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My husband had quintuple bypass in 1997 and recuperated beautifully from it. However, several years later his mitral valve was found to be leaking causing several side effects. At that point his memory was starting to deteriorate and no doctor would operate to close the leakage in the valve. I asked for details as to why they would not operate and was told that giving a patient with some memory loss anesthesia for surgery would act to hasten the memory loss to a worse state. He is now 87 and living with the leaking valve controlled by various drugs. Unfortunately, his memory has deteriorated into dementia, but he did have several years before that occurred.
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The authors might consider the possibility that hypoglycemic episodes during and immediately post surgery could contribute to this problem. People undergoing surgery receive nothing my mouth for a prolonged period before surgery, then receive minimal glucose during and after, not nearly enough to provide for the basal metabolic rate, much less the additional caloric needs related to tissue damage and repair. It is not the norm, but perhaps should be, to monitor the patient's glucose before, during and after surgery until eating by mouth is reestablished. This should be considered in light of recent research published in JAMA April 15, 2009 by Whitmer and others, showing the a single significant episode of hypoglycemia in diabetics is associated with a higher risk of dementia. This could hold true for non-diabetics as well, particularly people who are APOE4. Mary T. Newport, M.D. preemiedoctor@aol.com
Reference: "Hypoglycemic Episodes and Risk of Dementia in Older Patients with Type 2 Diabetes Mellitus," RA Whitmer, et. al., JAMA April 15, 2009 Vol 301, No. 15 p 1565-1572
Interesting information from you, as always, Dr. Newport. Thank you for taking the time to add this valuable information.
Carol
I am nervous.My wife has the beginnings of alzheimers.She is still alert but does forget a lot of things.She is due to go into the hosopital for an operation on her back to relieve pain.After reading this article on anesthesia and aldz it worries me.Is there a list of rules or suggestions to prevent one from becoming worse after an operation?
It is scary and there is yet so little known. Please read Dr. Newport's reply on this list about glucose. She knows her stuff and you may want to talk to the doctors about this. Also, if you read the article I linked to (about the anesthetics) - maybe even print it out for the doctors, you may be able to help her avoid isoflurane.
Other than that, be with her as much as you can to help calm anxiety and the disorientation that people feel from hospitalizations. The sites and sounds, plus the feeling of being ignored can be frightening to anyone, let alone a elder who just underwent surgery.
All the best to you and your wife. Work as closely with the doctor as our system permits. You are doing your best. Remember that. I hope the surgery helps.
Carol