Anaesthetics / Alzheimers

[CraigC]

Hi All,

My uncle needs to go in for some serious surgery and has early/mid stage alzheimers - vascular. The doctor has warned my auntie (among other things) that anaesthetics can cause a lot of problems with someone with alzheimer's.

I'm starting some research but wondered if anyone has any direct experience/knowledge about this.

Obviously, the concern is whether anaesthetics are going to cause additional damage - they are obviously going to cause additional stress in his condition. This is a new one to me and I could do with any advice, particularly based on experience.

Many Thanks
Craig

 

[Lynne]

Hi Craig

I thought (and had read) the same re anaesthesia, BUT ...
Mum was diagnosed May 06, fell & broke arm Oct 06, had op. with general anaesthetic to pin unhealed break in Jan 07 (aged 87).
I did make a point of discussing it with the anaesthetist before the op., to make sure he knew about Mum's Alzheimers, as she could on a very 'normal' face when she wanted to.
Sailed through it, piece of cake; only problem while she was in hospital overnight (only 1 night) was that she couldn't remember/understand
that she was catheterised, which made her feel urge to pee all the time. Was very distressed that she might wet the bed.

(See http://www.alzheimers.org.uk/talking...69&postcount=5 re op. for broken hip on another.)

I hope all goes well.

 

[Skye]

Hi Craig

I've no personal experience of this, but Nebiroth's father recently had an operation to repair a broken hip. The following day he had a massive heart attack or blood clot and died.

http://www.alzheimers.org.uk/talkingpoint/discuss/showthread.php?t=13032

Not exactly what you're asking for, but relevant to someone with vascular dementia.

 

[daynurse]

hi craig aneasthesia can have complications for anybody fit or unwell if you are concerned you can request to speak to the aneasthetist again, someone that has dementia when they wake up from surgery can be even more confused/dissorientated/agitated
however this can happen to anyone! the aneathetists are experts in there field try not to worry too much.
every operation can bring postoperative complications but the benefit of surgery out weigh the risks this is only my opinion craig only your auntie can decide

 

[Nebiroth]

Well I should say that my father's heart-attacks were really waiting to happen - it;s likely that the stress of his broken hip followed by surgery was the casue. I don't think that it was related to the general anaesthetic or dementia as such - he was just a very frail, elderly man whose body underwent an awful lot of strain through his injury and the surgery to repair it.

However, this said, I DO think that people with dementia can take a "hit" from general anaesthetic, apparently it;s very common for confusion to be a lot worse after they come round and this can take much longer to recover from than it does in someone who hasn;t got dementia and that the decline can be accelerated. Dementias are bascially diseases of the brain although the mechanisms differ, and I think they do limit the brain's powers of recovery from things like a general compared to a healthy person.

My dad's dementia was apparently much worse after the surgery (to the point where he would be classed as "very advanced stage" ie unable to speak or move) , but then again, it;s difficult to say whether this was the after-effect of the anaesthetic, the pain relief, the sedatives, the physical illness, the stressful situation, the change in environment or a combination of any or all of these things.

I can only suggest that you have a talk with whoever is proposing the surgery to discuss the risks involved and what is eing done to minimise them.

I should think that, given the problems generals can present to patients with dementia, there is little choice but for your uncle to have the surgery. I rather suspect that for someone with dementia, the doctors wouldn't opt for surgery if it could possibly be avoided.

 

[jenniferpa]

Craig - I saw a study that indicated that for people at high risk (and those were people with an existing dementia diagnosis) the rate of adverse reactions was 37%. Mind you, adverse reactions meant anything from temporary delusions up to death. For most people with these adverse reactions there was an increase in dementia symptoms which gradually resolved within 5 weeks. An of course, that means that for 63% there were no adverse reactions at all.

 

[lesmisralbles]

Dear Craig

You might know that Ron has a skin cancer problem on his face. The consultant said it was not likely to spread from where it is. It is an ulcer, and he has given us cream to clear this up. Anyway getting to the point, he said he would NOT operate on Ron as with his dementia it could cause problems. I questioned this, he said that it was not advisable.

Barb X

 

[Mameeskye]

Hi Craig

My Mum underwent emergency surgery for a burst ulcer almost 5 years ago. She also had a UTI at the time (which was fortunate as it meant she was in hospital at the time the ulcer burst!!)

Prior to this she had been just on the cusp of coping at home by herself. Possibly had another 12 months there as the support was about to kick in. Her first meals on wheels came the day before she was admitted for the UTI, CPN visits etc. scheduled to start in the next week or so.

She was given a 1/3 chance of coming through.

The anaesthetic most definitely made her confusion as a result of VAD worse. For weeks afterwards she was confused, incontinent and could not walk (op at the end of OCtober). She was moved to a NH at the end of the first week in Dec after a week without a catheter and a few accidents.

She became depressed after surgery but after a few weeks in the home she became continent, started to eat again and after a few months walked well without a zimmer. She did lose the fitness levels she had had. Four weeks before surgery she had spent 5 hours in town shopping with me and my sons, walking about 2-3 miles in total. This was possibly due to her not walking her dog on a daily basis once she moved into the home and the lack of anyone to take her out on a daily basis in the winter due to slippy paths etc.

In summary a huge immediate drop after surgery and recovery coming up to but not quite reaching her previous level.

The consultant geriatrician warned me that losses in dementia generally result from the effects of the anaesthetic and also the deskilling that occurs when you are on a hospital ward, rather than doing things for yourself..because you cannot at this time. And with dementia they can be too hard to relearn.

Hope that all goes well for your Dad. It must be hard for you at the moment, not having had a break since your Mum died this year form it all.

Remember to try and take time for yourself too.

Love

Mameeskye

 

[Helen33]

Hello Craig

My husband has a semantic dementia of the fronto temperal lobe and he needed a hernia operation a couple of years ago. I was informed that he would need a general anaesthetic.

On the day of the operation the anaesthetist came to see Alan and said he was unhappy at needing to use a general anaesthetic as it could cause irreparable damage but he said he was very willing to use another kind of anaesthetic and he went off to speak to the surgeon to see if the surgeon was happy about this change.

Anyway the surgeon was o.k. about it and Alan was absolutely fine. I am not sure what the anaesthetist used but Alan came out very happy. He seemed a lot more cheerful that all the others that came out and I presumed it must have been from something he had been given!?

Love and best wishes

 

[TinaT]

Hi there,

My husband recently underwent a hernia op under general anasthetic. I told the surgeon about his dementia and he then sent the anesthetist to me. She explained that it is not the dementia which is the problem but that AZ drugs such as Rivastigmine (Aricept)(which is prescribed for my husband) which causes the problems. Apparently in rare cases if they have to administer a stimulant during the anasthetic, it would not work because of the dementia drug. I was told to stop his dementia drug for two days before the op and this would then allow the operation to go ahead.

The dementia itself did cause problems when he was recovering. He had drips and other equipment in his arms and as he was coming round from the anesthetic, I stayed with him as he was trying to pull out the drips etc., and was very, very restless, throwing himself all over the bed as well as trying to get out. I spent several long hours lying across him and talking to him to try to reassure him. By the time he was calm, I was wet through with sweat and exhausted. When he was fully recovered from the anesthetic he was allowed back to the care home later that night after having had his op in the morning.

I spent the night with him sleeping on the floor and again, hardly slept as he kept getting out of bed in a very confused state. The next morning, although he was sore from the op, he was almost back to his 'normal' self.

Hope this info is useful for you.

xxTinaT

 

[Helen33]

Just to be clear, Alan has never been on any medication and the anaesthetist was reluctant for other reasons of which only he knows.

 

[daynurse]

dependent on the type and length of surgery other options are available local aneasthesia, sedation and spinal block/ epidural
for example a hernis repair could be done under spinal the whole area is numb therefore the patient is awake/or sedated this is commonly used when patients are at risk from having a general aneasthetic hope that helps?

 

[Helen33]

Hi Daynurse

Alan was awake throughout and I think he had an epidural. Originally the surgeon insisted he needed a general anaesthetic and it was the anaesthetist who took matters in hand.

 

[daynurse]

at the end of the day its the aneasthetists call and his responsibility i would think the surgeons would prefer to have all there patients a sleep! easier for them however its up to the gas man!!! as i call them.x

 

[TinaT]

Ken had a gas lady - she was obviously confident that he could have a gen anesthetic. We did talk about a spinal epidural but agreed that in view of Ken's dementia it would probably be better for him if he was put completely to sleep with anasthesia.

In view of the difficulties when he was recovering from the anasthetic, he may have been better with a spinal. Still - he recovered well with no side effects at all.

xxTinaT

 

[May]

Hi Craig

My Mum had a replacement knee op 8yrs ago when she was in the early stage of Alzheimers ( we hadn't had a 'formal' diagnosis at that point, just a trip to the memory clinic and the injuction to 'go away and enjoy your holiday it might be your last'). When she came out of the anasthetic she was very confused, the first night was a nightmare as she pulled all the drains out of her knee,, and although we told the nursing staff she couldn't remember things, they had put her on a machine to self administer pain-killer (sorry can't remember what they're called)so she was in pain too. The good news is after we got her home, (we discharged her after four days as the nursing staff weren't coping too well!) in a settled atmosphere she improved to almost back where she was before the op. Would also say that the op benefitted her enormously in terms of mobility, so on balance it was worth the trauma. Hope your aunt can make the right decision for her and your uncle.Take care.

 

[citybythesea]

Hi Craig,

mom had to have a full study of her GI tract about 4 years ago and in order to do it the Dr. to put her under. The drug they used is called versed in the US it is also known as the amnesia creator in some circles. Under normal circumstances it puts the patient under and when they awake the remember nothing for those few hours and have no "small recolections" When mom came out she had the normal confusioon from an AZ patient being in a hospital looking for some memory to help her make sense of the atmosphere. Thus asking me where her newborn was, but after an explanation and taking her home she quuickly got back to herself as an AZ patient in the beginnning stages and forgot all about her tests.


You might want to consult on that particlar drug. I know that her dr.'s said it was her only option because of the AZ.


Hugs

Nancy

 

[Nebiroth]

Use of things like local anaesthetics and epidurals will be totally dependent on the patients ability to comprehend the need to co-operate with the surgeon and their ability to actually do this.

Surgeons will be very resistant to anything other than a general if they feel there is a risk of the patient moving around during the operation, for example.

Apparently even local anaesthetics can increase the confusion - indeed, virtually anything can make it worse! - so there would need to be a very careful assessment before going down that path.

Exactly the same goes for using sedation.

 

[sammyb]

When my laddo went into hospital with his broken vertebra, he was in major pain. I was not aware of any underlying dementia. He had three operations in three weeks. The first two were under local anaesthetic the third under general. He was as he ever was coming out of the first two operations. However, I didn't recognise him from a psychological point of view after the third. The general anaesthetic didn't do his brain much good.

Love from Sammyb

 

[lesmisralbles]

Ron has cancer on his cheek.
If it does not clear by January 2009 they said they have to remove it by operating.
They will use local not general.
The reason given is AZ.

Barb XX