...where do our minds go?

quote:

To better understand our brains and design safer anesthesia, scientists are turning to EEG.

https://nautil.us/under-anesth...-our-minds-go-20845/

I find this an interesting and terrifying topic. After a fairly minor surgery, my mother experienced the post-operation delirium symptoms described in this article for patients over 65 years old. She went from no cognitive problems at all to full-blown dementia pretty much instantly. It never improved so I never really got to talk to her again. She died a few months later.

So, any improvements they want to make in the understanding of how to avoid this sort of issues before I ever have to undergo surgery, that would be great…

(The doctors had warned us about the risks of anesthesia at her age, but there really weren’t a lot of choices).

I'm sorry to hear that. The fog is real. I haven't seen someone have that severe a reaction, but it's a real risk.

I'm thinking it's a lower risk for the light sedation situations that are very quick ... think colonoscopy, cataracts ... using a touch of propofol. Deep anesthesia for long periods during complex operations (the article mentions 3+ hours) seem very different.

I have some personal experience with some of the responses to anesthesia described in that article.

During a cataract and corneal transplant operation I underwent, I became aware of conversation among the surgeon and staff in the operating room while the surgery was in progress. They were discussing their plans for the upcoming Thanksgiving holiday. Otherwise, I had no sensations or pain.

After the emergency surgery attempting to repair the damage after the incision from my initial knee joint replacement reopened, I was under a general anesthetic and took around two days to return to normal consciousness. I was unaware of my state, but my wife was extremely alarmed at the thought that I might be permanently impaired.

I have been anesthetized a number of times over my life, starting with a tonsillectomy as a child, knee surgery as a young adult, multiple colonoscopies, my initial knee replacement surgery, and multiple surgeries to repair the injury from the failed joint replacement. The two incidents I described above are the only two where I had an unusual reaction. The initial knee joint replacement was performed with a nerve block in that leg in combination with a spinal anesthetic. You can be sure that I've carefully told the anesthesiologist for all surgeries subsequent to the one with the slow recovery about my condition then. No additional complications have occurred.

I will also mention that one of my wife's uncles appeared to have some degree of cognitive impairment after a surgery in his eighties. We wondered at that time if that might be attributable to the anesthetic.

I'd love to hear from George at TNCR regarding this subject.

Big Al

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During a cataract and corneal transplant operation I underwent, I became aware of conversation among the surgeon and staff in the operating room while the surgery was in progress. They were discussing their plans for the upcoming Thanksgiving holiday. Otherwise, I had no sensations or pain.

Ditto. I heard the surgeon commenting about my "floppy iris" and started to comment back to him about why. The gas passer gently said, "do you really want to be talking to the guy who has a very sharp knife in our eye" as he dialed up the propofol a bit.

The so-called “conscious sedation” protocol didn’t always include Propofol. The reason … there’s no countering agent. If they give you too much Propofol, they have to bag you and ventilate you manually until it wears off.

However, conscious sedation allowed the patient to move. During my second colonoscopy, I remember discomfort and shifting to avoid it. Afterwards, the doctor grumbled (as if I could control it) and told the nurse to put in my chart … next time, Propofol.

As I understand it, most hospitals have switched to Propofol as the standard now.

I'm starting to think perhaps I may need to reconcile myself to never being able to walk normally again. As a result of side effects from my 8-9 hour complex spinal surgery, my left foot and hip "toe out" leaving me with a pronounced mobility impairment.

I used to run and bike regularly (not even counting all the gymnastics and other exercise), but now I can't even walk outdoors on a forest path. Leaning on a son, yes, but it's not the same besides which I see them so rarely.

I've been thinking up to now of going through a "revision" surgery (would last as long, and with uncertain improvement). I've been considering the main risk/drawback as the excruciating pain - known as one of or THE - worst operations for that, plus many risks. The long recuperation with disability (expensive too) is dreaded by all us "spinies"- we all know it's a "crapshoot" and only go through it in hopes of reducing our present pain and with the prayer of at least semi-normal ambulation.

This business of possible brain damage from the long anesthesia (as if I hadn't had enough surgery already - at least a dozen, though only that one super long one!) is putting the fear of G-d in me. I sometimes wonder if it already left me with deficits, apart from the usual residue of aging.

I need to study this more carefully, and get a (much) better notion of the odds.

Feeling sad, that I may never regain anything like a normal gait and independent function (I already need aides to dress - shoes and socks especially. ) I went through so much deliberation about the other surgery, largely for fear of pain and side effects reconciling myself to it. I went through it, in hopes of avoiding ever increasing deformity (tower of Pisa effect) and greater disability which is all too common even with the best surgeons and facility.

I scarcely even dwelt on the anesthesia angle.
It's been hard just to try to evaluate and face my "ordinary" cognitive losses with aging. This feels like the last straw. I wonder how much safety depends on the quality of the anesthesiologist...

Or is it another "crapshoot" outcome?

More trivial, but on my mind - I really MUST go through a much overdue endoscopy/colonoscopy. Once I did it without anesthesia (so as to be able to attend younger son's 2nd grade show, driving myself.) The GI doc sympathized, having a child in the class, and OK'ed it. (It wasn't bad at all).

For that matter, I've been in the process of lining up a minor heart op ("Watchman procedure") to - hopefully - allow me to discontinue blood thinners. More anesthesia. Then too, hearts are hearts, plus requiring anesthesia for pre-op and post-op checks.

Wish I could I could have other procedures with at most twilight sleep, but they no longer give me choices. Still mad at a maxillo-facial doc who insisted I have it for an implant placement. (I'd had another with only a local on the other side, same location.) He refused, costing me hundreds more plus cost of hiring a driver.

Patients aren't involved enough with vetting anesthesiologists (they used to interview them in this town), nor are the risks adequately represented). (At least, they and ER docs are no longer allowed to "balance bill" if it turns out they're not in your network!)
Thanks very much wtg for bringing up this important topic.

Doug, what a frightening story about your mother's anesthesia reaction!

May I ask how old she was when she had the operation and how long it lasted? Do you know what anesthesia they used?

I too sure hope they succeed in learning more about this delirium phenomenon in the elderly! I've read sevoflurane is far more apt to lead to this cognitively destructive reaction.

Almost did not come out of the effects of anesthesia after a melanoma biopsy in 1986. They took a saucer sized and shape plug out of my back.

After an ankle surgery in 1991 I was able to use crutches to get to the bathroom to p.
Was not happy when my hand could feel myself, but myself could not feel my hand.
That anesthesia did wear off, but not soon enough.

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Originally posted by Amanda:
Doug, what a frightening story about your mother's anesthesia reaction!

May I ask how old she was when she had the operation and how long it lasted? Do you know what anesthesia they used?

.

It was not a long operation, less than an hour I think? Like we fear as we get older, it started with a fall and a broken bone. But she was 92 years old, and while in comparatively good health for her age, she had any number of conditions that probably combined with the effects of the anesthesia. To my unscientific eye, the anesthesia was the final straw, but she died of old age as various organs were starting to fail on her. The fall and the surgery probably cost her a year or two.