  6. If you expect a hospital stay after surgery, bring a clock, family photo, and a calendar (i.e., your cell phone) to help keep you oriented.
  7. Stay hydrated. You won’t be able to eat before your surgery, but most anesthesiologists will want you to have clear liquids (anything you can see through, such as water or tea) until several hours before your surgery.
  8. If you are not particularly anxious before surgery, skip the midazolam, an intravenous medication used to keep you calm. It can have lingering effects and is optional, in most cases. 
  9. Get your pain under control. Whether you’re getting pain medications in the intravenous line or by mouth, ask for the medicine when you are first becoming uncomfortable. Pain medicines are securely locked and require your nurse and a witness to get them out and ready for administration. This process takes time. Don’t wait until you are having significant pain before asking for your next dose. Having just a little discomfort? Ask for Tylenol or Motrin if they are effective for you. 
  10. Get moving. Your chances of getting postoperative delirium decreases the earlier you are up and about.
  11. If you have a family history of dementia or are concerned you are growing more forgetful, ask for a pre-surgical cognitive test. It will serve as a comparison, should you have postoperative memory and thinking issues.

Postoperative Delirium

  • The most common postoperative complication
  • Characterized by the sudden   onset of agitation, aggressive behavior, prolonged sleepiness, or confusion
  • Can begin immediately or up to 24 hours after surgery, and last up to 3   months
  • Preventable up to 40% of the time

Postoperative Cognitive Dysfunction (POCD)

  • Less common than postoperative delirium
  • Refers to a decline in thinking, related timewise to anesthesia and surgery
  • Diagnosed with neuropsychological tests
  • Age, pre-existing impaired memory, genetics, lower education levels, and comorbidities increase the chance of POCD

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