Expert: Ronald Levy, M.D. - 3/13/2008

Question
QUESTION: Following my wife’s successful operation before she was 60 she I noticed a very subtle loss in her memory. It was only because of our close relationship that I noticed the loss. I spoke about things she should remember. One example was the refrigerator we purchased together several years ago but she did not remember it. She has always had a keen, razor sharp memory and while she still has a very good memory for most things she does not remember certain things in recent weeks/months and years. She does not remember some important memories and others that are not important but is inconvenient when she is unable to corroborate an event or conversation.  

My father at 89 had a hip replacement and following anesthesia it was obvious from his memory to his communication skills he was greatly impacted. After his operation, he was the same person that went into the operation and that continued for a full year with memory issues and foolish ideas such as the electric cart he used for transportation needed the oil changed. That continued until he passed away a year later. This had to do with the anesthesia. He had similar memory issues after his 4 way bi-pass 3 years earlier and I asked the nurse to tell the anesthesiologist to try to avoid this degradation of his mind again. It was worse.

My mother-in-law at 89 now had a very keen mind and each time after several surgeries her memory was also degraded. She still functions ok but something including the ingredients in anesthesia, age, oxygen, and detoxification by her body seems to have had several negative side effects in the quality and function in her life.  

My only short duration operation occurred recently under anesthesia (drip). I have found it has left me with a bit of dyslexia and memory loss that was not there before  and has me concerned for myself and others as we age.          

I have spoken to other doctors who have similar concerns about anesthesia and the amount of time under anesthesia. I have been told that there are three ingredients in modern anesthesia. One of these is to make people forget about the pain. That is the ingredient that I suspect the most though other factors may contribute. Have animal studies shown memory loss from anesthesia?  Are there any studies on the age of  human patients, the length of time under anesthesia and the specific ingredient dosages and form (gas or drip) in the anesthesia used?  It is my impression that anesthesiologists must follow set dosage requirements for administering anesthesia set by the AMA no mater what age of the patient. What flexibility or rights are there for anyone, especially older patients that expect to be anesthetized for an operation?

Thank you, Would you please return your answer to my e-mail: bhobza@surewest.net
Bob

ANSWER: The drug we use for amnesia is called Versed and while it does cause memory loss for the time immediately around the time of surgery, I am aware of no specific studies linking long term memory loss to anesthesia. I know there have been many people reporting memory losses but they can usually be ascribed to other causes. In the case of the bypass surgery, being on the heart-lung machine is known to cause a variety of neurologic and memory problems. In other cases it might be related to the severity of the illness, age, nutrition, etc. Anesthesiologist don't follow a cookbook when administering anesthetics. All anesthetics are tailored to the individual and it is related to age, weight, and other health problems of the patient. As patients, you have the right to know what kind of anesthesia you will receive, the risks and benefits and the alternatives. All anesthesiologists would be happy to discuss your concerns.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: TO: Dr. Levy
First, I am very impressed with your fast, succinct answers to my windy inquiry (Sorry it was so windy). Thank you! Could you please address my following questions?

1.   Have researchers ever looked into the effects of anesthesia on human memory specifically on older patients (50+) following their operations?  Does risk increase?
2.   Could you identify any medical or citizen groups involved in studies involving the documentation or research on human memory loss associated with post operative older patients following exposure to common anesthesia practices?
3.         Has the AMA ever sponsored medical follow-ups after 6 months to assess whether the patient (especially older patients) or a close family/friend has recognized a loss in short or long term memory following surgery with anesthesia?  

Thank you again.
Bob

P.S Please return your answer to my e-mail: bhobza@surewest.net


Answer
1. Have researchers ever looked into the effects of anesthesia on human memory specifically on older patients (50+) following their operations?  Does risk increase?

There have been many studies looking at memory loss in the elderly. The link below is a report from one such study.

http://www.reuters.com/article/healthNews/idUSN0217191020080103

>>>>>>>>>>>>>>
2. Could you identify any medical or citizen groups involved in studies involving the documentation or research on human memory loss associated with post operative older patients following exposure to common anesthesia practices?

I refer you to the above article from Duke University. I don't know of citizen groups.

>>>>>>>>>>>>
3.         Has the AMA ever sponsored medical follow-ups after 6 months to assess whether the patient (especially older patients) or a close family/friend has recognized a loss in short or long term memory following surgery with anesthesia?  

I don't know the answer here but you can contact the AMA directly if you wish.


Hope this helps,

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston