My mother recently had hernia surgery and we requested a post op anesthesia consult for the purpose of inquiring about POCD “post operative cognitive decline”.  We wanted to see if there were safer, less volatile alternatives  such as propofal or whatever may be available.  I know very little about the subject so I was relying heavily on his expertise.

I won’t get into the details our meeting  but he didn’t seem very comfortable discuss any other options other than the fluorine type gasses that are typically used.  After our meeting he in fact contacted my mom’s surgeon and informed him that he would not be the anesthesiologist on her surgery.

We were shocked!

At the time of our consult, he did say he would not use Versed but would use Fentanyl (sp?) and noted that in her file.  Another anesthesiologist handled her surgery.

Is this POCD a touchy subject?  I felt that it was a reasonable concern since there is actually an anachronim for the problem.  

The reason we did a consult was because my cousin had knee replacement surgery and has cognitively never been the same since.  It’s been over a year.

I understand all anesthesia has side effects and risks, but are there less volatile ones that don’t affect the brain as bad?

I’m currently leaning about the methylation process and how there’s a certain percentage of the population that have genetic mutation (polymorphisms?) which prevent them from converting nutrition the various things the body need to perform optimally, getting rid of toxins, etc…..  

Any information would be greatly appreciated.  Thanks  Pam Crawford

It's not a touchy subject but rather one that is not well understood. In fact, the anesthesia community is actively researching this area and will probably have more definitive answers to these questions over the next few years. To my knowledge there is no current scientific proof that POCD exists although there is plenty of anecdotal evidence. Hopefully this research will provide the answers. My feeling is that the anesthesiologist was more concerned from a medicolegal standpoint and thought your interest was in suing him if things went bad, rather than just your concern for your mother. I hope it all worked out well.

Ronald Levy, MD
Professor of Anesthesiology


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Ronald Levy, M.D.


Associate Professor of Anesthesiology, University of Texas Medical Branch at Galveston. I am a board certified anesthesiologist who can answer all questions related to any type of Anesthesia with the exception of Pain Management.

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