Surgery may impact the brain

Many METARs are elderly and may need surgery at some point. Millions of surgeries are done every year so this has Macro impact.

https://www.theguardian.com/science/2022/apr/24/the-hidden-l…

**The hidden long-term risks of surgery: ‘It gives people’s brains a hard time’**
**by David Cox, The Guardian, Sun 24 Apr 2022**

**...**
**We have known for a long time that operations can have hidden consequences for the brain. As far back as 1887, the British Medical Journal published a paper describing cases of delirium after surgery with anaesthesia. A century later, scientists in the 1980s began to look at cases of older patients who had shown a decline in memory and concentration after cardiac surgery, but it has only been more recently that this has become apparent as a risk factor for all over-65s who undergo surgery, especially when under deep sedation.**

**In the last 20 years, studies have shown that POCD symptoms can affect everything from memory to attention, judgment and perception, and those with pre-existing health conditions are especially vulnerable. ...** [end quote]

After my hysterectomy in 2009, I felt that my brain was affected. I had brain fog for several months afterward. When my mastectomy was scheduled in 2015, I told the anesthesiologist about that. He may have adjusted his procedure because I did not have brain fog after that surgery, which lasted 7 hours. I think that the anesthesiologist used a local block (epidural) plus heavy-duty NSAIDs to use less inhaled anesthesia.

Wendy

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…studies have shown that POCD symptoms can affect everything from memory to attention, judgment and perception…

Thanks, Wendy.

Also, as a side note to make sure everyone is on the same page: POCD is “postoperative cognitive dysfunction.”

If you google POCD you will come up with something quite different.

Pete

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Something that the article also mentioned was the body’s inflammatory response to the surgery itself in addition to the anesthesia. I don’t think this can be discounted completely.

Improvements in anesthetic safety and surgical techniques has meant that more and more extensive procedures are being performed on older and/or sicker patients (who might not have been considered suitable candidates for surgery a couple of decades ago)

It’s not inevitable, mind. My husband had open heart surgery just over three years ago, age 70(a bio-Bentall procedure, specifically) which added over 90 minutes on bypass to everything else. Was worried a bit about this plus “Pump Head” (but not as much as him dying so a moot point, really) I was there as he was extubated and my first question was “Who’s the prime minister of Bangladesh?”…got a weak smile and a thumbs up. Amazed but thankful for the apparent zero after effects.

Husband always asks this question to lighten the mood for relatives of his encephalopathic patients when he’s doing a cognitive function test…everyone else in the room was puzzled too when I asked. Except husband.

We have known for a long time that operations can have hidden consequences for the brain. As far back as 1887, the British Medical Journal published a paper describing cases of delirium after surgery with anaesthesia.

Dad went seriously manic after a 10 hour surgery. Lasted for about 6 months, followed by deep depression, and cycling after that. We were not warned in advance of this possibility, (nurse Sis was in the pre-op appointments,) although given the surgery was for esophageal cancer, it would have been done no matter what the possible side effects. Would have been nice to have a heads up, however. Was disconcerting to say the least.

Perhaps it was because he drew more attention to his actions, but that operation, while highly successful in cutting out the cancer, was the start of the end mentally. That experience with Dad is the source of my constant question “How do we protect ourselves from ourselves as we age?” I never want to put our kids through that.

IP

So many comments to make from a former inmate, no particular order…

…for you particular followup surgery, probably used propofol (an IV drug) instead of an inhaled anesthetic gas. Propofol has a very nice drug profile, quick on, quick off, almost like a light switch. The reason it is not used all the time for long cases is cost and set up to run infusion.

…DW had her hysterectomy done under propofol because anesthetic gases make her violently sick.

…the longer the surgery time, the greater the risk for POCD. Last I read, seemed the 2-3 hour mark was when things started happening.

…cardiac/bypass surgery in infamous for cognitive changes. Numerous protocols have been tried with little to no success.

…in the past 10-15 years the BIS monitor (Bispectral Index System) has become common. Think of it as a poor mans EEG, used to monitor level of consciousness. This potentially allows for less general anesthesia and faster wakeup time. In the past you went by the patient’s blood pressure and heart rate to gauge depth of anesthesia/consciousness which was not always accurate but the only thing we had to go by for years.

…drugs, monitoring, and surgical procedures (think robotic and laparoscopic) have advanced enough that you are now able to do sicker/more complicated patients than in the past.

…science is still not 100% sure how anesthesia works. We have a high suspicion where in the brain is responsible for consciousness.

…anesthesia, even after all the advancements over the past 30-40 years, is still as much art as science. I’m still a little surprised at how crude anesthesia was before I started my residency training.

JLC

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