Post Operative Cognitive Decline (POCD)
There are many reports of seniors who had a surgical operation and after it experienced memory loss, trouble with multi-tasking, difficulty in learning new skills, inability to concentrate and other cognitive problems. This is called postoperative cognitive decline (POCD) which is usually temporary, but in some cases it remains the same and in others it can progress until it becomes full-blown dementia. The onset of dementia may be in the weeks, months or even years after the operation. There are also reports of seniors who develop delirium, especially after heart surgery.
However, few seniors are warned about the risk for POCD before they undergo surgical operations. While surgery may be necessary and life-saving, seniors are not always told that many operations can also be carried out by using local anesthesia rather than general anesthesia. Local anesthesia deadens pain, but allows a person to remain awake during the surgery and they do not need to go to a recovery room after the operation. General anesthesia (GA) is sometimes accompanied by serious complications in the elderly. Seniors must ask their surgeons exactly what risks they face with the operation and if the operation can be done with local rather than general anesthesia.
Risk Factors for POCD
- Past issues with cognitive function
- Diabetes raises the risk by 84% to develop POCD after surgery
- High blood pressure
- Past surgical operations
General Anesthesia (GA) or Surgical Trauma
Several studies have been carried out to try to determine if the cause of this postoperative cognitive decline (POCD) is from the general anesthesia (GA) or from the trauma of the surgery. Some studies show that the surgery itself causes inflammation in the body which can cross the brain barrier and spread to the brain and damage the brain. Other studies show that the general anesthesia which puts patients into a coma-like state may be responsible for making changes in the brain, especially in seniors who may already be genetically likely to develop dementia. Some animal studies show an increased rate for developing Alzheimer’s disease after surgery with general anesthesia, but more research is necessary to form positive conclusions concerning humans.
If research proves the general anesthesia is responsible for POCD, seniors can explore the possibility of doing the surgery under local rather than general anesthesia. General anesthesia also carries a higher risk for other complications in the elderly like pneumonia.
Local anesthesia like lidocaine blocks pain, but the patient does not get put to sleep. In fact, the patient can converse with the surgeon and even answer questions. It is much safer for seniors than general anesthesia, but it cannot be used for every kind of operation.
Here are a few of the operations that can be carried out under local anesthesia. Surgeons will be able to give you more information about other surgeries that may also be able to be carried out under local anesthesia. Your doctor will also decide, depending on your general health which is the best anesthesia to use.
- Removal of lipoma fatty tumors from arms, legs, etc.
- Hernia Repair Surgery
- Surgery for varicose veins
- Laser surgery on eyes
- Removal of wisdom teeth
- Hemorrhoid Surgery
- Colorectal surgery
- Gynecological surgery
- Plastic surgery
- Breast Surgery
- Eye surgery
While surgery may be necessary and life-saving, all operations carry risks for the elderly, especially when general anesthesia is used. Seniors should only have surgery when at least two different doctors say they really need it. Seniors should also ask their doctors about all possible risks they might face and if the surgery can be done under local rather than general anesthesia. Further research may show why some seniors have postoperative cognitive decline after surgery and what can be done to prevent it.