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Does General Anesthesia Affect Brain Function?

Many older people report cognitive decline following major surgery and general anesthesia. Does the anesthetic used affect brain function?
Does General Anesthesia Affect Brain Function?

Q. I know two senior citizens (in their 70s) who had misadventures with surgical anesthesia. They are both rapidly losing their short-term memory.

Do specific anesthesia drugs cause this in genetically susceptible individuals? Or would this result from lack of sufficient oxygen during surgery or its aftermath?

A. This is a very controversial question. Anesthesiologists disagree about how commonly people experience post-operative cognitive decline and how long it may last. Some experts insist that most patients recover their normal mental function within three months (British Journal of Anaesthesia, March, 2014), while others fear that nervous system injury is often permanent (British Journal of Anaesthesia, online Sep. 8, 2014).

They are all struggling to answer your questions, but no definitive cause has been identified. One review suggests that the inhaled anesthetic sevoflurane is associated with more post-operative cognitive decline than IV propofol (Clinical Interventions in Aging, online Sept. 24, 2014). One reader reported:

“I’ve had several elective procedures with propofol and no resulting cognitive problems. I’m a 75-year-old male.”

This is just one case, but it points up the importance of talking in advance of the surgery with the anesthesiologist. Find out the type of anesthesia that is being planned for any elective surgery . We had a conversation several months ago with one of the leading anesthesiologists in the country. He confided to us that he prefers propofol when it is appropriate because he sees less cognitive impairment in his patients afterwards.

Here is Loretta’s story:

“At 35, I broke my arm in a car accident and had to undergo surgery. Afterwards, my short-term memory was clearly affected and finally after about 3 weeks of cognitive difficulties, I called my surgeon’s office, desperate to see if my memory problems could be in any way related to my surgery. The nurse immediately said that it was from the anesthesia and that it would diminish in several months. It did.

“After a colonoscopy years later I experienced the same diminished cognitive state post-procedure. It was significant enough that when I had to have a hysterectomy at 55, I asked my OB/Gyn if I could have an epidural instead of going under. She recommended against that.

“Finally, I asked an anesthetist who recommended I request propofol only-no Versed [midazolam]. Apparently Versed is a drug that keeps one from having any memories of the procedure (should one become conscious at any time during the surgery).

“The propofol worked beautifully for me and I had no cognitive complications post-op. Was it the Versed causing my memory problems? I don’t know. I do know that I won’t ever willingly allow it to be used again. I’m curious to hear whether others have had similar experiences with Versed.”

Share your own experience with general anesthesia in the comment section (“What Do You Think?”) below.

 

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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