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Anesthesiology/Anesthesia and Elderly Impact

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Question
My mother in law is 89 years old and in generally very good health for her age.  2 years ago she had heart surgery for a valve replacement that additionally turned into a 3 way by pass.  After completing the procedures, the surgeon had a very difficult time getting her heart re-started and instead of being under GA for the normal 4-5 hours, it became more like 9 hours.

For the first 18 months post operation, she complained about scary dreams, hearing music and occasional visions.  This then turned to threatening voices and visions to the point that my husband and I believed she was suffering from paranoid schizophrenia (there is no history of mental illness in the family, but she did suffer from very traumatic events in her early adult life).

Now, 24 months post surgery, the visions and perceived threats are so real, that she can no longer live on her own or be by herself for more than about 15 minutes out of fear.  My husband has not been able to work for the last 4 months because of the situation.  There are some days she is so scared that he can't even go to the restroom without her banging on the door to know where he is.

Our neurologist is zeroing in on the heart surgery of 2 years ago as a possible cause of the brain "short circuiting" now.  We are wondering if there is research to suggest that this may be the cause and whether or not it is permanent.  We are looking for answers.

Anything you can tell us would be greatly appreciated.  The stress of the situation has completely changed all of our lives and we would like a plan forward but can't until we understand the situation.

Thank you so much.

Answer
This a very unusual case. Post operative cognitive decline is a hot topic in anesthesia research right now. The most journal has several papers reporting on studies looking at post op cognitive impairment in the elderly.  All studies to date find that patients who suffer from pot op ognitive impairment suffer the largest deficit early on and then improve over one variable period of time. By one year post op there is no difference between surgical patients and those who have not had surgery.

However, at age 89, there is little reserve. A big operation that didn't go we'll could easily unmask underlying cerebral disease that was hidden.  It seems clear that symptoms started after surgery so some mild impairment that was caused during surgery has been made worse.  It is likely that in a younger patient, there would be no obvious brain impairment but with little reserve to overcome the insult, things have gotten worse.  Of course, as your mother in law ages it only worsens the symptoms.  While I can't say what caused this or even whether it will get better, it is likely that maximizing meaningful social interactions, avoiding isolation can be helpful, or at least, prevent it from getting worse.

Dr. Russell

Anesthesiology

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Rex Russell

Expertise

Any question dealing with general anesthesia issues. With particular emphasis on regional anesthesia.

Experience

I am a board certified anesthesiologist, graduated from residency in 2004 from Johns Hopkins Hospital. I have since worked as an anesthesiologist first in the Air Force for three years and then most recently in Texas in Private Practice.

Organizations
Texas Medical Association Texas society of Anesthesiologists American Society of Anesthesiologists

Education/Credentials
BS, BYU MD, U of Texas, Galveston Intern-St. Joe's Hospital, Phx, AZ Internal Medicine Residency-Johns Hopkins Hospital, Baltimore, MD

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