Has anyone listed for an ablation under GA or deep sedation been warned about the risk of cognitive dysfunction and dementia post procedure? This is a well documented side effect of anaesthesia in the elderly, and has been described as taking away part of the brain, with permanent effects on memory, concentration, judgement, etc., and can trigger dementia.I suspect this issue is not taken into account by cardiologists, who are focussed on the success rate of the ablation procedure regarding AF.
I note that the RCA (Royal College of Anaesthetists) has warned medics the patients under deep sedation should be monitored by a qualified anaesthetist with breathing support as with GA, but cardiologists in some clinics appear to be using deep sedation if an anaesthetist is not available for GA.
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This has never been mentioned to me. Interesting to read though. I guess it's a bit late for me 🙄I had 5th a blation 9 weeks ago under GA. Previously, 3 were under sedation and one GA. I have LAAO with sedation(I hope...) next week.
I've also had 28 dccvs 😱.......is there any hope for me ??? (I shall be 80 in a couple of months time )
28 DCCVs? Good Grief! I won't live long enough to receive 28, I was made to wait 2 years for my first one, and when that failed after a few months, I had to wait 14 months to even get another appointment at the clinic.The reason I am concerned about GA/deep sedation, is that after the second DCCV, under propofol, I felt confused and disoriented for several days, and I am still not quite right.
When I woke up after the procedure, I noticed that the monitor had flagged up an apnea. When I asked about this, and asked to see the record of my O2 saturation during the procedure, I was told that there wasn't one.
I have severe sleep apnea, and was asked to bring my CPAP machine, but it was not used, and there was no anaesthetist present.
Re my 28 dccvs......I didn't have to go on a waiting list for any of these. They were all performed as 'emergency' .
Interesting to hear what you hsve to say about Propofol as recently I had enquired whether this was responsible for my undue breathlessness and exhaustion following dccv. I was told that it was more likely to be due to the amount of time I spent in AF before presenting at A&E.
No, but anaesthetics can affect people of any age adversely though the risk increases with age. This one of the reasons I am not pushing for a hip replacement - though I believe they use a local for that these days, certainly in our area, and my daughter told me that this is the way they are going with as many procedures/operations as possible. My friend had a hip replacement and was sent home the same day, much younger than me though. I remember my auntie (so long ago) being affected when she had hip replacements and accusing the nurses of stealing things.
Anaesthetic does affect the brain and nervous system. It can take several weeks for this to be expelled from the body and the after effects of anaesthetic can make you feel poorly after an operation, which adds to the recovery period. Again, what affects one, probably doesn’t another. I know a lady that was quite ill with her nervous system whilst recovering from an operation. Many don’t take into account, when recovering, that some symptoms may be the after effects of general anaesthetic.
The cause has been blamed on the toxic effects of the various drugs used in GA, and not necessarily oxygen deprivation due to insufficient breathing support.
I never mentioned oxygen deprivation just the effect general anaesthetic has on the brain and nervous system, which is the various drugs needed to put you out. The drugs alter, temporarily, the brain circuits and the nerves “paralysed” so that you feel nothing. I am not sure l understand where oxygen deprivation comes into the equation? I was not aware that during general anaesthetic there is insufficient breathing support? I recently was sedated, and with just the sedation my numbers were displayed on a monitor during the procedure and the medics were constantly aware of my well being.
I have discovered that my cardio clinic has been using deep sedation instead of GA when an anaesthetist is (often) unavailable. The RCA (Royal College of Anaesthetists) must be aware of this practice because they have told medics that the same breathing support must be available from a qualified anaesthetist during deep sedation as during GA. Furthermore, O2 deficits during anaesthesia are not unheard of, even when an anaesthetist is available.This is one of the many issues around ablation giving me second thoughts.
I underwent a DCCV under deep sedation with only a cardiac nurse and an oxygen mask to monitor breathing. I have severe sleep apnea and need a CPAP machine at night, so I would have stopped breathing during the procedure, especially as I was on my back. I will not be allowing them to do that again. I felt confused afterwards for several days, including one episode when I woke up and couldn't remember where I was for several minutes.
Well if you have comorbidities then it will make you more at risk, and extra precaution should be taken. The medics should be made aware and prepared for that risk. I once had a biopsy taken from the roof of my mouth. Being on an anticoagulant they assured me that everything was in place should l have a major bleed. I felt safe. That is what we should feel, safe. If there is lack of care in that area, it is imperative for the patient to ask questions as it is not something to be taken lightly. Our reaction to all medications are different with each individual, so it can be a hard task. I can understand your concerns and worry and hope you find some help here with your post.
The main drug, propofol, is made out of egg lecitin. The gases used are rapidly excreted from the body. The narcotics used are reversible as are the muscle relaxants. I add I am not afraid of anesthesia in competent hands at an excellent facility: 4 scoliotic spine surgeries, gallbladder removal, hysterectomy, bilateral mastectomies / recon for breast cancer, small bowel resection, ventral hernia repair and pulse fiekd ablation. I still win at Scrabble.
This is false: I am a retired nurse anesthetist -worked 37 years. If a person has an hypoxic episode of long duration but that doesn’t happen with modern monitoring techniques. The patients’ underlying disease: obesity, diabetes, pulmonary, themselves can cause the issues outside of anesthesia.,Other possibilities are, fat embolus, amniotic fluid embolus and many other conditions patients come to surgery with.. Anesthesia has been blamed for crazy stuff ; I’ve heard it all.
Yes, I have. Two years ago I broke my hip and had to have emergency surgery, the Anaesthetist came to see me, she said exactly that (which surprised me) and she further said she was going to place what sounded like sticky tape on my forehead to help avoid this. Please don't ask me what it was because I don't know! She said much more but I was dopey on drugs at the time so didnt take it all in, I was also diagnosed with Covid on admission soooooo. Anyway, all went well and I was fine, lost nothing but gained a new hip. So it is a fact and your anaesthetist should advise, in fact if it was me I would ask. When I had an ablation I did not have a general anaesthetic, I had sedation.
Yes, ive been on them for over 20 years and normally, prior to any surgery or dental they ask you to stop 24 hours beforehand. My hip was an emergency however I waited from 11.0a.m. to 4.0 a.m. to get into a bed and then the surgery was conducted in the afternoon of the following day as due to Covid they left my surgery to last as once I had been in there they had to do a floor to ceiling clean!!! I have had two major surgeries now whilst on anticoagulants and all well.
So the anticoagulant should have been well out of your system by then. Was just interested to know if you need immediate surgery can they do it, such as for a strangulated hernia. Thanks for your reply.
Yes, they would find a way, Diathermy is used whilst operating to seal off but I am not a medic so don't really know but, yes in a case of dire emergency, I feel confident that they would operate and deal with any bleeds that arise as a consequence.
"what sounded like sticky tape on my forehead to help avoid this"
I just had my first and hopefully only PF Ablation on Tuesday with GA had an excellent Anesthetist he also put a sticky thing on my forehead said it was to monitor brain activity during sedation. So far, I am feeling pretty good, no pain no sore throat from tube, apart from feeling a bit `dopey' (what's new😂) having to take things slowly and keep an eye on the wound sites in my groin.
cognitive impairment and dementia from anesthesia are just two of the many reasons why I would never consider an ablation, unless the burden of AF would become really intolerable.
On top of these two come the prolonged period of potential harmful radiation, the relatively high risk of dangerous complications and the less than stellar success rate.
It always baffles me to read here how people with paroxysmal AF, having only a few episodes per year, decide anyway to undergo this evasive procedure where the heart tissue is damaged on purpose. I can’t help thinking about the brain lobotomies in the 50-ies when I think of how ablation is done.
Because its a very safe minor procedure that has a reasonably high chance of stopping afib and allowing you return to a much more rewarding lifestyle. Most of all it can avoid taking rhythm drugs of which all are toxic and some have dreadful side effects. It is progressing into the most common procedure to tackle afib.
Yes, l agree and it also helps the heart not to deteriorate which can lead to heart failure. It’s a personal decision between EP and patient. The advantages and disadvantages are discussed with reference to the patient’s medical history, age etc. There are risks involved with any medical procedure and a pre-op. assessment takes place for this particular reason, unless it’s an emergency. GA is used everyday for 100’s of people. I agree that the risk for the elderly must be higher, but not a certainty.
Thank you for your reply and yes there are risks but they are so minimal when you consider what your risks of heart failure or stroke are with afib asymptomatic or otherwise, so much rubbish and misinformation going around regarding anything medical related. The chances of dying when having an ablation are 1 in a thousand and most of those were seriousely ill patients to begin with. All data from the British heart foundation which is one of the most reliable sources around.
’Very safe’ is not really the term that medical professionals would use for a procedure with a mortality rate of 2%. And my AF episodes have been clearly less frequent since I stopped all rhythm drugs. So everyone is different. But I trust one of my best friends in this matter, because he is an experienced radiologist with AF himself. He would never, ever consider having an ablation. He calls it ‘barbaric’ and a ‘cash cow system’.
It depends on the severity of AF. He probably would if it was affecting his career. Some don’t even know when they have an AF attack, whilst with others it can have a very detrimental effect on their life. Sometimes ablation is the only option especially if it is frequent, affecting the heart or making one pass out (my friend’s son passed out, until an ablation). It’s easy to say “never for me” when you have it under control but when it progresses to an unbearable degree, l would be first in the queue.
Me too. I am an anxious person and was terrified to have an ablation but I did it because I simply couldn't live with the terrible symptomatic episodes that went on for hours. It was a big step but a no brainer for me. I had the ablation in March and as far as I know no episodes since. Ablation is becoming the first line treatment for paroxysmal AF
No you have really got your facts wrong? according to the British heart foundation the chances of dying from catheter ablation are 1 in a 1000 which is .001% as opposed to your 2% or 20 in a 1000??. What you possible read was a long term study of heart failure patients who died from all causes having had a prior ablation. thank you for your helpful input though.
Thats a dated study(2010-2015) and the 0.46% is all cause mortality in which most cases were related to health issues not related to the ablation like congestive heart failure present when the ablation was carried out, and also Low volume ablation hospitals inexperienced with the procedure, and as I do not have CHF and my cardiophysiologist is one of the best there is my original 1-1000 still stands. You are male, 74 years old with Afib so really what do you think your mortality chances are at present??. Like I said the chances of dying as a result of cardiac ablation are 1 in a 1000 which is reasonably good odds no matter what way you look at it.
I think you will find there are a lot of reasons here, one being a low throughput of procedures, consultant experience etc etc etc. Those who are unfortunate to die as a result usually have comorbitites and are generally unwell. I still go with the BHF website and all the research I did before my ablation to confirm it's a relatively safe procedure. No operation/procedure is without risk
I had extremely symptomatic paroxysmal AF, although only about every 4 months the episodes were debilitating lasting 36 hours with rapid heart rate. After many discussions and research I understood that AF nearly always progresses and later my episodes were becoming more frequent. I expect eventually they would be much worse. The thought of normality and better quality of life was enough to make me weigh up the risks and the benefits and proceed with an ablation which I had in March this year. As far as I am aware I have had no episodes since.
I’m very glad to hear that things worked out perfectly for you. As I wrote, when AF would become so be symptomatic and with an unbearable and not manageable high heart rate, I would certainly also consider a procedure. But in my case, instead of being progressive, my episodes of AF have become less frequent AFTER I stopped all anti-arrhythmic medication.
I also expect that if I should ever have permanent AF, that I would be able to get used to it, just like I got used to my tinnitus and the ‘floaters’ in my eyes. So I’m a very unlikely candidate for the ablation squad, even more so because I hate hospitals and operations. 😉
Good point about anti arrhythmic drugs which surprisingly can cause arrythmias themselves.You would be surprised at how many prescription drugs have side effects worse than the treated disease, and drugs have many contraindications with other drugs. I always check the official NICE website and the NHS app if I am prescribed a drug or treatment to see if it has been flagged as inappropiate.
Sometimes people complain about the side effects of medication when their discomfort is part of the illness they have. I was particularly interested in the ‘cascade effect’ where doctors prescribe a drug for the side effects of one and then a drug for the side effects of the previous one and so on. I saw this in action with my friend who kept complaining to her doctor and got more and more pills and felt more and more ill! Eventually she realised what was happening and cut out one pill at a time until she worked out which one she really needed and put up with the side effects.
Retired 82 year old nurse anesthetist here. I had my pulse field ablation for paroxysmal AFib last April under general anesthesia. I am also a high risk for anesthesia because of scoliotic restrictive lung disease. I did very well. The anesthetic does not last for days and it should not make a groggy for days. The agents use now specifically, propofol, is made out of egg lecithin. On chronic benzodiazepines, those were interact with the anesthetic and they will indeed be groggy, but not from the anesthetic . There is no reason why a properly administered anesthetic/ general or local sedation, with adequate monitoring and competent personnel, cause cognitive issues. What’s important is to go to an excellent facility with competent staff.
my sister developed dementia after surgery to replace a valve in her heart. But that was a long operation under a full anaesthetic . It’s put me off though
I Used to do psych assessments in 2 hospitals in my county. Delirum/cognitive impairment is frequently seen in elderly patients on many of the wards in a major hospital. It can be due to surgery, medication, dehydration etc. It can easily be overlooked by clinicians. The theory is that past traumas, alcohol misuse, illicit drugs, prolonged periods of extreme stress etc can predispose the patient to delirium in later life. The term The Compromised Brain describes this. I am not aware of any association between surgery and dementia. A delirium has a rapid onset and is fluctuating in nature. The initial onset of dementia can be very difficult to detect, progression is very slow. I fail to see how a surgical procedure can influence this progression.
Not a very conclusive study, also most of the effects are generally short term 24-96hrs after procedure. But possible higher risks of longer-term effects in elderly patients.
Probably why you are told not to drive or sign any legal paperwork for 48 hours after anesthetic. The article also mentions drug interactions such as digoxin and other arrythmia medications and alcohol can exacerbate the effects of the GA.
I was told in the standard preop information letter to stop these including drinking alcohol 3 days prior if applicable.
ive just remembered, the strip they placed on my forehead showed my oxygen saturation level and enabled the Anaesthetist to monitor the amount of anaesthetic she was giving!!! I think this is right but it was two years ago and I was high on morphine and goodness knows what else lol, but whatever it was, it worked!
How common is this, is the question to get answered, do you actually know the figures? There are many thousands of procedures done daily with anathesia, without which, growing old would be even harder for us.
Don’t let it worry you Gfern. I would be more worried if there was no GA. It saves lives and as you say we probably wouldn’t get old without it. I don’t see many zombies walking about do you? I wouldn’t get obsessed as it depends on many factors other than just old age. I think there are a lot of contradictions and lack of evidence and depends on the individual’s circumstances.
Admit I was initially a bit sceptical about thus but I've read the article you kindly referenced and am sharing here the abstract from it. Many factors to consider and it seems to be saying, if we don't screen sufficiently well for existing predisposition, this is when cognitive issues might appear post operatively. I'm going to hunt for the guidelines produced by society of anaesthetists. " Postoperative cognitive dysfunction and dementia: what we need to know and do
Approximately 12% of apparently previously cognitively well patients undergoing anaesthesia and noncardiac surgery will develop symptoms of cognitive dysfunction after their procedure. Recent articles in this Journal have highlighted the difficulties of confirming any clear links between anaesthesia and cognitive dysfunction, in part because of the lack of consistency regarding definition and diagnosis. Postoperative cognitive dysfunction (POCD) is usually self-limiting and rarely persists in the longer term, although plausible biological mechanisms for an impact on brain protein deposition do exist. Clinical research studies are frequently confounded by a lack of agreed definitions and consistency of testing. Preoperative assessment of neurocognitive function and risk factor identification is imperative in order to ascertain the true extent of POCD and any causative link to anaesthesia and surgery. At present a multidisciplinary care bundle approach to risk factor stratification and reduction is the most attractive management plan based on evidence of slight benefit from individual interventions. As yet no individual anaesthetic technique, drug or mode of monitoring has been proved to reduce the incidence of POCD. Providing patients with appropriate and accurate information can be difficult because of conflicting evidence. The Royal College of Anaesthetists’ patient liaison group has produced a useful patient information leaflet that is designed to provide guidance in discussions of individual risks whilst considerable uncertainties remain."
Yes and I have also seen this happen with elderly relatives who have gone into hospital for an operation with sort of the start of dementia - forgetfullness etc and come out a little worse each time. I don't react well to GA so always choose local anaesthetic and sedation for all my operations/procedures. I have had a hip replacement and total knee replacement with epidural and sedation and it is so much easier to recover from the sedation than the GA which leaves you in a fog for days or weeks.
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