studies warn about anesthesia and the onset of post op delirium

When it comes to medical procedures requiring the use of anesthesia, a patient will be administered one of three types.

The first, local anesthesia, is designed to numb a very small portion of the body (a finger, tooth, etc.) and is generally considered to be quite mild. The second, regional anesthesia, is designed to numb a larger portion of the body and is typically administered along with a smaller dose of an otherwise powerful sedative that will keep the patient groggy but awake. The third, general anesthesia, is a mixture of drugs designed to render the patient completely unconscious for the duration of the surgery.

While there is no disputing the inherent value of any of these types of anesthesia, there is an increasing body of evidence showing that those patients administered general anesthesia are far more likely to experience a condition known as postoperative delirium, which is characterized by confusion, memory loss, communication troubles and even frightening hallucinations.

While previous studies attributed the incidence of postoperative delirium to underlying stressors associated with the procedure such as lack of sleep, medication regimens and the surgery itself, more recent studies suggest that the incidence of postoperative delirium likely has more to do with the amount of anesthesia used in the procedure.

To illustrate, consider a study by researchers at Johns Hopkins University School of Medicine that involved giving 57 elderly patients undergoing hip surgery enough propofol — a powerful sedative — to achieve regional anesthesia and another 57 elderly patients undergoing the same surgery enough propofol to achieve general anesthesia. Here, only 11 of the former patients experienced postoperative delirium versus 23 of the latter patients.

It should be noted that other studies have linked the occurrence of postoperative delirium with longer-term cognitive problems, including poor performances on memory and attention tests several months after the surgical procedure was completed.

The good news is that more physicians are becoming aware of the problems posed by postoperative delirium and are actively taking steps to help protect patients. For instance, patients are being asked to stay both hydrated and nourished prior to the surgery, visit with friends and family after surgery, exit their beds during the day and stop any medications that could potentially alter brain functions. These steps, it’s thought, can help encourage stimulation of the nerve cells and, by extension, stimulate connections within the brain.

It should be interesting to see what scientists continue to learn about postoperative delirium over the coming years. In the meantime, however, those victimized by anesthesia errors or other forms of medical malpractice need to remember that the pursuit of justice should never be abandoned without careful consultation with an experienced legal professional.

Source: Salon, “The hidden dangers of going under,” Carina Storrs, March 20, 2014

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