confused older man, anticholinergic load

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.

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  1. Joy
    West midlands
    Reply

    My husband recently had a half knee replacement. He was fine for about six hours after surgery but then became completely confused, seeing things that were not there and not recognising his family.It was terrifying and took three days to get back to normal. After two weeks he still seems a little bit dazed although his concentration is a lot better. Judging by the amount of people writing on this forum, I think patients should be made aware of this before spinal anathetics and strong post operative opiates are administered.

  2. Leopard
    SG
    Reply

    I underwent 5 surgeries over a course of 2 years to fix some fracture non-unions when i was still in university. When i returned to school, i noticed that i was reading my texts with comprehending; i could read every word out loud from the front to the back of a 12 page essay without understanding what is being said. It was horrifying. Even now 3 years after my accident and half a year since my last surgery, i consantly find myself invaded by mental fog at the most inopportune moment and left open-mouthed facing interviewers, having lost track of what they were asking.

  3. BONNIE
    louisiana
    Reply

    I am glad I found this website…. I had back surgery 1 1/2 years ago at the laser spine institute in Louisiana. Since then I have memory loss bad. I am 74 yrs old.

    I am still in business with my husband. I am getting customer orders wrong and can’t even remember dates or appointment. Missed another appt. Yesterday even written on my calendar. I told my primary dr. And he sort of giggled.

    Beginning to think I have senile dementia.

    Any suggestions would be appreciated.

    DUMB IN LOUISIANA

  4. Deb
    South Carolina
    Reply

    I’m having surgery tomorrow morning (prolapsed bowel) and will BEG the anesthesiologist for Propofol. I hate doing it at the last minute, but when I asked the surg. nurse, she said I must take it up with anesth. I’m out of time if they don’t grant my wish.

  5. Clara
    AZ
    Reply

    In 2012 my husband had anesthesia for broken bone surgery. Even though he was 82 yrs old, he was given Versed. We didn’t know anything about that particular anesthetic at the time. When he was in recovery, he did breathe on his own…he had to be TOLD to breathe. He would take a breath and then not again. The nurses asked me to help tell him to breathe, and it was an hour and a half before he began breathing on his own. Later I researched Versed on the internet and learned that it should not be administered to elderly people! When will anesthesiologists learn?? Versed should be discontinued. We were told it would keep my husband calm when going into the operating room, but he had shown NO signs of agitation or fear and had been in ORs before without a problem.

  6. Michael
    Maryland
    Reply

    I had a routine colonoscopy with general anesthesia in my mid-sixties. During the following 10 days or so, I suffered two potentially deadly incidents of poor judgement on my routine daily drive to work. In one, I proceeded thru an intersection while the red light I had stopped at was still red. In the other, I drove straight on a left turn only green arrow. As soon as it happened, I realized my ‘goof.” I mentioned this to a couple of friends who reported similar incidents.

    I suspect that the ‘informed consent’ form failed to advise about this.

  7. Jack
    Reply

    For me- 3 colonoscopys with practically euphoric feelings afterwards and no negatives, and then the shoulder surgery and a total leg-arm swelling which crippled me, caused me to fall 2 days afterwards and ripped the shoulder repair, and still I feel I’m not right in cognitive function!

    It’s a shame that a determination can’t be made pre-op to see if the “new” antithesia is right for you!

    Knee replacement is next and propofol is the one and only for me.

  8. Charlie
    Greensboro, NC
    Reply

    I had multiple surgeries due to a perforated bowel. The reversal was successful and I’ve moved on with my life over the last six years. However, I’ve been diagnosed with essential tremors. I’m male and 58 yrs. Could the anesthetics have triggered this condition?

  9. Cindy M. Black
    Seattle, WA
    Reply

    Thank you for this very interesting article! It’s not the first time I’ve heard of this post-anesthesia “dementia” problem. I will NEVER allow Versed to be used on me in the future. Actually, due mainly to sports injuries, I’ve had many many surgeries (at least 20) and, fortunately, have never noticed any problems with short-term memory afterward. I’m tempted to think it’s because I take such an extensive daily supplement regimen which I have researched and fine-tuned time and time again. I think it’s so important to take one’s supplements!

  10. Hank Roberts
    left coast
    Reply

    A surgeon told me anesthesia (propofol) clears the body within an hour.

    A neurologist told me long-lasting effects may be due to lacking a gene for an enzyme that clears the anesthetic.

  11. Peter C
    Ireland
    Reply

    I’m a nutritionally-interested pharmacist. I’ve had 2 patients report serious cognitive changes following anaesthesia. The more severe of the two underwent 3 surgeries (one for complications) in under 2 months. He was left with poor energy, inability to think and depression – he missed a lot of time at work. 3 years on, he is still on antidepressants but is now happily back at work and functional.

  12. Kathy LeCompte
    New Jersey
    Reply

    The last time I had an endoscopy was three years ago, I was given IV propofol, and
    I have had word loss ever since. Some days are worse than others. I’m beginning
    to think the word loss is related to something else, perhaps vascular dementia since
    I’ve had hypertension for over thirty years.

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