My husband had prostate surgery yesterday to open up scar tissue left from a previous operation for benign prostate enlargement. I was fairly strongly in favor of the operation because he was retaining 300 cc or so of urine in his bladder when he emptied, which I thought would cause problems down the road, and because he had had a couple of episodes in the last six months of not being able to go at all and needing to be catheterized.
But I was positive about the surgery partly because two urologist assured me it could be done with a spinal and sedation, not general anesthesia. That didn't work out--the spinal didn't work properly so they had to do general. I was upset because I hadn't discussed with the anesthesiologist what they would use for a general, and I had done research and had strong opinions. It actually has worked out remarkably well--it is just 24 hours after surgery and my husband just walked upstairs to tell me he didn't want the milkshake I brought him. For more on the specific story see: http://deeplanguage.blogspot.com/
I started this topic to share the results of my research. The idea that general anesthesia can accelerate Alzheimers is getting close to being accepted scientific knowledge. I haven't seen the full text of the articles, but the reference I would give a doctor is: http://www.j-alz.com/issues/anesthesia.html I have been following this for myself as well as for my husband (who actually has Lewy Body Dementia, which has similar issues) because some studies say fairly clearly that people with the gene for Alzheimers should not have general anesthesia. Late-onset Alzheimers runs strongly in both sides of my family.
From my research I compiled a list to show the doctor: Least safe: isoflurane and halothane Possibly not as bad: sevoflurane is better in some respects, desflurane better still Even safer: Thiopental, diazepam, and propofol (though this last showed negative effects at high concentrations)--but be careful because these are often used before something else or for deep sedation, not as general anesthesia by themselves. IV anesthesia is generally safer than inhaled (because it is larger molecules) Glycopyrrolate, an anticholinergic drug which does not cross blood-brain barrier, is preferable to scopolamine or atropine. One place to start if you want to do your own research is: Anesth Analg. 2009 May;108(5):1627-30. Consensus statement: First International Workshop on Anesthetics and Alzheimer's disease. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769511/?tool=pubmed
My husband was given sevoflurane, propofol, lidocaine and Fentanyl, as well as Zofran for nausea. The nurse-anesthetist assured me she gave him as little as possible to keep him under, for as short a time as possible. That he is doing so well the day afterwards makes me understand more fully that there are two issues here. How deep and how long the anesthesia is has a big effect, irrespective of the medication used. But I'm convinced by what I've read that which medication is given is also signficant.
The thing I would have done differently is insist on discussing what general anesthesia they would use if the spinal didn't work, even though I think they would have tried to assure me that I didn't need to worry, the spinal would work. They did listen to our concerns that he was confused for a week after his previous anesthesia, but my impression was that knowledge about issues of dementia and anesthesia has not really reached the working doctor level.
I, too, copied this.. DH may be having knee surgery soon...I'm wondering at what point types of anesthesia would matter anyway.. He hasn't had an original thought in his head for a very long time.. just echos what I say, agrees and pretends with the rest... Pam, Your research will help us all.. anything we can learn about this disease is a plus... The moment our LO's started this journey was the moment we as spouses,became Doctors, specialty care nurses as well as caregivers...I wish we could frame our degrees... Thanks..
We have had a lot of discussions on this board about general anesthesia and its effect on AD patients. I have written blogs about it, but your research, explanations, and questions to ask doctors are the best and most informative we have seen thus far. Thank you so much for sharing it with us. When I get back to "normal", and can type more (with both hands), I am going to add a new resource about AD and anesthesia to my home page of resources on the left side. I will be sure to include all of your information.
I thought this part was interesting: ""The evidence for anesthesia per se being responsible for the changes we saw in this study is not definitive – in fact, our work in animal models of Alzheimer's is beginning to suggest that the surgical procedure itself produces a larger effect than anesthesia," said Dr. Eckenhoff. "The next step in this line of research is to determine whether anesthetic management can modulate the neuroinflammation caused by surgery, whether this brief inflammatory insult can actually change the trajectory of something like AD, and given that surgery is usually not strictly elective, development of a strategy to reduce the inflammatory insult to the brain"