Millions of older Americans undergo anesthesia and surgery each year, and many develop delirium after surgery. (Shutterstock/The Epoch Times)
Cognitive decline and personality and behavioral changes occur following surgery in large numbers among older Americans. If you are over 65, there is a good chance that you will be a different person after surgery. Research shows that at least a quarter and perhaps as much as half of the population suffers from postoperative delirium, a serious condition that causes sudden changes in thinking and behavior.
Delirium is the most common complication of surgery. It’s unclear whether the stress and trauma of surgery or the lingering effects of anesthesia are to blame, but researchers have identified several risk factors that could help determine which type of patients are most likely to develop the disease.
What is delirium?Facts about delirium
Delirium is a common change in psychological function that is more common in older adults. During an attack of the disease, patients may have confused thoughts, drastic changes in temperament and talk nonsense, they may be very excited, but sometimes they may be silent and lethargic. The symptoms of delirium are sometimes confused with those of dementia.
Based on the evidence and research to date, the Global Council on Brain Health lists the known facts about delirium, including the following:
• Delirium can come and go and manifest itself in very different ways over the course of hours or days.
• Delirium may last days, weeks, or be permanent.
• Delirium most commonly occurs after injury, illness, surgery, dehydration, infections, or medical procedures such as dressing changes.
• Delirium is often overlooked, misdiagnosed, or poorly managed.
• Many healthcare professionals do not understand delirium.
• Delirium can be a sign of other health problems.
• Delirium can lead to falls, prolonged hospitalizations, and loss of independent living.
• Hearing or vision problems, frailty, underlying medical conditions, alcohol or drug abuse, and opioid use are risk factors for delirium.
Until recently, these consequences were ignored. But researchers believe it deserves further study given its link to permanent, long-term neuropsychiatric problems and that the consequences are avoidable.
Delirium can easily be confused with many primary mental illnesses, as its symptoms are also present in conditions such as dementia, depression and psychosis. Symptoms may also vary depending on the patient and over time.
A review published in the Journal of the American Medical Association found that up to 65% of patients over age 65 develop delirium after noncardiac surgery, and 10% experience long-term cognitive decline. Delirium can lead to prolonged hospitalization, increased days spent on mechanical ventilation, and decreased function. Even after discharge from hospital, functional and mental health worsens and the risk of progressive cognitive decline, dementia, and death increases.
According to a study published earlier this year in JAMA Internal Medicine, postoperative delirium was associated with cognitive problems in 40% of 560 elderly patients monitored for 72 months after elective surgery, related to an accelerated decline in ability.
According to the Alzheimer’s Association, delirium is accompanied by regional cerebral hypometabolism. The darker areas in this brain scan show lower glucose metabolism in the brain. The top row of images is a PET scan of the delirium and the bottom row is a scan after the delirium has occurred. (Sage Publications)
The Global Council on Brain Health warns that delirium should be treated as a medical emergency. In its 2020 report on Protecting Brain Health During Illness or Surgery, it said delirium and related complications cost about $164 billion annually in the United States.
However, few people understand delirium or know that it is preventable. In a survey of 1,737 anesthesiologists, only about a quarter regularly discussed the risk of postoperative delirium or other cognitive impairments with their patients.
As awareness of the problem grows, so do concerns about how to protect patients.
“How older women recover after such postoperative cognitive deficits is an important question,” Dr. Anthony Kaveh, a California anesthesiologist, told The Epoch Times. “We don’t know how to prevent it. It happens. But we know a few factors that help predict what kind of patients are likely to respond over a long period of time, or for the rest of their lives. And that’s pretty scary because no one wants to be there for always. In the fog.”
Risk factors for postoperative delirium
In many cases, those who develop delirium after surgery have cognitive impairment that was not diagnosed before surgery, but there are many other known risk factors.
“As we age, many changes occur in the human brain, resulting in patients’ reduced ability to adapt to perioperative stress, making older adults more susceptible to neurocognitive deterioration before and after surgery,” the authors write. research published in 2022 in Anesthesia & Analgesia.
The perioperative period refers to the period of time before, during, and after surgery.
The use of opioids, even as part of the anesthetic mixture, is a factor associated with postoperative delirium. (Photography)
A known cause of delirium is opioid use. These drugs are often used during surgery as part of the anesthetic mixture and to relieve pain after surgery. The difficulty is that high levels of uncontrolled pain during and after surgery also increase the risk of delirium.
A 2017 review published in the journal Drugs and Aging looked at six studies that evaluated the use of eight different opioids and found that none of them were better at reducing the risk of delirium, safer than another opioid.
Uncontrolled factors such as age and type of surgery can also complicate the risk. According to the American Medical Association, anyone over age 60, as well as those undergoing orthopedic or cardiac surgery (which require longer sedation than elective surgeries), are more susceptible.
Other risk factors for delirium include cognitive problems, frailty, malnutrition, alcohol use disorders, depression, uncontrolled diabetes, and comorbidities. Screening can help surgeons and anesthetists identify patients who may need prehabilitation to reduce the risk of delirium.
What is the relationship between delirium and anesthesia?
Delirium is more common in patients taking multiple medications. Surgery almost always uses anesthetic drugs in addition to medications that may be used to treat pain, as well as prophylactic antibiotics. Various studies have attempted to understand the effects of anesthesia.
“This is not something to take lightly. Because all organ systems are involved, the risks can be serious,” Dr. Matt Hatch, an anesthesiologist and vice chair of the American Society’s Communications Committee, told Big News Epoch Times of Anesthesiologists. .
Anesthetic drugs have been shown to be safe: they keep patients alive but unconscious during surgery. However, anesthesia carries inherent risks that are compounded by factors such as the fragility of the human mind and medical conditions.
Clinicians must carefully balance the patient’s anesthetic needs with the risks of various drug combinations and the patient’s medical history. (nd3000/Getty Images)
“Minimizing the risk of anesthesia to the brains of older adults is something I worry about, especially when I occasionally care for elderly patients in their 80s, 90s, and even 100s,” Dr. Hatch said.
Large studies with longer follow-up have shown an inherent risk of postoperative delirium when using general anesthesia, although some smaller studies with shorter follow-up have found no association.
For example, a meta-analysis published in 2022 looked at 18 studies and found that regional anesthesia reduced the relative risk of delirium by 53% compared to the use of general or general anesthesia. The analysis was published in the Journal of the Italian Society of Anesthesiology.
Meanwhile, a randomized clinical trial of 950 patients published that same year showed no significant difference in delirium after hip surgery between patients who received regional anesthesia and those who received general anesthesia.
Conflicting results in other studies suggest that the dose or type of sedative may have an effect.
Anesthesia can be as simple as a single injection to numb a part of the body, or it can involve a mixture of pills, injections, and gases administered through an anesthesia machine. (Photography)
A randomized clinical trial involving 655 high-risk patients undergoing major surgery found that patients receiving light anesthesia had a lower incidence of postoperative delirium than those receiving deep anesthesia. They were evaluated for delirium and cognitive impairment for one year. The findings were published in the British Journal of Anesthesia in 2021.
A smaller study published in 2021 in Anesthesiology examined postoperative delirium in patients undergoing lumbar fusion. The researchers evaluated the patients in the days following surgery and found no significant differences between the group receiving general anesthesia and the group receiving targeted sedation. The study did not follow patients long-term.
Other studies have looked at the effects of different drugs. Dexmedetomidine, an expensive but powerful sedative used to keep patients asleep during surgery, thus reducing the need for other drugs, was found in a study of 732 healthy older adults undergoing lower-limb orthopedic surgery. In human studies, dexmedetomidine has been associated with lower rates of postoperative delirium than propofol. The mechanism of action of propofol is poorly understood by the medical community. The findings were published this year in the journal Anesthesiology.
In a 2023 study published in Anesthesiology, dexmedetomidine was associated with lower rates of postoperative delirium than propofol. (Photography)
Risks of anesthesia
Dr. Carvey explains that a person’s tolerance for surgery has a lot to do with their “reservations.” Dr. Carvey offers a unique perspective as an anesthesiologist and integrative medicine expert trained at Stanford and Harvard. He explains the reserve as “extra bandwidth” to resist fluctuations in blood flow, tissue damage and other trauma.
Nutrition, physical fitness, and positive psychosocial characteristics can improve reserves. However, unlike cardiac reserve, which can be tested, Dr. Carvey said cognitive reserve is more complex to assess. This means that it is difficult to fully determine a patient’s risk of developing delirium after anesthesia.
Although some people think that anesthesia is simply a way to put someone to sleep, its impact is much greater.
“We’re actually turning off the light bulb in the brain and central nervous system, and it’s not just about sleep,” Dr. Carvey said. “If you put electrodes on your head, you will see that anesthesia is related to what people see in their brain while they sleep. The electrogram, EEG and characteristics are different, it’s more like a coma.
Anesthesiologists rely on preoperative exams (at least in non-emergency situations), which can be more like a first appointment with an unfamiliar healthcare provider. Anesthesiologists need to know a complete history of medications, supplements, medical conditions, previous surgeries, diagnoses, diet, physical activity, medication use, and, perhaps most importantly, general anxiety associated with the procedure.
All of this determines the various types and doses of anesthetics, gases, and drug combinations used during surgery. These combinations can reduce pain, put the body into a comatose state, reduce postoperative delirium, and even induce temporary amnesia.
No two patients will receive the same combination of narcotics, as it is an individualized combination that depends on many variables.
California anesthesiologist Dr. Anthony Carvey administers anesthesia to the patient. (Courtesy of Dr. Anthony Carvey)
“We have to design with a wide range of variables in mind, which is why we go to school for so many years, so we know the safe amount to treat and how to resuscitate the body based on body weight to maintain its function and maintain the patient will wake up at the end of the surgery,” Dr. Carvey said.
The reality is that patients with mental health problems are at greater risk of complications. This is often because they are more likely to take prescription or illicit drugs (marijuana is the most common) to cope with anxiety, which increases their need for narcotics, Dr. Carvey said.
“The more the central nervous system is enlarged or trapped (there are certainly studies that show this), the more anesthesia is needed,” he said.
Take steps to protect your brain
The Global Council on Brain Health report lists dozens of steps patients and their caregivers can take to reduce risks, including being honest about their anxiety levels.
Dr. Carvey has created a library of popular YouTube videos that demystify anesthesia, including the story of a patient using hypnosis as an alternative to microdosing supplemental narcotics. Even things like positive affirmations from others can help relieve anxiety, and Dr. Carvey demonstrates in his video how breathing techniques can affect your heart rate.
Patients who adopt a positive mindset and use visualization techniques can reduce their need for medications, which can include the amount of anesthesia needed, Dr. Hatch said.
Other helpful measures include bringing familiar items from home, such as hearing aids, glasses, dentures, and any medications and supplements. It’s also important to make sure you eat well, get enough sun exposure, get enough sleep, and get back to your normal routine as soon as possible.
Even challenging mental activities, such as learning a musical instrument or doing crossword puzzles, can improve cognitive function. (Photography)
More and more experts and surgeons recognize the importance of postoperative cognitive rehabilitation. Just as patients undergoing orthopedic and other surgeries are asked to get up and move around immediately after surgery, there is evidence that doing crossword puzzles and other cognitive activities can help prevent delirium, Dr. Hatch said.
“Most of these activities are risk-free, don’t cost much and don’t even require drugs,” Dr. Kawei said. “It’s all about making a human connection and treating patients with dignity. If we can do that for post-operative patients, that, especially with at-risk patients and their families supporting this type of activity, can greatly reduce the cost emotional impact that surgery has on people.”
In fact, sleep and support systems are two important ways to prevent delirium, according to an article published in Anesthesia & Analgesia. Hospital staff often wake sleeping patients to take medications, and the various beeps from hospital equipment can disturb sleep. For those who are hospitalized after surgery, it is crucial to minimize sleep disturbances.
“This is especially important for elderly patients, as maintaining natural sleep is another key to their recovery. It is important that family involvement and social support are implemented early before surgery,” emphasizes the item.
Detoxify with antioxidant foods
Naturopathic doctor Rosia Parrish says the inherent risks and side effects of anesthesia can be offset by increasing the body’s antioxidant capacity before and after surgery.
“Anesthesia depletes glutathione, an important antioxidant that protects cells from oxidative stress. Reduced levels of glutathione can hinder the body’s ability to heal after surgery,” Parrish told The Epoch Times in an email .
Glutathione depletion can weaken the immune system and lead to muscle weakness and pain, joint discomfort, and cognitive problems, including brain fog, poor concentration, and memory problems. It can also cause fatigue and low energy due to cell damage, as well as worsen mood problems due to its role in regulating neurotransmitters, leading to anxiety and depression.
She suggests that many foods can improve the body’s detoxification process after anesthesia, including milk thistle, N-acetyl cysteine, curcumin, glutathione, vitamin C, dandelion root, chlorella, spirulina and burdock root, nettle, coriander , ginger and green tea. supplements.
Dandelion root can help detoxify the body. (Photography)
Dr. Carvey says the best way to detox from drugs is to stay healthy first so you don’t need larger doses.
Be sure to talk to your doctor or anesthesiologist about the supplements you plan to take, Dr. Hatch says, because some can interact with medications. He said detoxification after surgery is not necessary, especially for people who do not have kidney and liver disease, which can slow the process of removing drugs from the body.
“There is no magic pill that will eliminate the effects of anesthesia,” Dr. Hatch said.
For the report in English, see the English version of The Epoch Times: Anesthesia: The Lesser-Known Side Effect That Could Be Mind-Altering.
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Responsible editor: Li Fan
2024-01-25 06:39:15
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