When a doctor discusses the pros and cons of elective surgery, the conversation often focuses on the desired benefits and the potential risks of the procedure itself. Rarely does the subject of surgical anesthesia come up. Very few patients learn about the type of anesthetic that will be used or its effect on the brain.
Anesthesiologists have been debating the impact of surgical anesthesia on brain function for years. Some research suggests this is a temporary problem (British Journal of Anesthesia, March, 2014). Other anesthesiologists maintain that surgery and anesthesia may have a longer-lasting negative impact (British Journal of Anesthesia, online, Sept. 24, 2014).
One reader shares his experience:
Q. After a 13-hour surgery, it took weeks before I could read the newspaper again. My brain simply wouldn’t work well enough.
I think that anesthesia scrambles the neurons. I had insomnia, an inability to concentrate and vivid dreams. This also happened many years ago when I was younger. I believe that rest, good nutrition and brain training exercises can help speed recovery.
A. General anesthesia represents one of the great advances in medicine because it allows for pain-free surgery. Surgeons have been using medications to induce a temporary coma for 165 years, but we still don’t know exactly how they work and what else they might be doing to the brain.
Postoperative cognitive dysfunction (POCD) is not unusual, particularly in older people (Annual Review of Nursing Research, Jan., 2017). Most patients recover their cognitive function with time, though it may take several months. There is ongoing debate about the benefits and risks of inhaled anesthetics compared to intravenous anesthetics when it comes to recovery.
Reader Responses re: Surgical Anesthesia
Heather in Huntington, WV wrote:
“I had a 7 hour surgery two weeks ago and the following brain fog is getting more frustrating every day. I am 40 with four kids. They, of course, find it hilarious that it takes me three trips to the kitchen to get what I originally went in there for, but it is driving me crazy.
“I return to work tomorrow and am concerned that I won’t be able to focus. Even just now, I stopped typing to answer my daughter`s question then started filing my nails not remembering that I was mid sentence in my typing. I was given Versed before my anesthesia. I’m very hopeful this will resolve itself sooner rather than later.”
David in Texas reports:
“In July of 2013 I had total knee replacement surgery. I was out nearly 6 hours due to some ‘problem’ as my doctor told me. At any rate…my short term memory was really bad at first and after four weeks I returned to work part time. I was almost dysfunctional because I could not remember SH**!.
“Now after 18 months, my memory is still not completely back to normal and it still sucks, but at least I am functional!”
Carole in Virginia shared a similar experience:
“I also had knee replacement in 2013. I was 65. I also had complications and 6 hrs of anesthesia (no idea what kind) and had no short term memory for months after. I now still have to work at getting out some words and still forget, but I am able to function once again.”
Kristin in Arizona has some good news to offer:
“Two weeks ago I had a total knee replacement. For a week following the surgery, I had severe short-term memory loss: not remembering appointments, if I had eaten or taken pills, had visitors, etc. I also lost the ability to comprehend even the simplest math—even basic arithmetic was a challenge. Friends told me I repeated myself over and over. From what I can tell, it was like fairly advanced dementia.
“I have had numerous surgeries, and never had this reaction before. My memory began to return to normal on day 8 and is now back to where it was pre-surgery. I do not know what surgical anesthesia was used, but I will find out and try to avoid it in the future.”
A follow-up from Kristin:
“The anesthesia that was used was VERSED. Since that surgery, I had hand surgery and requested propofol and NO Versed.
“This time I awoke very quickly with no brain fog and no memory issues at all. What I have read is that, following surgery, Versed causes memory problems that last about 2 weeks in up to 40% of patients. In 17%, the memory problems last up to 3 months. And in about 4%, the memory problems are permanent. In my opinion, there is no excuse to continue using Versed. I was not told about the high likelihood that I could have memory problems. I will never allow it to be used again. The propofol worked MUCH better for me.”
The data on intravenous propofol vs. other types of surgical anesthesia remain confusing. Some researchers have maintained that propofol intravenous surgical anesthesia is associated with rapid recovery of cognitive function. Others say there is no difference between IV anesthesia with propofol and inhaled gas anesthesia (Canadian Journal of Anesthesia (Oct., 2016).
People’s Pharmacy Take Home Message:
We think it is important for patients to always speak with the anesthesiologist before undergoing elective surgery. A candid conversation about POCD (postoperative cognitive dysfunction) and the type of anesthesia that will be used is essential, especially in older people.
Share your own surgical anesthesia experiences below in the comment section.