Having Surgery? What You First Need to Know About Anesthesia

By on July 23, 2017

By Cheryl Nimmo, DNP, MSHSA, CRNA—

It’s no secret that as we age, we are likely going to need more medical attention than during our younger years – more frequent doctor’s visits, more medications and even more procedures, some of which will require anesthesia. 

There has been a lot of discussion and research on the effect of anesthesia on cognitive function in seniors, specifically whether there is evidence to suggest that two of the most prominent complications from anesthesia – postoperative cognitive dysfunction and postoperative delirium – should be of special concern for the senior population.

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Postoperative cognitive dysfunction or POCD is a decline in a patient’s comprehension, especially visual and memory, language, visual perception, concentration time management and attention span. POCD can occur after a patient has received anesthesia. Postoperative delirium, on the other hand, is a highly disturbed state of mind that is characterized by restlessness, illusions and incoherent thoughts and speech. 

There are numerous factors believed to play a part in why the aging population is at higher risk for POCD and post-op delirium, but none are consistent across the entire demographic. In general, more serious and invasive operations like abdominal, cardiac, thoracic and vascular surgery, present a greater risk than less-serious outpatient surgeries. These surgeries typically require a longer period of anesthesia administration, and because aging bodies do not process that anesthesia as quickly or efficiently, the risk of negative reactions increases.

Although research regarding the risk of long-term cognitive decline after anesthesia in the aging population is mixed, there is much evidence that says short-term decline is a problem. And while often temporary, if these conditions aren’t addressed properly, they can cause significant mental deterioration. 

Especially as you approach your senior years, there are several steps you should take before and after any procedure that requires anesthesia to better ensure cognitive function is not impaired and that you achieve optimal outcomes:

  1. Speak up. Communicate with your Certified Registered Nurse Anesthetist (CRNA) and surgeon in advance of the procedure and provide them with a thorough medical history, including prior illnesses, hospitalizations and surgeries, reactions to anesthesia, current medications and treatments, and personal as well as family history of mental illness, dementia, depression and drug or alcohol abuse. Also, consider setting up a pre- and post-operative cognitive functions test.
  2. Get your check-up. Going into the surgery, it is important to be as healthy as possible. By getting a physical prior to the procedure, your doctor can address any outstanding issues you are having and help make sure you are in good shape come surgery day.
  3. Ask for help. Make sure you have a family member or friend with you when you wake up to help reorient you, make sure you have important personal belongings like glasses and hearing aids, provide safe transportation and care for you upon returning home. And ask them to check on you frequently in the days after your surgery.
  4. Drink water. While you may not feel thirsty after your procedure, it is important to drink plenty of fluids, especially water, as dehydration can contribute to confusion and falls. After you have introduced fluids, you can progress to a light meal. 
  5. Have a clear plan. Prior to your procedure, make sure you talk to your doctor about what you are to do after and write it down. You may need to avoid certain medications or activities, and you may need to increase others. Writing this information down ahead of time, along with helpful phone numbers, can help ensure you don’t make any mistakes. 

Most importantly, if you or a loved one notices any signs of cognitive decline after your procedure, talk to your doctor immediately. By engaging your multidisciplinary care team (CRNA, surgeon, etc.), your doctor can assess your condition and determine appropriate next steps. 

Dr. Cheryl Nimmo is a Certified Registered Nurse Anesthetist and president of the American Association of Nurse Anesthetists. She has more than 30 years of clinical experience in various healthcare settings, including 12 years in the U.S. Army Reserve. 

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Having Surgery? What You First Need to Know About Anesthesia