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Anesthesia and the Patient with Alzheimer's Disease (AD)
Family caregivers and health care professionals often report that people with dementia seem to have a delayed recovery time from general anesthesia and appear to be at increased risk for a postoperative condition called Acute Confusional State.*
The National Capital Area queried specialists in the fields of Alzheimer's care and anesthesiology in an attempt to bring caregivers updated information. This tip sheet has been designed to highlight what is known about the use of anesthesia in older people with dementia, and to provide family caregivers with some basic guidelines when planning surgery for their loved ones.
What do we know?
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- There is no systematic information concerning anesthesia for patients with Alzheimer's disease or a related dementia. Research studies focus on general anesthesia as a potential risk factor for the later development of AD. Data thus far have not shown general anesthesia to be a significant risk factor in developing AD. (Ritchie, et al.)
- Significant cognitive dysfunction has been found to be common in older persons 1-3 days after surgery. (Ritchie et al)
- Researchers believe that post-operative confusional states in people with dementia, and the elderly in general, are due to many complex factors, including the use of anesthesia. Separating out one factor from another is what makes designing research on this subject especially difficult.
Additional factors may include:
- Post- operative pain
- Medication reactions and interactions
- Overall stress of surgery and hospitalization
- Disorientation related to a change of environment
- Post-operative infection
- Patients with middle to later stage dementia are not good candidates for local or regional anesthesia because they have difficulty cooperating, understanding directions and keeping still.
*Acute Confusional State is seen frequently in hospitalized patients of any age, but particularly in geriatric patients with dementia. Clinically there is clouding of consciousness; memory impairment; impaired cognitive function; impaired perception; disturbance of emotion; depression of psychomotor activity; but repetitive, stereotyped activity such as plucking at bed clothes or tossing from side to side may be seen." (Davis, F.A. 1993. Taber's Cyclopedic Medical Dictionary Edition 17).
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Guidelines to follow when planning surgery for a person with dementia:
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- A close family member or guardian must provide an accurate medical and surgical history, including past response to drugs, and a current list of medications prescribed.
- To avoid overtaxing the person with dementia, the number of people conducting the preoperative interview should be kept to a minimum, preferably one interviewer.
- A close family member or paid caregiver should remain with the patient the evening prior to surgery to ensure compliance with preoperative instructions, such as withholding food or fluids. For early stage patients, written reminders may be sufficient.
- Delayed recovery from anesthesia may require prolonged observation in the recovery room or patient's room.
- The patient should be kept warm and well hydrated during the recovery phase because hypothermia and dehydration can contribute to post-operative confusion.
- A private duty nurse or close family member should provide one-to-one supervision following surgery to help reorient and reassure the person with dementia coming out of anesthesia. This will help reduce the need for restraints and protect against falls, injuries, and the accidental removal of catheters and intravenous feeding tubes.
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References:
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Special thanks to Michael Todd, MD, Editor in Chief, Anesthesiology, University of Iowa.
Davis, F., Taber's Cyclopedic Medical Dictionary 1993, Edition 17.
Dijkstra, J., Operation under general anesthesia as a risk factor for age-related cognitive decline: results from a large cross-sectional population study. Journal of the American Geriatric Society. 1998, Oct; Vol. 46 (No. 10): p. 1258-1265.
Ritchie, K., Polge, C., deRoquefeuil, G., Djakovic, M., Ledesert, B., Impact of anesthesia on the cognitive function of the elderly. International-Psychogeriatrics. 1997 Sept.; Vol. 9 (No. 3): p.309-326.
Waugaman, W. 1988. Surgery and the Patient with Alzheimer's Disease.
Geriatric Nursing. July/August;. p. 227-229.
Whitaker, J., Postoperative confusion in the elderly. International Journal of Geriatric Psychiatry. 1989, Nov.-Dec.; Vol. 4 (No. 6): p. 321-326.
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In the National Capital Area chapter service territory, for more information about
Anethesia, please contact the Chapter's telephone Helpline at 703-359-4440 or toll-free 1-800-272-3900. Outside the National Capital Area, please contact your local Chapter.
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© 1997 - 2005 Alzheimer's Association, National Capital Area. All rights reserved.
703-359-4440 or toll-free 1-800-272-3900
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