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Fractured hip and anaesthetic

rafferty

Registered User
Dec 27, 2011
85
cardiff
Hi all I haven't posted for a long time but I'm after some advice . This morning my mum has fallen and broken her hip she is going to need surgery to repair it . I would say she is at a moderate stage of Alzheimer's and we are managing to maintain her living at home with a lot of support , family and carer . She will have surgery tomorrow and I have questioned the use of general anaesthetic to do this as I'm concerned about cognitive decline after the op . The orthopaedic doctor dismissed my concerns . I'm wondering if anyone has experience of this . Also has anyone had experience of this op being done with an epidural and sedation. I would be very grateful for any advice .
 

min88cat

Registered User
Apr 6, 2010
581
Hi there,

No experience of hip op with a GA, but what I will say is that our local hospital now more or less operates on anything below the waist with an epidural. It is known that Alz /dementia sufferers can often become more confused after a GA. I had a hysterectomy with an epidural as the recovery period is quicker and there is less chance of complications. I would certainly explore this route further with the specialist.
 

jugglingmum

Registered User
Jan 5, 2014
5,629
Chester
No first hand experience but a lot of posts on here of people taking a step down after a GA.

Also seen a lot of posts saying epidural was used, but patient needs to be aware enough of what's happening to stay still etc I think.

My MIL (no dementia) had a hip replacement 12 years ago aged 79 with an epidural and is having a knee replacement soon (now aged 88) and the surgeon has told her it will be epidural due to her pacemaker etc.
 

Spiro

Registered User
Mar 11, 2012
522
She will have surgery tomorrow and I have questioned the use of general anaesthetic to do this as I'm concerned about cognitive decline after the op .
The outcome of your Mum's surgery and her ability to tolerate the anaesthetic will depend to a degree on her general health. If I were in your position, I would want to discuss the situation with the anaesthetist. Make sure that she has been prescribed appropriate pain relief post op. Also, find out what the hospital's dementia policy is - they should allow you visit outside the standard visiting times.
 

Loopiloo

Registered User
May 10, 2010
6,118
Scotland
Hello rafferty

I had a total hip replacement 11 years ago done with an epidural. Also given a sedative which put me to sleep until the latter part of the surgery. I was told there is a lot of noise which can be distressful for the patient.

My husband who has vascular dementia fell at home and fractured his hip. No full hip replacement but pinned. It probably depends on the degree of damage.

It is well documented that anaesthetic can cause dementia to progress. It happened with my husband, although in time he regained some lost abilities. But he was further on than the moderate stage you said your Mum is.

I agree with what Spiro said, discuss the situation with the anaesthetist and also the surgeon. If they do the epidural ask about her being sedated as well.

I spoke to the surgeon before my husband's surgery and asked if he could have the epidural instead of an anaesthetic. He was noncommittal. But he had the anaesthetic. Later I was told this was because he could not sit up to have the epidural injected into the area required.

Just realised you may be offline by now, sorry if I’m too late.

Wishing your Mum all the best
Loo
 

rafferty

Registered User
Dec 27, 2011
85
cardiff
Thank you so much all for taking time to reply I will speak with the hospital again in the morning . It is much as I suspected that anaesthetic and Alzheimer's are not a good combination .i am so worried .
 

BR_ANA

Registered User
Jun 27, 2012
1,079
Brazil
Last year my mom had hip surgery and a dental surgery. Both were GA. She was so confuse with pain before hip surgery, that I didn't noticed any worsened. And on teeth surgery, she was much better a month later than before (tooth pain worsened her dementia, and she didn't understand 'keep mouth open'

But, asking someone with dementia to exercise after hip surgery was almost impossible.

After teeth, she was worsened for 2 weeks, then she went better.

I would ask to talk with anaesthetist, and explain her dementia, and her health issues.
 

Cath59

Registered User
Jan 23, 2015
46
Won't go into what we're going through at the moment-not good. I just want to advise you to be very careful about discharge. My mother has some heart problems and it was obvious that things weren't as stable as they should be after her hip op. (Done urgently under general anaesthetic after fracture.) She was "difficult " and uncooperative after so on the one day she seemed better I had a phone call to say they were discharging her back to her care home while she was "well ". She was readmitted the next day and is very poorly. Hopefully your mother is physically fitter but do make sure the difficulties of managing someone with dementia together with the pressure to free up beds doesn't mean she is rushed out.
 

susy

Registered User
Jul 29, 2013
801
North East
It's the anaesthetist you need to speak to, not the surgeon. The surgeon does what they need to do while the anaesthetist is the one who keeps the patient safe and pain free during the procedure. A spinal anaesthetic would probably be best in this situation. It is well documented in the medical press that general anaesthetic can have a detrimental effect on dementia. A hip fracture in itself often does make a person more confused in the days following it happening but that usually resolves itself after a week or so. I agree about asking about visiting time. It would be great for your mum to have a familiar face around to help in her rehabilitation. Prepare to be flexible as sometimes going away for a coffee is best while the physio puts her through her paces for the first few times. But that is all down to the individual. You know your mum best so you will know what she will respond best to xxx

Hope she (and you) are ok xxxx
 

Owly

Registered User
Jun 6, 2011
538
If you use the search function you'll find previous posts on this - or look at one of my recent posts.

Basically, nitrous oxide in anaesthetics can deplete B12 stores but no-one may notice unless a blood test is done afterwards. Low B12 leads to bad brain functioning which may be put down to "worsening dementia" but can be corrected with supplements or injections.
 

WIFE

Registered User
May 23, 2014
856
WEST SUSSEX
All I can add about anaesthesia is make sure the nursing staff watch out for post-operative delirium which can have a significant effect on someone with even the mildest of dementia symptoms as in the case of my late husband last year. It usually shows itself approximately four to five days following the operation and can take many forms including confusion, obviously delirium, total loss of mobility, refusal to eat and drink, inability to control bodily functions etc etc. My poor husband was never well enough again to come home and went to a Nursing Home after ten weeks in hospital following the devastating effect the anaesthesia had on his brain function. His hip fracture healed remarkably well!
 

tre

Registered User
Sep 23, 2008
1,353
Herts
My husband had hip surgery under a general anaesthetic in 2011. He was diagnosed with dementia in Jan 2008. Although he was very confused in hospital and I had to fight to be allowed to be with him outside visiting hours as he could not cope with the call button ( I was allowed to stay from 8.00am to 8.00pm every day), he did manage to get back his mobility. He was incontinent of urine on discharge but we got back to being continent too. Things were especially difficult for him as he has a rare dementia which has also left him blind. As you can imagine, this was a bit of a challenge with the walking frame. When he was discharged from hospital his wound was infected as well but we got through all this and by three or four months post OP he was certainly no worse than he had been before he went in. So it may be OK for your mum to have a general anaesthetic too. I do not think, because of the dementia, he would have been able to cope with being awake during the OP. Hip surgery is quite noisy and brutal and he would have been terrified.
Tre
 

Witzend

Registered User
Aug 29, 2007
4,291
SW London
Just to say, my mother had a fractured hip fixed under GA when she was over 90 and her AD was quite advanced. To be honest there were no noticeable after effects - she seemed no worse than before and in fact made a good and pretty quick recovery. It never occurred to me that there would have been any alternative to a GA - none was ever mentioned - and she would certainly not have been able to understand about keeping still, or have been able to cooperate with any procedure where she was not completely knocked out.
 

chrisdee

Registered User
Nov 23, 2014
171
Yorkshire
Its Complicated

No one here would want to add to your worries further. It seems to me to be partly dependent on the stage of AD your mother is at. In common with some here, my Mum 'went down' after her op. which in itself was successful. Agree very much with the post about misdirected discharge. My Mum had to go into a Nursing Home, as residential was not set up to give her the care she needed. I have had a spinal aneas.myself. You have to sit very still for them to get the needle in accurately, I could not see many dementia patients having the degree of co-operation needed.
I do hope it all goes well, I know how anxious I got but it seems a very common scenario.
 

rafferty

Registered User
Dec 27, 2011
85
cardiff
So sorry for not replying sooner but I have spent the last four days in the hospital with my mum . It's been quite eventful . She had her surgery with a spinal block and minimal amount of sedation . This was decided after discussion with the doctors who were willing to give it a try with the proviso that if mum wasn't cooperative it would have to be a G A. Thank goodness mum was in the mood to cooperate . Mum came back from surgery smiling ,We all breathed a sigh of relief . Oh dear how premature . The following morning I arrived at the hospital to find my mum semi conscious the nursing staff though she was sleeping . Her blood pressure was almost too low to measure and she was in severe heart failure . Yesterday was spent trying to stabilise her which thank goodness they did . I left her sleeping peacefully at midnight . I was back in the hospital by 8.am. To be greeted by my usually gentle happy mum who was angry, paranoid,and confused it has lasted all day . She's refused to eat ,drink or take meds. Through all this I can't praise the hospital staff enough . The hospital operate the butterfly scheme which means we can spend as much time as we want with mum . So we have a rota set up from early morning until she goes to bed to try and reassure her . The butterfly is placed above her bed and on her notes so all staff are aware that she has dementia . Everyone so far that we have come across has treated her and us with dignity and respect some staff going above and beyond the remit of their. job to demonstrate to mum that they are acting in her best interest and I am so grateful to them
 

susy

Registered User
Jul 29, 2013
801
North East
I am so pleased that you are all being treated well. Glad the blood pressure drop was sorted. As I said earlier having a hip fracture alone can cause confusion that does go, the fact she has dementia added into the mix and light the blue touch paper and off she goes. So glad you and your family are able to go and help her through this part of her journey. Good luck for the future xxx
 

rafferty

Registered User
Dec 27, 2011
85
cardiff
I am so pleased that you are all being treated well. Glad the blood pressure drop was sorted. As I said earlier having a hip fracture alone can cause confusion that does go, the fact she has dementia added into the mix and light the blue touch paper and off she goes. So glad you and your family are able to go and help her through this part of her journey. Good luck for the future xxx
Thank you Suzy . Xx