#Postoperative cognitive dysfunction

[blackbird-brewster]

It's nearly been one month since I had surgery, and while the sutures have mostly healed, the debilitating (very unexpected) side effects have only gotten worse.

I wish I could find the words to express how scary and emotional this has been for both me and my partner. But the whole problem is that I've lost my ability to understand/interpret complex language (amongst other serious cognitive problems).

I have tried to stay optimistic, but it's so fucking hard when every one of the past 27 days has been nothing but a blur. I've lost all short-term memory, I cannot tell you a single thing that's happened in the past month. Hell, I can't even tell you what I did this morning!

I am completely unable to perceive time. I have what we call 'time slips' where I lose chunks (usually hours) of time with no recollection of what I did during them. Yesterday I was SO certain something happened 4 days before and my partner had to remind me it had only been the day before.

I can't remember routines. I can't cook, I need help doing housework. I have post-it's all over the house, with step-by-step instructions for even the most basic tasks. There's one taped to the outside of the shower glass, because I was having difficulty remembering the steps of how to shower. Prior to making this instruction sheet, I had gotten stuckin the middle of showering, because I genuinely couldn't remember what came next in my routine. I couldn't even recall of I'd already washed my hair, so I had to start all over again.

Usually, writing would be my coping mechanism. But I have lost the ability to write altogether. I can put words on a page but they're completely disorganised and make zero sense. I can't read either, even my own fics I've read 100x before feel like they're in another language when I try to read them.

Because of this constant state of confusion, I can't drive, I can't look after myself without my partner helping me tons. I have basically lost all of my autonomy.

It is as if I developed full blown dementia overnight. It's so terrifying to suddenly lose all cognitive function.

I feel like I've lost what makes me, me. My partner has had to become a full-time carer on top of their full-time job. Without them constantly checking in with me throughout the day, I wouldn't even remember to eat or take meds or drink water. We've had to put so many systems in place just to try and make sure I remember to do the very minimum tasks relating to daily living.

We have been through plenty of hardships over the past seven years, but this current situation has been the worst, it's a constant test of our relationship. I am forever grateful to have such a phenomenal partner to help me through this rn. I love you so much @phantomhag-666.

We're hoping our new doctor might be able to give us some answers. But bc I have such a complicated medical history, it might take some time to figure out what's happening. At this point, I can only pray this isn't a permanent change for me.

[randallkrawcheck]

Understanding the Role of a Surgical Intensivist

A surgical intensivist is a physician trained in surgery and critical care who specializes in managing critically ill surgical patients. Unlike general surgeons, they oversee life-threatening conditions before, during, and after surgery, ensuring comprehensive ICU care. Their expertise allows them to anticipate complications, manage physiological stressors, and provide advanced life support, including mechanical ventilation and precise fluid and medication management.

The responsibilities of a surgical intensivist extend beyond performing procedures. They stabilize patients with complex post-surgical needs, managing ventilation, hemodynamic monitoring, and multi-organ dysfunction. By integrating critical care principles with surgical expertise, they make time-sensitive decisions that can be life-saving. Their vigilance ensures continuous monitoring and timely treatment adjustments, reducing severe complications and improving survival rates in postoperative infections or acute organ failure.

The presence of surgical intensivists in the ICU significantly improves patient outcomes. Studies indicate that intensivist-led care models reduce mortality rates, shorten ICU stays, and optimize resource utilization. Their expertise ensures effective management of critical conditions such as sepsis, acute respiratory distress syndrome, and post-surgical infections. By quickly adapting treatment plans, they reduce hospital-acquired complications and enhance ICU efficiency while maintaining individualized care.

Collaboration is central to the work of a surgical intensivist. They function as part of a multidisciplinary team that includes anesthesiologists, internal medicine specialists, nurses, and respiratory therapists. This collective approach ensures that surgical patients receive holistic care that addresses their immediate and long-term medical needs. Their leadership in ICU rounds allows for real-time decision-making, optimizing surgical recovery and overall patient health.

Surgical intensivists also play a key role in ethical decision-making within the ICU. They help families choose life-sustaining therapies by balancing medical feasibility and patient requests. Their clarity and sensitivity in communicating complicated prognostic information ensure that patients and their families actively participate in long-term care and quality-of-life decisions.

In addition to direct patient care, surgical intensivists contribute significantly to medical education and research. They play an integral role in training surgical and critical care fellows, imparting knowledge that strengthens future physicians. Their experience managing high-acuity patients allows them to develop and refine treatment protocols, leading to advancements in the field. Integrating data-driven decision-making into their practice will enable them to continually assess and refine strategies for improving patient care, ensuring that evidence-based methods drive their interventions.

The evolution of surgical intensive care has underscored the importance of specialization in critical care medicine. With the increasing complexity of surgical procedures and a growing population of high-risk patients, the demand for surgical intensivists continues to rise. Their expertise is vital in trauma centers and academic hospitals, where patients often require advanced interventions beyond standard surgical care. The integration of intensivists into these settings has reshaped critical care, emphasizing the need for dedicated specialists who can navigate the intricate challenges of modern medicine.

Beyond immediate critical care, surgical intensivists contribute to post-ICU recovery strategies, recognizing that survival alone is not the ultimate goal. They work with rehabilitation professionals to reduce cognitive impairment, muscular atrophy, and functional deterioration. Addressing these issues early improves patient outcomes outside the ICU, easing the transition to regular life and boosting well-being.

The surgical intensivist's role remains indispensable as healthcare systems refine their critical care approaches. Their unique combination of surgical accuracy and critical care abilities enhances patient survival and rehabilitation. In addition to patient treatment, their research and teaching advance critical care medicine. Surgical intensivists in the ICU demonstrate the need for specialized, high-quality treatment for the most vulnerable patients in an era of increased scrutiny of patient outcomes.

[alankayeshreveport]

Dr Alan Kaye Shares The Link Between Anesthesia and Postoperative Cognitive Dysfunction

Welcome to Dr. Alan Kaye's podcast, where we dive deep into the world of anesthesiology. In today's episode, we will explore a topic that has garnered significant attention in recent years: the link between anesthesia and postoperative cognitive dysfunction (POCD). Join me as we unravel the complexities of this fascinating subject and discuss the latest research findings and insights.

[flowbeast]

FKKFUCI Patient Turning Aid Pad Turning Device U Type, Turning Care Aid PU Leather, Multifunctional Bedridden Senior/Patient Turner U-Turn Turner for Paralyzed Patients,Leather Price: [price_with_discount] Customer satisfaction rating (according to Amazon product Details) The patient turner is specially designed for turning and repositioning patients/elderly, which can help patients in simple bed rest and spinal correction exercises. It can prevent muscle atrophy caused by prolonged bed rest and make the condition worse. This reversible pillow is a great help for caregivers.Provide considerate services for people who cannot care for themselves and for sick patients. In addition, bedridden, deaf or disabled patients are cared for, as well as paralyzed postoperative patients. It is also suitable for nursing in hospital wards, nursing homes and homes, making beds more comfortable and nursing staff more comfortable.Our swivel device allows the patient to lie on his side, which normalizes blood circulation and speeds up the healing process.Simple and effective care, our rotating pillows are easy to use and can help patients turn over with just one caregiver.specificationDimensions: 450mm x 430mm x 130mm / 17.7"*16.9"*5.1"Surface material: leatherInternal material: high-density, high-hardness sponge, special processing of high-density, low-elasticity spongeBrown colorWeight: 800 gramspacking list:1 * patient rotator [EASY TO TURN]: Easy to use. There are two handrails at each end. Put the upper part of the knee into the two slots on the product, which can be easily pulled to help the elderly to roll over. The power steering can be operated by one person, which relieves the family. The sides are extended and curved to prevent the legs from slipping. [HIGH-QUALITY MATERIAL]: High-density sponge is used, which is delicate, soft, comfortable to wear, and not easily deformed. Long-term use will not be deformed. A certain degree of flexibility can prevent injury or disease in the older legs. The waterproof PU leather surface can prevent moisture and protect the health of the elderly. [EXERCISE SUPPORT]: The patient rotating device can help the patient to do simple bed rest exercises and correct the spine. The patient puts both legs on the rotating pad and swings to the left and right to prevent muscle atrophy caused by prolonged bed rest and aggravate the patient's condition. [HELP THE ELDERLY STAND UP EASILY AND SAFELY]: The patient turner is suitable for obese patients, cognitive dysfunction such as general anesthesia, limb movement disorders, craniotomy, spinal surgery and other difficult to turn and bedridden patients. [REDUCE THE NUMBER OF CHANGES]: Arrange the clothes/sheets, clean the body, change diapers, reduce the difficulty of excretory care when going to the potty, change posture easily, reduce pressure sores, and reduce the pain of patients. #FKKFUCI #Patient #Turning #Aid #Pad #Turning #Device #Type #Turning #Care #Aid #Leather #Multifunctional #Bedridden #SeniorPatient #Turner #UTurn #Turner #Paralyzed #PatientsLeather See more related items: FKKFUCI Patient Turning Aid Pad Turning Device U Type, Turning Care Aid PU Leather, Multifunctional Bedridden Senior/Patient Turner U-Turn Turner for Paralyzed Patients,Leather Read More: This site is affiliated with Amazon

[tylerscottpupper-blog]

Critical Suggestions About Furnace Installation

If you're upgrading from Windows 8.1, you may have already installed Windows Store apps. If you're upgrading from Windows 7, the Windows Store is new and so are its apps. If you are considering developing and delivering a training program for your organization, here's the first step! There are certain words that register to the heart directly, such as “amazing” and “wonderful.” These are words that you feel first or associate with something before you think about what they actually mean. A possible exception is cognitive impairment lasting beyond the first couple days after surgery, known as postoperative cognitive dysfunction (POCD). These are just but a couple of suggestions that I have for you. Yes, absolutely out of the world the users relish experience and all of these happy users have rated the commodity to be number one in the market as of now; choose to place your orders online too, now, here. If you happen to experience any of these symptoms, please refer to your doctor immediately. With all the modifications, there is bound to be anxiety. Author's Bio: Sam Collier is a senior research writer and provide help for observation essay and observation essays.Feel free to contact for any sort of help in this regard. Author's Bio: Aislinn O'Connor is a motivational writer and audio producer. Author's Bio: Charles Martin is a genius who writes interesting and thought provoking content on a interview tips. Being disappointed from lots of rejections, canadian pharmacy online 24 candidate may get over conscious about answering the questions and this may lead to poor performance in the interview. The melancholy fears being out of control of situations and the Sanguine has quick, hot flashes of anger that pass as quickly as they start. Because of the critical nature of the melancholy they may be very difficult to please. Learning to improve your writing skills is not as difficult as it may seem. Here are 5 suggestions you can put to use immediately to help you 'demystify' the writing process and make your efforts easier and more productive. This leads to the conclusion that what we call our subjective mind is really the use that we, as individuals, make of something which is universal. The error margin can be very low because limits can be set in software by putting in choices, suggestions and error messages etc. This allows for more precise and clear data which results in an equally perfect information output. As you take suggestions from a nutritionist about your health, so why can't you take suggestion about your 'wealth' from right advisor. Understanding another's temperament can help you adapt your communication to theirs or, at the least, understand why you have problems with them. One temperament type is dominant and one is secondary. Factually, no one can argue that point. 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Q - Was my preparation about the job profile or company knowledge poor? The perfect steps to burning fat quicker include exercise, eat healthy meals, and detoxify your computer to support you with your fat reduction progress. In beginning fat burning, it is best to decide on a sport which you enjoy and consider joining the local gym or purchasing training equipment just to be in a position to exercise. Aside from eating healthily and exercising, a detoxification process can even help your entire body burn unwanted weight quicker. In the event you cannot work out your differences, counseling can help. This not only gives them a reason to give you their name and e-mail but keeps your art in front of them when they work on their computer. Dr. Infande also serves as a University Professor where he teaches courses in Human Resources Management. If you are looking for actually inexpensive car insurance, ensure that you collect quotes and look in the car insurance price assessment graphs provided by a minimum of 4 - 5 web sites. One of the benefits of using your PowerPoint slides to just reinforce your key points is that they cannot substitute for your notes. One duct is primarily responsible to transfer each of the heat and warm air to the targeted places and rooms, while on the other hand, the second duct returns back with all of the cold air in it.

[biomedgrid]

Biomed Grid | Postoperative Cognitive Decline

Opinion

Post-operative cognitive decline (POCD), described many years ago [1], remains a challenge for all physicians who care for elderly patients. A lot of work has been done in this area but investigators need to be mindful about incorporating some basic precepts into their research protocols. While central nervous system dysfunction after surgery and anesthesia has been described to occur, especially in older adults, it is important to bear in mind that, as Silverstein and colleagues [2] point out, any illness requiring hospitalization may be associated with cognitive decline. This introduces the possibility that cognitive decline occurs as a concomitant of generalized illness rather than being causally related to surgery and anaesthesia and speaks to the need for not only age-matched controls but also disease-matched and hospitalization-matched clinical cohorts, as well. Another confounder of the correlation between POCD and mortality reported by Monk and colleagues 3] is the observation made by a number of investigators that cognitive decline itself increases the risk of mortality in older adults [4,5]. As suggested by Newman and colleagues [6], the very term POCD as a binary definition of what may be, in reality, a continuous process may require modification to reflect the necessity of examining cognitive change as a continuum that marches through discrete events such as surgery and anesthesia. This will necessarily influence the methodology by which changes in test performance are analyzed.

Of major but little-recognized importance is the 15-minute neurological examination developed by Inzitari and colleagues [7] to elicit subtle but clinically detectable neurological abnormalities (SNAs). These SNAs are defined as abnormalities demonstrated in the absence of patient complaints which are also not associated with any neurological disease. Follow-up examination at four and eight years revealed that patients who had three or more SNAs at initial evaluation had an increased risk of cognitive decline, cerebrovascular events, and death, possibly because the SNAs signaled a concomitant decline in cognitive reserve [8]. The authors did not track whether patients had had surgery and anesthesia during the follow-up period. In light of the progression of the otherwise non-detected neurological deterioration demonstrated by Inzitari and colleagues [7], it is therefore essential that studies of POCD include a uniform neurological examination of all patients and control subjects. The neurological examination must have good inter-rater agreement and reproducibility. Without prior knowledge of SNAs, it is impossible to assign causation to the cognitive dysfunction that may occur after surgery and anesthesia. Is it the normal progression of a condition, however subtle, present preoperatively or is it the effect of surgery and anesthesia alone or have surgery and anesthesia worked in some way to hasten the progression of the preoperatively present condition? Clearly, whatever else the experimental protocols include to achieve uniformity and facilitate inter-study comparison (age- and disease-matched controls in every study and uniformity of operation, anesthesia, neuropsychological evaluation tools, testing intervals, statistical analysis, control subjects), neurological examination for both gross and subtle neurological abnormalities must be included too.

Even in the absence of POCD study protocols, preoperative information about SNAs would facilitate the discussion of informed consent when older adults are contemplating surgical procedures as neurological abnormalities, even in the absence of overt symptoms, have been correlated with POCD [3]. It may thus be advisable for an SNA “score,” as developed by Inzitari and colleagues [7] with their brief neurological examination, to be included with the other vital signs measured in older adults before surgery. Clinicians can work to mitigate some of the risk factors associated with POCD. For example, postoperative delirium [9], a correlate of POCD [10], is associated with increased intraoperative blood loss and postoperative transfusions, a postoperative hematocrit of less than 30%, and severe postoperative pain. The Hospital Elder Life Program has also developed interventions to decrease the incidence and severity of delirium. These include the frequent presentation of orienting information, physical activity, cognitive stimulation activities, use of visual aids and auditory amplifying devices, sleep inducement through non-pharmacological methods, assistance with alimentation, geriatric-psychiatric consultations, and patient and family education. The risk of delirium has been shown to be reduced using these techniques [11,12] and thus perhaps the incidence of POCD.

Read More About this Article: https://biomedgrid.com/fulltext/volume4/postoperative-cognitive-decline.000806.php

For more about: Journals on Biomedical Science :Biomed Grid | Current Issue

[falgunikurian]

Top 5 Things You Should Know About Anesthesia

Anesthesia is a medical treatment that prevents the patient from feeling pain during the surgery. The medication is safe and is infused intravenously in the body before surgery. A specialist known as Anesthesiologist gives you anesthesia and takes care of you before, during, and after surgery. To brief the mechanism of anesthesia, anesthesia works by interrupting the nerve signals in the brain and body. Various medicines that are infused intravenously help induce sleep. Today, anesthesia works to achieve four goals, to make sure that you have no pain, that you're asleep or unconscious, that your body doesn’t move so that the surgery can be performed on it, and that you aren't left with any sign of an unpleasant memory of the procedure. Read on to know about the various types of Anesthesia, its uses, symptoms, and complications.

1. What are the Types of Anesthesia?

Unless you've made it through life without extracting your wisdom teeth or had an injury needing stitches, you've definitely had local anesthesia. Local anesthetic medicines are administered near the area to be treated, and their results are limited to only a small area. Typically, they are provided by a professional nurse, dentist, or doctor who must ensure the region is numb. In reality, giving local anesthesia does not necessitate specialized training. Although you may not feel pain with local anesthesia, you may feel some symptoms of pressure. If that causes discomfort, ask your Anaesthetic Doctor  for a sedative to ease your worry.

Local anesthetics are administered via regional anesthesia near nerve clusters to numb a wider area, or region, of the body to manage pain. A common example is hand surgery where, depending on the type of numbing medication used, a shot of numbing medication near the nerves in the armpit can help make the whole arm go numb for three to 24 hours.

Neuraxial anesthesia involves spinal and epidural anesthetics. Numbing medication is positioned near the spinal roots in neuraxial anesthesia, leaving an even greater portion of the body numb than regional anesthesia does. Epidurals are generally prescribed to manage labor and childbirth pain, or pain caused by a broad incision of the abdomen. Spinals that block the abdominal and lower body sensations are frequently used for cesarean sections and knee surgeries. 

It’s surprising to note that with regional and neuraxial anesthesia, you will be able to choose how conscious you are during the operation. You'll be comfortable with limited sedation but you will be mindful of what's going on. Moderate sedation will put you under a "twilight sleep," in which you drift into and out of consciousness but can easily be aroused. You are practically fast asleep with deep sedation and are unable to recall anything.

General anesthesia affects the whole body and leaves patients unconscious and unable to move. They may have difficulty remembering things once it wears off. This is used by surgeons when operating on internal organs and for other invasive or time-consuming procedures like back surgery. Many major, life-saving operations will not be feasible without general anesthesia. This includes open-heart surgery, brain surgery, and organ transplants. 

Physicians administer general anesthetic either directly (intravenously) into the bloodstream, or as a gas which is inhaled by the patient. General intravenously injected anesthesia works rapidly and easily vanishes from the body. It helps patients to return home faster following surgery. Anesthetics inhaled can take longer to wear off. 

General anesthesia is usually safe. Age is an important factor for possible side effects. But for certain patients, such as the elderly or people with chronic illnesses like diabetes, they can pose risks. In certain patients, mostly children, side effects can also persist for many days and must be monitored carefully everyday. Though there are some risks, as with any medical procedure. Specialized doctors called anesthesiologists closely monitor unconscious patients to reduce these medical complications, and may change the amount of anesthetic they get. Patients may sometimes need additional therapy for health management. 

2. How to Plan your Anesthesia Procedure?

When you are having a procedure requiring regional, neuraxial, or general anesthesia, you may have a pre-operative consultation with an anesthesiologist, nurse, or physician assistant a few days before your operation. It 's important to let the doctor know all the medications you're taking everyday. You will also be asked whether you have ever had an adverse reaction to anesthesia and whether you have ever been reliant on drugs, alcohol, or other substances. The knowledge will help you determine the type of anesthesia you are getting. You should be able to select between regional, neuraxial, and general anesthesia for several procedures depending on your age. In certain cases, a combination may be a better option. For example, even if general anesthesia is required, a regional block or epidural can also be provided to help with pain management after surgery, minimizing the need for narcotic pain relievers when you recover. Using regional or neuraxial anesthesia often decreases the amount of general anesthesia you need, and thus side effects such as delirium, nausea, and delayed bowel and bladder function are less likely to manifest.

3. What does a Physician Anesthesiologist do? 

According to Mayo Clinic, your anesthesia team is responsible for overseeing all changes in your health condition and wellness including heart rate, blood pressure, and, in general, blood and oxygen delivery to your organs while at the same time keeping you unconscious and relaxed during your operation, so that you are pain-free and comfortable. Gradually the anesthetic will wear off and you'll wake up in the intensive care unit with improved health.

4. Will my mind work the same after being administered anesthesia? 

Postoperative cognitive dysfunction (POCD) is the term used to describe a potential loss in memory, quick reasoning, or behavioral changes that may be the outcome of a general anesthesia cardiac operation. Anesthesia Awareness Facts reveal that many patients can experience this health condition after surgery for a few days or weeks, but most are back to normal health within two to three months. Doctors from Cleveland recommend staying as healthy as possible before surgery, and get active quickly after the procedure to reduce the risk of infections and other overall complications to improve recovery speed.

5. Will I wake up in pain afterward? 

The comfort, wellness, and health of patients are top priorities for physician anesthesiologists. Some of the heavy pain medications slow your breathing, so they will balance medications to keep you relaxed while monitoring your respiratory functions. Physician anesthesiologists operate to relieve pain using a wide variety of medications, and they’ll try to alleviate the discomfort if you don't feel relaxed when you recover from anesthesia.

Conclusion

Today, most anesthesia wears off pretty fast, however, following surgery you can still feel groggy, have a loss of memory, or have poor judgment and have no idea what’s going on. For the first 24 hours after surgery, people are advised not to make any big life decisions or drive a car or run machinery. You may also be advised extra therapy. We suggest that you consult with your healthcare clinic’s anesthesia team openly about any questions or concerns you may have before the surgery.

[siva3155]

300+ TOP ANESTHESIA Interview Questions and Answers

ANESTHESIA Interview Questions for freshers experienced :-

1. Can You Die From General Anesthesia? “For a patient to die on the operating table is rare — but for patients with serious problems in their medical history, post-traumatic stress after a long operation can under some circumstances lead to death.” Complications relating to anesthesia are rare, and can usually be brought under control very quickly. 2. What Type Of Anesthesia Is Used During Surgery? General anesthesia. General anesthesia is an anesthetic used to induce unconsciousness during surgery. The medicine is either inhaled through a breathing mask or tube, or given through an intravenous (IV) line. A breathing tube may be inserted into the windpipe to maintain proper breathing during surgery. 3. What Are The Long Term Side Effects Of General Anesthesia? Side effects of general anesthesia include: temporary confusion and memory loss, although this is more common in the elderly. dizziness. difficulty passing urine. bruising or soreness from the IV drip. nausea and vomiting. shivering and feeling cold. sore throat, due to the breathing tube. 4. Can Anesthesia Cause Memory Problems? Why anesthetics cause prolonged memory loss. ... Until now, scientists haven't understood why about a third of patients who undergo anesthesia and surgery experience some kind of cognitive impairment -- such as memory loss -- at hospital discharge. One-tenth of patients still suffer cognitive impairments three months later ... 5. Can Anesthesia Cause Confusion? Rarely, general anesthesia can cause more serious complications, including: Postoperative delirium or cognitive dysfunction – In some cases, confusion and memory loss can last longer than a few hours or days. 6. Do You Stop Breathing During General Anesthesia? Breathing Tubes: During your surgery you will probably not need any breathing device other than an oxygen mask, if you are having local or regional anesthesia, or sedation. General anesthesia decreases your ability to breathe on your own, and anesthesiologists have several ways to assist your breathing. 7. How Long Does Anesthetic Take To Wear Off? We're often asked how long the numb feeling will last. With most anesthetics, the tooth will be numb for 1-2 hours your lips and tongue will be numb for 3-5 hours from the time of injection. The numb feeling goes away as the blood flow carries it away from the injection site to be broken down or metabolized. 8. Do You Dream When You Are Under Anesthesia? Of course dreaming isn't the only unusual thing that happens under general anesthesia. One might experience hallucinations or “intraoperative awareness” — a state of paralysis during which you see yourself undergoing surgery but are unable to move or speak. 9. Do All Anesthesia Put You To Sleep? General anesthesia is treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery. After you receive these medicines, you will not be aware of what is happening around you. 10. Do They Use Anesthesia For An Endoscopy? Propofol requires different patient monitoring during the procedure and, depending upon circumstances, may require anesthesia personnel, and so involve additional patient cost. Most of the time, the medicine is given through a vein. Some patients have their endoscopic procedures done without sedation.

ANESTHESIA Interview Questions 11. Can You Feel Pain During Anesthesia Awareness? The condition, called anesthesia awareness (waking up) during surgery, means the patient can recall their surroundings, or an event related to the surgery, while under general anesthesia. Although it can be upsetting, patients usually do not feel pain when experiencing anesthesia awareness. 12. What Are The Chances Of Dying From Anesthesia? “It varies depending on the kind of procedure and condition of the patient, but in general, it's extremely safe to go under general anesthesia— we're talking about having less than 1 in 10,000, maybe 1 in 100,000 chance for anything to happen from the anesthesia itself.” 13. Is Endoscopy A Painful Procedure? The endoscopy procedure. An endoscopy isn't usually painful, and most people only experience some mild discomfort, similar to indigestion or a sore throat. The procedure is usually carried out while you're conscious.The endoscope will be carefully inserted into your body. 14. How Rare Is Anesthesia Awareness? Several studies put the incidence of anesthesia awareness at 0.1% of all general anesthesia patients. That works out to be about 21,000 of the 21 million people in the U.S. who get general anesthesia in a typical year. ANESTHESIA Questions and Answers Pdf Download Read the full article

[clearslime]

POCD is postoperative cognitive dysfunction, nothing to do with what we're talking about.

do you realize that acronyms can have multiple meanings

[eathealthylivefree]

Postoperative Depression… the Struggle is Real

A year ago, I struggled with depression after a foot surgery. I experienced feelings of hopelessness, worthlessness, fatigue and overwhelm. I thought this had something to do with my reaction to my limitations after surgery: restricted mobility and not being able to work, etc. while I was healing. But when these same symptoms repeated a year later after a similar surgery (even with much quicker healing and return to work) I began to realize that depression may be related to the surgery itself. I investigated this phenomenon and found that postoperative depression is a very common occurrence. If this is so common, why didn’t anyone prepare me? In hopes that my experience might help someone else as they face or recover from a surgery… I’d like to share what I’ve learned…

Depression is a well-documented adverse effect of many surgical procedures. According to the American Heart Association, 25% of patients experience depression after cardiac surgery. Depression can result from a number a reasons, including pain and discomfort, decreased mobility, and increased dependency on others. For patients who have had a surgery to remove an organ or body part, a feeling of loss can also contribute to depression. In addition, the brain’s immune response to anesthesia and surgery can cause cognitive dysfunction.

Symptoms of postoperative depression may include:

fatigue

difficulty making decisions

memory problems

eating more or less than usual

sleeping more or less than usual

loss of interest in activities

irritability and restlessness

slower movement

slower speech

anxiety and stress

feelings of despair or hopelessness

suicidal or self-harming thoughts

Depression can also increase the risk of physical illness and slow the recovery from an injury or operation. Furthermore, depression after surgery can increase a patient’s perception of pain.

While it is normal to experience many of these symptoms after surgery, if they persist longer than two weeks, talk with your doctor. He or she may be able to prescribe a medication temporarily to help you feel more like yourself.

There are several things you can do to beat the post-surgery blues…

Take care of yourself

Ask for help

Spend time outdoors

Get enough sleep

Eat a healthy diet

Surround yourself with loved ones

Do something you enjoy

Ease SLOWLY back into routine

The American Heart Association (AHA) has resources including this pre-surgery checklist and postoperative recovery milestones. AHA offers these tips for recovering from surgery:

Manage Expectations – ask questions ahead of time to know what to expect for your recovery

Take it slow – if you push it too fast, you can slow your healing. Give your body and mind the time they need to heal

Move, but at your own pace – exercise can aid in healing, but only what your doctor has approved

Celebrate progress – while recovery can seem to take forever, a look back to see how far you have come can be encouraging.

If you or a loved one is facing surgery, learn as much as you can about the physical, and emotional effects of surgery in order to improve chances of feeling better while recovering.

Sources:

American Heart Association. (2019). Post Surgery Milestones: Managing Your Mood, Expectations and Goals The Emotions of Surgery Recovery. Retrieved from: https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/recovery-and-healthy-living-goals-for-heart-valve-patients/post-surgery-milestones-managing-your-mood-expectations-and-goals#.WSVLfBPyuu4

Chowdhurry, S., (2019, Feb 6). “Why Some People Get Depressed After Surgery—Even if They’ve Recovered Just Fine.” Retrieved from https://www.health.com/condition/depression/depression-after-surgery

Depression and postoperative complications: an overview. Ghoneim MM, O’Hara MW. BMC Surg. 2016;16:5. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736276/

Johnson, J. (2017, May 25). “Depression after surgery: What you need to know.” Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/317616.php.

Mirani, S. H., Areja, D., Gilani, S. S., Tahir, A., Pathan, M., & Bhatti, S. (2019). Frequency of Depression and Anxiety Symptoms in Surgical Hospitalized Patients. Cureus, 11(2), e4141. doi:10.7759/cureus.4141 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485537/

Writer: Shannon Carter, Ohio State University Extension, Fairfield County, carter.413@osu.edu

Reviewer: Misty Harmon, Ohio State University Extension, Perry County, harmon.416@osu.edu

from Live Healthy Live Well https://ift.tt/2UufG0r

[jendvmposts]

WSAVA 2019 Friday, Part 2

The Feline Anesthesia Enigma - this was a case-based presentation by Dr. Paulo Steagall, beginning with...

THE BLOCKED CAT - these guys have reduced GFR, hypothermia, hyperK, acidemia, and circulatory collapse - the hyperK and acidosis are the major concerns.

- get a catheter in and draw your bloodwork sample - he will typically bolus with NaCl, but LRS is fine (the K concentration is too low to make the hyperK worse), 10-20 ml/kg at a time according to need.  Rates will typically be 45-60 ml/hr when there’s obvious poor perfusion and severe dehydration, as long as there isn’t CVS disease.

- he won’t sedate/anesthetize the cat if the K is > 6 mEq/L - uses Ca gluconate to address the hyperK, if this is too short lived, will use dextrose and perhaps insulin.  Ideally, should have ECG in order to see the pattern normalize as the hyperK resolves

- sedates with a combo of torb and midazolam IV

- he likes to use propofol at a low dose, 1-2 mg/kg, usually followed by midazolam 0.25 mg/kg - doesn’t mix these in the same syringe.  The addition of midazolam as a co-induction drug allows you to reduce your propofol dose by 25%.  Obviously no ketamine, as this is excreted largely unchanged. 

- discussed the sacral-coccygeal epidural - 2% lido, 0.1-0.2 ml/kg, but this is risky if done before fluid therapy d/t autonomic effects leading to hypotension.

Sue Little is a proponent of therapeutic cystocentesis for pain relief before unblocking these cats - I am not sure how I feel about this.  I’ve never experienced bladder rupture in a cat and I never, ever want to!

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THE GIFB CAT:  uses an opioid in combination with incisional/intraperitoneal analgesia and avoids using NSAIDs - studies have shown there is a higher incidence of leakage when NSAIDs are given. IP bupivacaine will provide analgesia for up to 8 hrs.  He does this at the time of closing. He likes opioid or ketamine CRIs for these cats. Cautions that regurg can occur at the time of induction for these cats, so there is an enhanced risk of aspiration pneumo - care should be taken in how these cats are positioned during induction. Uses Cerenia 1 mg/kg IV.

____________

THE HYPERTHYROID (potentially aggressive cat you can’t get your hands on) going under for a dental tx:

- don’t use ketamine, as these cats already have higher sympathetic tone, and they don’t need a drug that will elevate HR more.

- likes Alfax + midazolam IM, sometimes uses a pure mu opioid like hydro or methadone

- likes Emla application to facilitate IVC placement

- for cats you can’t get your hands on, as a LAST resort - try OTM dexdomitor 30-40 ug/kg

- for acute pain: buprenorphine 0.02 mg/kg, but this should be used in a multimodal pain management plan

- there is nothing published yet, but pre-visit gabapentin doesn’t appear to change the physiologic parameters in these cats, so go ahead and use it

___________________

Dr. Steagall’s next presentation was Anesthetic Challenges in Geriatric Patients.

- there is an increased risk of GER in these patients (gastroesophageal reflux), obesity, CVS disease (assymptomatic valvular disease is present in 25% of dogs > 9 yrs), periodontal disease, reduced muscle mass (hypothermia risk increases), their pain inhibitory system is down-regulated, and they often have up to a 50% decrease in functional nephrons, so should be IRIS-staged.

- 30% of dogs > 8 yrs have changes related to cognitive dysfunction - I think we need to better educate our clients.  What we will see is a higher incidence of emergent delirium (huskies, dogs that start to flip over etc) and dysphoria (the constant vocalization) after anesthesia, so they need anxiolytics. He likes trazodone for these dogs as a PVP.  Dysphoria is often related to opioid overdose, so he will often give them some naloxone.  He’s a huge fan of the microdose of dexdom IV (0.5 to 1 ug/kg).

- avoid ace if there is liver disease, as it will take a long time to be metabolized, and if they become hypotensive, you will need higher doses of a pressor to address it.

- if DM, they should have 1/2 their insulin dose that day

- preoxygenate these dogs for at least 3 min prior to and during induction - this has been shown to prevent post-induction hypoxemia related to propofol or alfax - keep it going until you are able to intubate.

- he doesn’t use benzodiazepines in his premeds, but does use the midazolam as a co-induction agent with propofol or alfax as above.

- likes midazolam and fentanyl - these are very CVS-friendly drugs.

- he only uses anticholinergics to TREAT bradycardia, not to prevent it.

LUNCH and more time chatting with other vets and reps, plus collecting lots of free pens, lip balm, mints, treat bags, and even a beach ball (for Angus, I think). I finally found a couple of classmates of mine and did some catching up!

I sat in on Dr. Monteiro’s lecture on Treating Postoperative Abdominal Pain Using Intraperitoneal and Incisional Anesthesia, hoping to settle once and for all how incisional blocks should be performed.  IP blocks seem to do a better job at circumventing post op pain than the incisional blocks, so I’m going to begin doing them for my spays - calculating the total dose, using 1/4 of the volume for my incisional block, and reserving 3/4 of the volume for splash blocks onto both ovaries and the uterine body.  As for the incisional blocks, here’s how they recommend doing them at Ste. Hy:

https:youtu.be/76dwKuirqt0

Friday afternoon was spent in the WSAVA hereditary diseases stream - the lectures were: The Welfare Impact on Dogs When Breeding for Extreme Conformation with Dr. Megens from the Netherlands, followed by Sue Little’s lecture Brachycephaly and Other Breed-Associated Problems in cats. Very impactful presentations.

I had such a great time at WSAVA 2019!  Next year’s conference is in Warsaw, Poland!  I elected to head home a bit early on Fri., to hopefully avoid experiencing a parking lot on the DVP, so I left just after the 3:30pm coffee break.  Drive TO the city was just slightly over 4 hrs.  Drive home was 5 1/2 hrs! Max speed on the DVP was 60 KPH....

[ampkpropofolconsciousness]

Anesthetic drug & AMPK activator Propofol shown for the first time to excite neurons before loss & return of consciousness: Hypothesis substantiated

Source: By Lt.Cmdr. Jesse Ehrenfeld - https://www.army.mil/article/141145/anesthesiologists_keep_soldiers_safe_in_afghanistan, Public Domain, https://commons.wikimedia.org/w/index.php?curid=71554756

A recently published paper in December of 2018 in the journal Frontiers in Molecular Neuroscience demonstrated for the first time that the popular anesthetic drug and AMPK activator propofol (the anti-diabetic drug Metformin also acts via AMPK) paradoxically activated neurons in the brain of rats just before loss of consciousness and return of consciousness [3]. These results provide direct support and substantiate my previous hypotheses in which I proposed for the first time that low doses of anesthetic drugs including propofol promote paradoxical excitation in neurons before loss of consciousness and may potentially facilitate restoration of consciousness via cellular stress induction and AMPK activation (i.e. increases in calcium [Ca2+], reactive oxygen species [ROS]), etc.) [1,2].

As seen in the figure below, the authors showed that propofol induced an abrupt increase in Ca2+ levels and activated parabrachial nucleus (PBN) neurons in vivo just before loss of righting reflex (LORR, analogous to loss of consciousness in humans) and recovery of righting reflex (RORR, analogous to return of consciousness in humans) in rats [3]. Such evidence indicates that propofol is excitatory at low doses and promotes paradoxical excitation and possible facilitation of return of consciousness via cellular stress induction (i.e. Ca2+ and/or ROS), after the concentration of propofol decreases in the brain to a low, stimulatory level upon anesthetic removal [1,2].

Source: See Reference #3

During the initial period of general anesthesia, known as induction, a bolus dose of an anesthetic drug is administered that leads to loss of consciousness as evidenced by a lack of response to an oral command [1]. However, an intriguing phenomenon known as paradoxical excitation may also occur after initial administration of an anesthetic drug [1]. When administered at a low dose, nearly every anesthetic induces behavioral signs of neuronal activation such as eccentric body movements and a transient increase in beta activity (13–25 Hz) on the electroencephalogram (EEG) [1]. Consequently, many anesthetics appear to paradoxically excite the brain before inducing unconsciousness [1]. Anesthesiologists and neuroscientists are currently unable to explain how anesthetics are able to induce paradoxical excitation.

However, as noted in the figure above, the increase in Ca2+ levels in PBN neurons just before LORR in rats is analogous to paradoxical excitation in humans demonstrated by several anesthetics, including propofol [4]. PBN neurons have also been shown to play critical role in maintaining consciousness [9].  In addition to behavioral signs of neuronal activation, an increase in EEG beta power has also been observed during paradoxical excitation and just before return of consciousness in humans [4,5]. Because propofol increased Ca2+ levels and activated PBN neurons just before both LORR and RORR, propofol is likely excitatory at low doses and promotes paradoxical excitation and possible facilitation of return of consciousness via cellular stress induction. This notion is in line with the recent findings that lower concentrations of anesthetics are present in the brain during emergence from general anesthesia compared to the initial induction phase [6,7]. Additionally, activation of glutamatergic neurons in the PBN accelerates emergence from sevoflurane anesthesia in mice and lesions in the PBN leads to a coma-like state in rats, indicating that low doses of propofol and other anesthetics may also paradoxically facilitate return of consciousness in disorders of consciousness (e.g. coma) [8,9].

Preconditioning refers to the exposure of a cell or an organism to a mild or sublethal stressor that leads to an adaptive response and protection against a subsequent and potentially lethal application of the same or a similar stressor [1]. Interestingly, propofol and many other anesthetics used clinically act as preconditioning agents at low doses and transient increases in intracellular ROS, Ca2+, and AMPK activation exert preconditioning effects in various cell types (e.g. neurons), suggesting that paradoxical excitation is analogous to both the increase in Ca2+ in PBN neurons just before RORR and preconditioning [10-15].

Anesthetic-induced paradoxical excitation has also been demonstrated in non-mammalian organisms, with exposure of the nematode C. elegans to volatile anesthetics initially resulting in a paradoxical increase in movement, later followed by a progressive lack of coordination, immobility, and ultimately unresponsiveness [16,17]. Loss of neural AMPK (aak-2 in C. elegans) inhibits movement whereas isoflurane acts as a preconditioning agent in C. elegans [18,19]. Additionally, the anesthetic drug diethyl ether was recently shown to induce a “sedation-like” effect in plants, epitomized by a lack of response to a stimulus that normally induces movement in the Venus flytrap [20]. Preliminary data however demonstrated that the production of ROS by cold (i.e. room-temperature) plasma induced activation and trap closing of the Venus flytrap [21], suggesting that a common mechanism of cellular stress-induced AMPK activation crosses species boundaries and underlies the phenomenon of anesthetic-induced paradoxical excitation.

Anesthetics and increases in ROS have also been shown to promote seed germination (analogous to paradoxical excitation) and AMPK (SnRK1 in plants), ROS, and Ca2+ promotes pollen germination and fertilization in Arabidopsis thaliana [22-25]. Also, although they do not have a nervous system, plants produce nearly all neurotransmitters (i.e. glutamate, acetylcholine, histamine, dopamine, serotonin and norepinephrine) that are critical for maintaining consciousness in humans and biotic and abiotic stressors have been well-described to increase the production and activity of these neurotransmitters in plants [26-28]. As several neurotransmitters that play key roles in human consciousness also act as preconditioning agents (i.e. glutamate, acetylcholine, histamine, dopamine, and norepinephrine), a common mechanism of cellular stress-induced AMPK activation by neurotransmitters may have been evolutionarily conserved to promote neuronal activation in the human brain [29-33].

AMPK, known as the master regulator of cellular metabolism, increases lifespan and healthspan in several model organisms, is present throughout the mammalian brain (e.g. neurons of the thalamus, hypothalamus, striatum, hippocampus, and cortex), and is activated by cellular stress (i.e. increases in ROS, Ca2+, AMP/ATP ratio, etc.) [34-37]. AMPK is also activated by nearly all neurotransmitters that play a critical role in maintaining consciousness (glutamate, acetylcholine, histamine, orexin-A, dopamine, and norepinephrine) as well as by several anesthetic drugs that are commonly used to induce and/or maintain loss of consciousness in humans (e.g. propofol, sevoflurane, isoflurane, ketamine, dexmedetomidine, and midazolam) [38-50]. Indeed, propofol has been shown to inhibit mitochondrial electron transport chain function and increase ROS levels in human neuroblastoma SH-SY5Y cells, effects that were enhanced via the addition of the AMPK activator metformin [51]. Metformin also promotes neurogenesis in both the subventricular zone and the dentate gyrus in vitro and in vivo, potentially enhancing brain repair and recovery from disorders of consciousness (e.g. coma) [52-55].

Interestingly, as long-term potentiation (LTP) is considered the cellular correlate for learning and memory, ROS inhibition prevents LTP in vitro and AMPK knockdown severely impairs hippocampal CA1 LTP and blocks long-term memory formation in mice (as I first hypothesized), indicating that cellular stress-induced AMPK activation is not only required for learning and memory, but may also play an indispensable role in the neural correlates of consciousness [56-58]. Indeed, AMPK has recently been shown to improve postoperative cognitive dysfunction in sevoflurane-anesthetized rats [59]. Overexpression of AMPKα1 upregulated the expression of phosphorylated/activated AMPK in the hippocampus of rats anesthetized with sevoflurane and also decreased escape latencies, increased target quadrant swimming times, swimming distances, and platform crossing times during Morris water maze tests. The AMPK inhibitor compound C however abolished AMPKα1-mediated improvement of postoperative cognitive dysfunction [59].

Lastly, as noted in my most recent publication, cellular stress and AMPK activation may link human consciousness with seemingly disparate physiological and pathophysiological phenomena, including aging (metformin and AMPK alleviate accelerated aging), human reproduction (stress and AMPK are critical for oocyte maturation and sperm acrosome reaction), gene regulation (e.g. transposable elements, stress beneficially activates “jumping genes” in human cells), plasma medicine (cold plasma induces beneficial effects in cells by increasing ROS), meditation (meditation increases genes in the AMPK signaling pathway in humans), parabiosis (i.e. young blood, young plasma activates AMPK), planarian regeneration (stress and AMPK play crucial roles in regeneration of worm body parts), and stress-induced CRISPR-Cas activation in bacteria (e.g. gene editing technology, various stressors including nutrient starvation and temperature stress activate CRISPR-Cas systems in bacteria) [60-70].

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[jesseneufeld]

Reducing your risk of changes in thinking following surgery

Cognition is an important function of the brain that enables us to acquire and process information, to enhance our understanding of thoughts, experiences, and our senses. Any condition that affects our ability to think, reason, memorize, or be attentive affects our cognitive ability. Some cognitive decline is a normal part of aging, but there are many things you can do to prevent or forestall cognitive changes as you age, including when planning for surgery.

Older adults are having more surgical procedures

As our population ages and medicine and healthcare advances, more older adults are likely to develop serious conditions (like heart problems) and undergo surgical procedures to treat or manage these conditions. Recent surveys suggest that progress in surgical techniques and control of anesthesia has increased surgical procedures in older people, with approximately 30% of all surgeries being conducted in people over the age of 70.

While advances in medicine may help people live longer, older adults are more likely to develop complications due to surgery. Some research suggests approximately one-quarter of those over 75 undergoing major surgery will develop significant cognitive decline, and about half of those people will suffer permanent brain damage.

Why do surgery and anesthesia cause problems with thinking for older adults?

There are degenerative changes in the brain with aging that predispose people to cognitive changes from surgery. Hence, age is a risk factor that needs to be considered when making decisions about surgery. Education level, mental health, and pre-existing medical conditions are also factors that affect an older person’s postsurgical cognitive functioning. People with higher levels of education tend to have more active brains due to regular mental stimulation. Mental and social activities promote brain health and decrease the risk of dementia and cognitive decline with normal aging.

Pre-existing medical conditions such as obesity, hypertension, coronary artery disease, diabetes, chronic kidney disease, stroke, and dementia predispose older adults undergoing surgery to more risk of postoperative cognitive decline. The reason these diseases cause cognitive decline is related to systemic inflammatory markers in the blood — proteins that are released into the bloodstream as a result of inflammation in the body. These markers enter the brain following a break in the blood-brain barrier (protective membrane) during the postoperative period, resulting in inflammation in the brain. This blood-brain barrier dysfunction is frequently seen in older people (even in the absence of surgery), and has been seen in approximately 50% of patients undergoing cardiac surgery.

Does the type of surgery and anesthesia matter?

Many surgical factors and techniques, blood pressure fluctuations during surgery, and longer time in surgery can adversely affect the cognitive function of older patients. Each factor affects cognitive functioning in a unique way. Younger patients tend to respond better to surgical stresses compared to older people.

Minor surgical procedures such as skin biopsies, excision of cysts, suturing of lacerations, and related procedures performed on an outpatient basis are unlikely to result in cognitive decline. However, as the complexity of a surgical procedure increases, with longer operative periods and greater exposure to more anesthesia medication, the likelihood of postoperative cognitive decline increases. This is especially true for cardiac surgery.

Studies suggest that incidence of postoperative cognitive decline is approximately 30% to 80% after cardiac surgery, while for noncardiac surgeries the prevalence is approximately 26%. While all major surgeries (such as orthopedic, abdominal, or gynecological) pose a risk for cognitive decline, cardiac surgeries have a much higher proportion of cognitive decline after surgery. The most common determinants of cognitive decline involving cardiac surgical procedures are the presence of pre-existing cognitive dysfunction and the use of bypass machines to replace the function of the heart and lungs during the surgery.

Anesthesia management before and during surgery affects what happens after surgery

The perioperative period refers to the time span of a surgical procedure, and includes three phases: preoperative, operative, and postoperative. Anesthesia management encompasses all three phases. The type and dose of anesthesia medication, the use of opioid analgesics, fluid, and glucose management can all influence a person’s cognitive function in the perioperative period. The use of multimodal anesthesia (where a combination of intravenous medications is used, instead of only inhaled agents) may protect against some cognitive dysfunction, as may using non-opioid analgesics for pain management in the postoperative period.

Are there strategies to avoid cognitive decline in the postoperative period?

Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure.”  No other condition exemplifies this saying better than preventing postoperative cognitive decline.

The following are some strategies you and your caregivers can use to prepare for surgery.

Before surgery is scheduled:

Eat healthy, balanced meals. Foods rich in polyunsaturated fatty acids are protective for your brain health.

Exercise regularly, or as much as allowed by your cardiac conditions. Physical activity promotes brain health.

Maintain a healthy weight.

Remain socially active and connected.

Reduce stress. Meditation significantly reduces stress and promotes a sense of calm and overall well-being.

Practice good sleep habits and try to get six to eight hours of sleep a night.

When surgery is scheduled:

Schedule a comprehensive geriatric assessment. This enables your physician to diagnose reversible aspects of frailty preoperatively (if they exist) and take adequate measures in a timely manner, such as altering medications you may be taking, and/or postponing surgery if you are extremely frail, to improve nutrition and incorporate lifestyle changes.

Talk to your surgeon about the risks and complications of the procedure. If you are having heart surgery, ask if a cardiopulmonary bypass machine will be used, and whether it is important to your surgery.

Talk to your anesthesiologist about

The types of medications they plan to use, and if there are alternatives for those medications. Have a conversation about need for opioid analgesics, and if alternative non-opioid pain medication can be used to decrease the risk of postoperative cognitive decline.

The methods of measuring medications that can reduce your risk of cognitive changes. For example, use of EEG machines during surgical procedures enhances the anesthesiologist’s ability to monitor the depth of anesthesia. Anesthesia depth is the degree to which the central nervous system is depressed by an anesthetic medication. EEG monitoring will result in adequate usage of anesthetic agents, avoid overuse, and reduce risk for postoperative cognitive decline by reducing anesthesia exposure.

Gather relevant information on your perioperative management. Discuss which medications you currently take and should continue taking, and which ones should be avoided.

After surgery and during recovery:

Make sure you have adequate control of pain with medications, and consider trying mind-body therapies, including meditation.

Keep active (walking, physical therapy, rehab), which prevents postoperative complications.

Have friends and family around to enhance recovery and provide social stimulation.

Practice behaviors that are help improve sleep, even when you’re recovering in the hospital.

Caregivers need to be informed about the need for keeping their loved one active and following physical rehab recommendations, and providing mental stimulation in the postoperative period. Puzzles, sudoku, board games, books, etc., will keep someone entertained while simultaneously providing them with some brain activity.

Finally, it is necessary to understand that although there is no cure for postoperative cognitive decline, preventive strategies and pre-planning with your team of surgeons, anesthesiologists, and geriatricians can help reduce the risks of cognitive problems that older adults often face following surgery.

References

Impact of frailty on outcomes in surgical patients: A systematic review and meta-analysis. The American Journal of Surgery, August 2019.

Postoperative cognitive dysfunction — current preventive strategies. Clinical Interventions in Aging, November 8, 2018.

Neurocognitive Function after Cardiac Surgery: From Phenotypes to Mechanisms. Anesthesiology, October 2018.

The post Reducing your risk of changes in thinking following surgery appeared first on Harvard Health Blog.

Reducing your risk of changes in thinking following surgery published first on https://drugaddictionsrehab.tumblr.com/

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Cognition is an important function of the brain that enables us to acquire and process information, to enhance our understanding of thoughts, experiences, and our senses. Any condition that affects our ability to think, reason, memorize, or be attentive affects our cognitive ability. Some cognitive decline is a normal part of aging, but there are many things you can do to prevent or forestall cognitive changes as you age, including when planning for surgery.

Older adults are having more surgical procedures

As our population ages and medicine and healthcare advances, more older adults are likely to develop serious conditions (like heart problems) and undergo surgical procedures to treat or manage these conditions. Recent surveys suggest that progress in surgical techniques and control of anesthesia has increased surgical procedures in older people, with approximately 30% of all surgeries being conducted in people over the age of 70.

While advances in medicine may help people live longer, older adults are more likely to develop complications due to surgery. Some research suggests approximately one-quarter of those over 75 undergoing major surgery will develop significant cognitive decline, and about half of those people will suffer permanent brain damage.

Why do surgery and anesthesia cause problems with thinking for older adults?

There are degenerative changes in the brain with aging that predispose people to cognitive changes from surgery. Hence, age is a risk factor that needs to be considered when making decisions about surgery. Education level, mental health, and pre-existing medical conditions are also factors that affect an older person’s postsurgical cognitive functioning. People with higher levels of education tend to have more active brains due to regular mental stimulation. Mental and social activities promote brain health and decrease the risk of dementia and cognitive decline with normal aging.

Pre-existing medical conditions such as obesity, hypertension, coronary artery disease, diabetes, chronic kidney disease, stroke, and dementia predispose older adults undergoing surgery to more risk of postoperative cognitive decline. The reason these diseases cause cognitive decline is related to systemic inflammatory markers in the blood — proteins that are released into the bloodstream as a result of inflammation in the body. These markers enter the brain following a break in the blood-brain barrier (protective membrane) during the postoperative period, resulting in inflammation in the brain. This blood-brain barrier dysfunction is frequently seen in older people (even in the absence of surgery), and has been seen in approximately 50% of patients undergoing cardiac surgery.

Does the type of surgery and anesthesia matter?

Many surgical factors and techniques, blood pressure fluctuations during surgery, and longer time in surgery can adversely affect the cognitive function of older patients. Each factor affects cognitive functioning in a unique way. Younger patients tend to respond better to surgical stresses compared to older people.

Minor surgical procedures such as skin biopsies, excision of cysts, suturing of lacerations, and related procedures performed on an outpatient basis are unlikely to result in cognitive decline. However, as the complexity of a surgical procedure increases, with longer operative periods and greater exposure to more anesthesia medication, the likelihood of postoperative cognitive decline increases. This is especially true for cardiac surgery.

Studies suggest that incidence of postoperative cognitive decline is approximately 30% to 80% after cardiac surgery, while for noncardiac surgeries the prevalence is approximately 26%. While all major surgeries (such as orthopedic, abdominal, or gynecological) pose a risk for cognitive decline, cardiac surgeries have a much higher proportion of cognitive decline after surgery. The most common determinants of cognitive decline involving cardiac surgical procedures are the presence of pre-existing cognitive dysfunction and the use of bypass machines to replace the function of the heart and lungs during the surgery.

Anesthesia management before and during surgery affects what happens after surgery

The perioperative period refers to the time span of a surgical procedure, and includes three phases: preoperative, operative, and postoperative. Anesthesia management encompasses all three phases. The type and dose of anesthesia medication, the use of opioid analgesics, fluid, and glucose management can all influence a person’s cognitive function in the perioperative period. The use of multimodal anesthesia (where a combination of intravenous medications is used, instead of only inhaled agents) may protect against some cognitive dysfunction, as may using non-opioid analgesics for pain management in the postoperative period.

Are there strategies to avoid cognitive decline in the postoperative period?

Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure.”  No other condition exemplifies this saying better than preventing postoperative cognitive decline.

The following are some strategies you and your caregivers can use to prepare for surgery.

Before surgery is scheduled:

Eat healthy, balanced meals. Foods rich in polyunsaturated fatty acids are protective for your brain health.

Exercise regularly, or as much as allowed by your cardiac conditions. Physical activity promotes brain health.

Maintain a healthy weight.

Remain socially active and connected.

Reduce stress. Meditation significantly reduces stress and promotes a sense of calm and overall well-being.

Practice good sleep habits and try to get six to eight hours of sleep a night.

When surgery is scheduled:

Schedule a comprehensive geriatric assessment. This enables your physician to diagnose reversible aspects of frailty preoperatively (if they exist) and take adequate measures in a timely manner, such as altering medications you may be taking, and/or postponing surgery if you are extremely frail, to improve nutrition and incorporate lifestyle changes.

Talk to your surgeon about the risks and complications of the procedure. If you are having heart surgery, ask if a cardiopulmonary bypass machine will be used, and whether it is important to your surgery.

Talk to your anesthesiologist about

The types of medications they plan to use, and if there are alternatives for those medications. Have a conversation about need for opioid analgesics, and if alternative non-opioid pain medication can be used to decrease the risk of postoperative cognitive decline.

The methods of measuring medications that can reduce your risk of cognitive changes. For example, use of EEG machines during surgical procedures enhances the anesthesiologist’s ability to monitor the depth of anesthesia. Anesthesia depth is the degree to which the central nervous system is depressed by an anesthetic medication. EEG monitoring will result in adequate usage of anesthetic agents, avoid overuse, and reduce risk for postoperative cognitive decline by reducing anesthesia exposure.

Gather relevant information on your perioperative management. Discuss which medications you currently take and should continue taking, and which ones should be avoided.

After surgery and during recovery:

Make sure you have adequate control of pain with medications, and consider trying mind-body therapies, including meditation.

Keep active (walking, physical therapy, rehab), which prevents postoperative complications.

Have friends and family around to enhance recovery and provide social stimulation.

Practice behaviors that are help improve sleep, even when you’re recovering in the hospital.

Caregivers need to be informed about the need for keeping their loved one active and following physical rehab recommendations, and providing mental stimulation in the postoperative period. Puzzles, sudoku, board games, books, etc., will keep someone entertained while simultaneously providing them with some brain activity.

Finally, it is necessary to understand that although there is no cure for postoperative cognitive decline, preventive strategies and pre-planning with your team of surgeons, anesthesiologists, and geriatricians can help reduce the risks of cognitive problems that older adults often face following surgery.

References

Impact of frailty on outcomes in surgical patients: A systematic review and meta-analysis. The American Journal of Surgery, August 2019.

Postoperative cognitive dysfunction — current preventive strategies. Clinical Interventions in Aging, November 8, 2018.

Neurocognitive Function after Cardiac Surgery: From Phenotypes to Mechanisms. Anesthesiology, October 2018.

The post Reducing your risk of changes in thinking following surgery appeared first on Harvard Health Blog.

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Reducing your risk of changes in thinking following surgery

Cognition is an important function of the brain that enables us to acquire and process information, to enhance our understanding of thoughts, experiences, and our senses. Any condition that affects our ability to think, reason, memorize, or be attentive affects our cognitive ability. Some cognitive decline is a normal part of aging, but there are many things you can do to prevent or forestall cognitive changes as you age, including when planning for surgery.

Older adults are having more surgical procedures

As our population ages and medicine and healthcare advances, more older adults are likely to develop serious conditions (like heart problems) and undergo surgical procedures to treat or manage these conditions. Recent surveys suggest that progress in surgical techniques and control of anesthesia has increased surgical procedures in older people, with approximately 30% of all surgeries being conducted in people over the age of 70.

While advances in medicine may help people live longer, older adults are more likely to develop complications due to surgery. Some research suggests approximately one-quarter of those over 75 undergoing major surgery will develop significant cognitive decline, and about half of those people will suffer permanent brain damage.

Why do surgery and anesthesia cause problems with thinking for older adults?

There are degenerative changes in the brain with aging that predispose people to cognitive changes from surgery. Hence, age is a risk factor that needs to be considered when making decisions about surgery. Education level, mental health, and pre-existing medical conditions are also factors that affect an older person’s postsurgical cognitive functioning. People with higher levels of education tend to have more active brains due to regular mental stimulation. Mental and social activities promote brain health and decrease the risk of dementia and cognitive decline with normal aging.

Pre-existing medical conditions such as obesity, hypertension, coronary artery disease, diabetes, chronic kidney disease, stroke, and dementia predispose older adults undergoing surgery to more risk of postoperative cognitive decline. The reason these diseases cause cognitive decline is related to systemic inflammatory markers in the blood — proteins that are released into the bloodstream as a result of inflammation in the body. These markers enter the brain following a break in the blood-brain barrier (protective membrane) during the postoperative period, resulting in inflammation in the brain. This blood-brain barrier dysfunction is frequently seen in older people (even in the absence of surgery), and has been seen in approximately 50% of patients undergoing cardiac surgery.

Does the type of surgery and anesthesia matter?

Many surgical factors and techniques, blood pressure fluctuations during surgery, and longer time in surgery can adversely affect the cognitive function of older patients. Each factor affects cognitive functioning in a unique way. Younger patients tend to respond better to surgical stresses compared to older people.

Minor surgical procedures such as skin biopsies, excision of cysts, suturing of lacerations, and related procedures performed on an outpatient basis are unlikely to result in cognitive decline. However, as the complexity of a surgical procedure increases, with longer operative periods and greater exposure to more anesthesia medication, the likelihood of postoperative cognitive decline increases. This is especially true for cardiac surgery.

Studies suggest that incidence of postoperative cognitive decline is approximately 30% to 80% after cardiac surgery, while for noncardiac surgeries the prevalence is approximately 26%. While all major surgeries (such as orthopedic, abdominal, or gynecological) pose a risk for cognitive decline, cardiac surgeries have a much higher proportion of cognitive decline after surgery. The most common determinants of cognitive decline involving cardiac surgical procedures are the presence of pre-existing cognitive dysfunction and the use of bypass machines to replace the function of the heart and lungs during the surgery.

Anesthesia management before and during surgery affects what happens after surgery

The perioperative period refers to the time span of a surgical procedure, and includes three phases: preoperative, operative, and postoperative. Anesthesia management encompasses all three phases. The type and dose of anesthesia medication, the use of opioid analgesics, fluid, and glucose management can all influence a person’s cognitive function in the perioperative period. The use of multimodal anesthesia (where a combination of intravenous medications is used, instead of only inhaled agents) may protect against some cognitive dysfunction, as may using non-opioid analgesics for pain management in the postoperative period.

Are there strategies to avoid cognitive decline in the postoperative period?

Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure.”  No other condition exemplifies this saying better than preventing postoperative cognitive decline.

The following are some strategies you and your caregivers can use to prepare for surgery.

Before surgery is scheduled:

Eat healthy, balanced meals. Foods rich in polyunsaturated fatty acids are protective for your brain health.

Exercise regularly, or as much as allowed by your cardiac conditions. Physical activity promotes brain health.

Maintain a healthy weight.

Remain socially active and connected.

Reduce stress. Meditation significantly reduces stress and promotes a sense of calm and overall well-being.

Practice good sleep habits and try to get six to eight hours of sleep a night.

When surgery is scheduled:

Schedule a comprehensive geriatric assessment. This enables your physician to diagnose reversible aspects of frailty preoperatively (if they exist) and take adequate measures in a timely manner, such as altering medications you may be taking, and/or postponing surgery if you are extremely frail, to improve nutrition and incorporate lifestyle changes.

Talk to your surgeon about the risks and complications of the procedure. If you are having heart surgery, ask if a cardiopulmonary bypass machine will be used, and whether it is important to your surgery.

Talk to your anesthesiologist about

The types of medications they plan to use, and if there are alternatives for those medications. Have a conversation about need for opioid analgesics, and if alternative non-opioid pain medication can be used to decrease the risk of postoperative cognitive decline.

The methods of measuring medications that can reduce your risk of cognitive changes. For example, use of EEG machines during surgical procedures enhances the anesthesiologist’s ability to monitor the depth of anesthesia. Anesthesia depth is the degree to which the central nervous system is depressed by an anesthetic medication. EEG monitoring will result in adequate usage of anesthetic agents, avoid overuse, and reduce risk for postoperative cognitive decline by reducing anesthesia exposure.

Gather relevant information on your perioperative management. Discuss which medications you currently take and should continue taking, and which ones should be avoided.

After surgery and during recovery:

Make sure you have adequate control of pain with medications, and consider trying mind-body therapies, including meditation.

Keep active (walking, physical therapy, rehab), which prevents postoperative complications.

Have friends and family around to enhance recovery and provide social stimulation.

Practice behaviors that are help improve sleep, even when you’re recovering in the hospital.

Caregivers need to be informed about the need for keeping their loved one active and following physical rehab recommendations, and providing mental stimulation in the postoperative period. Puzzles, sudoku, board games, books, etc., will keep someone entertained while simultaneously providing them with some brain activity.

Finally, it is necessary to understand that although there is no cure for postoperative cognitive decline, preventive strategies and pre-planning with your team of surgeons, anesthesiologists, and geriatricians can help reduce the risks of cognitive problems that older adults often face following surgery.

References

Impact of frailty on outcomes in surgical patients: A systematic review and meta-analysis. The American Journal of Surgery, August 2019.

Postoperative cognitive dysfunction — current preventive strategies. Clinical Interventions in Aging, November 8, 2018.

Neurocognitive Function after Cardiac Surgery: From Phenotypes to Mechanisms. Anesthesiology, October 2018.

The post Reducing your risk of changes in thinking following surgery appeared first on Harvard Health Blog.

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Beneficial effects of N-acetylcysteine on cognitive function and in a mouse models of postoperative cognitive dysfunction.

PMID:  Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2019 Aug 30 ;41(4):529-535. PMID: 31484617 Abstract Title:  [Effect of N-acetylcysteine on Cognitive Function and Nuclear Factor Erythroid 2 Related Factor 2/Heme Oxygenase-1 Pathway in Mouse Models of Postoperative Cognitive Dysfunction]. Abstract:  To investigate the effect of N-acetylcysteine(NAC)on cognitive function and nuclear factor erythroid 2 related factor 2/ heme oxygenase-1(Nrf2/HO-1)pathway in mouse models of postoperative cognitive dysfunction. Methods Fifty-four male C57BL/6J mice(3-4 months old)were randomly divided into control group,surgery group,and surgery+NAC group by block randomization.The intramedullary fixation for left tibial fracture surgery was performed to establish postoperative cognitive dysfunction models.NAC(150 mg/kg)was administered intraperitoneally in group surgery+NAC 30 minutes before and 3 hours,6 hours after surgery,while saline was given in control group and surgery group.Six mice in each group were selected randomly underwent Morris water maze test on the third day after surgery.Animals were sacrificed at the first and third postoperative days,and the hippocampus was harvested.Enzyme-linked immunosorbent assay was used to quantify the levels of interleukin-6(IL-6)and malondialdehyde(MDA)in hippocampus.Western blot and real-time polymerase chain reaction were used to measure the expressions of Nrf2 and HO-1 in hippocampus. Results There was no significant difference in swimming speed among three groups(=2.135,=0.114).Compared with control group and surgery+NAC group,the surgery group had prolonged escape latency(

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