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Thursday, April 24, 2014
General Anesthesia and Dementia
Are there any associated risks related to dementia when having a general anesthetic? My mother is 80 and has dementia. Will the general anesthetic increase her dementia? She needs a total hip replacement. I wonder if a regional block (epidural) would be the best choice?
General anesthesia does increase the risk of progression of dementia, as well as high incidence of postoperative delirium. I have had some patients sail through it unexpectedly well, thought many others do not. The worse the dementia, the greater the risk. Regional block, however, may be problematic in dementia patients as well, particularly if they tend not to be compliant with instructions or have a tendency to agitation, especially if they are severe enough not to be sure what is going on. Furthermore, some surgeons are just not comfortable with regional blocks for large operations such as a hip replacement. Compliance and comprehension of rehabilitation is also an issue. This is a complicated situation. If the surgery is elective, you may want to consider not doing it. This is a question to seriously discuss with your mother's health care providers. Otherwise, speak to the clinician familiar with the patient who is most knowledgeable regarding the issues of dementia care as well as the surgical team to come together for the best plan for that individual patient.
David Q Beversdorf, MD
Assistant Professor of Clinical Neurobehavior and Neurology
College of Medicine
The Ohio State University