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Thursday, July 24, 2014
Risk /Reward for Cataract Surgery
My father is 92 years old, diagnosed with Alzheimer`s at the moderate-severe stage, living in assisted living. He is still able to perform most activities of daily living, but almost no short term memory and deteriorating long-term memory. He is also anaphylactically allergic to both classes of local anesthetic - topical or injected. He goes into anaphylactic shock and seizures. He has cataracts in both eyes that have reduced his vision to 20/400. He is at risk for falling (uses a walker) and has trouble seeing a chair when you ask him to sit, or the toilet when he needs to urinate. The latter may result in his discharge from the assisted living facility where he has been for two years. Our doctor is recommending cataract surgery to improve his vision, and hopefully solve the behavior issues. I`m concerned about his dementia and general anesthesia. He is in excellent health, other than his dementia. No high blood pressure, diabetes, etc. I know that this surgery is usually quick. What are the potential consequences of putting a man with advanced Alzheimer`s under general anesthesia for cataract surgery?
General anesthesia does have risks for decline or post-op delirium in Alzheimer's disease, but this is lessened if the anesthesia is brief and the procedure is minor -- both of which are the case. The risk must be weighed against the potential benefit of the procedure. I have had several patients do well with minor procedures after such decisions.
David Q Beversdorf, MD
Assistant Professor of Clinical Neurobehavior and Neurology
College of Medicine
The Ohio State University