How dangerous is sedation or general anesthetic?

[easterncedar]

My guy is set to have a procedure that it usually done under anesthesia, but can be done, with some discomfort of course, with local anesthetic only. I have heard many stories of psp patients - and others - who suffer irreversible loss of intellectual functioning after anesthesia, but am I overreacting if I nudge the doctor to choose the more painful way? (Sometimes I do wish I weren't the one making these decisions.) I'd be glad of any advice. How prevalent is the problem? What has your experience been, good or bad, with anesthesia? Thanks!

[daughter_Julie]

How funny, dad is having a supra pubic fitted tomorrow, probably under local instead of the preferred general. Will be reading any replies with interest!

[Hidden]

Hello easterncedar

Just a quick reply. The chances of problems are rare. I do not want you to be alarmed at what I'm going to describe, especially since I'm no expert in these matters.

There is some evidence that there is "an increased risk of postoperative cognitive dysfunction (POCD) with a well-recognized decline in cognitive function after surgery (including delirium and confusion)".This can last for months or sometimes years in a few patients. Those at most risk are patients with such conditions as Alzheimer's.

(For those interested....

In both PSP and Alzheimer's there is a protein that is damaged (an initial step is it becomes hyperphosphorylated - has too many phosphate group on it). This protein is named as a culprit for final neuron death. It is called tau. Apparently, under anaesthesia, the core body temperature drops and this causes (through inhibition of enzymes called phosphatases) the normal protein tau to become hyperphosphorylated and can (in some individuals) exacerbate the process of some neuron damage or death. So keeping the body core temperature normal during anaesthesia can be important.)

Why not have a quick discussion about this with the surgeon/anaesthetist? You need some sort of reassurance and not have to make such decisions on your own. Remember, problems will not happen with most people having anaesthesia, but since PSP sufferers may be more susceptible to these problems (however minor and short-lived), you need to be comfortable with the medical choices that are made.

Hope all goes well.

Take care

T.

[easterncedar in reply to Hidden]

Strelley, you're the best! I especially appreciate the scientific detail. I always learn a great deal from your explanations, and that makes me feel better armored in this fight. Thanks!! Easterncedar

[jimandsharynp in reply to Hidden]

Strelley, Yes and I'd Google "Anesthesia and dementia" or "Surgery with dementia" to see what I could find out. Thanks for your usual informative posting. Jimbo

[goldcap]

easterncedar, this is interesting to me because my guy had a epidural injection for his back under anaesthesia and afterwards his balance got much worse. I also noticed his disposition became more negative. I thought the falls were due to him feeling less pain and becoming more aggressive in his movements.Now I am wondering... I would err on the side of caution and have the local if at all possible. Good luck with this. Take care, JG

[SharonAB]

Dear Eastern cedar,

I don't think you are over reacting and I do not envy your situation. Have you thought about posting the same question through an Alzheimer's Association or Parkinson's site - there are quite a few carers/family members that have stories to tell. I found them useful when was asking about general anesthesia for my husband and knee surgery (for which he did not go ahead with - perhaps fear of the unknown??) Regards, Alana - Western Australia

N.B. Just remember what ever decision is made - it is the best one because you made it.

[Heady]

Hi Eaterncedar,

S had a back Op and knee replacement, just before we about PSP. He was blaming all his movement problems on the the fact he did need these operations. While they did cure the main problems and he was out of pain, I am sure the symptoms of PSP got worse after them. Certainly after the knee op. Or, it might have been, because I was helping him with his physio exercises, that I realised that something was seriously amiss. Who knows!

The one thing I do know, and I agree with Alana here, the decision you make, will be the right one, because you will make it on the best advise you receive. My motto is, can I look myself in the mirror and say I think it's right, if so, that's the only decision I can make!

Talk to the "experts" and make the decision together if you can.

Best of luck, my thoughts are with you.

Lots of love

Heady

[carolinesimmons]

My husband went in for elective hip replacement as an active, independently functioning guy. He reacted badly to the anesthesia, suffered a gallbladder attack that almost killed him. He became immediately disabled. Could not swallow, put on feeding tube with pump for continuous feed. Six months later he was diagnosed with PSP. He probably had had it for years and managed to disguise it as just part of the aging process. In retrospect, I believe that the anesthesia exacerbated his disease progression. I would NOT put him through any procedure that was not absolutely essential to his well-being. Remember Murphy! "If it can go wrong, it will."

[jimandsharynp]

My brother-in-law is an anthologist nurse. He said that sometimes people with brain diseases do not recover well from anesthesia. Not to say every patient is the same of course. If possible I would avoid any unnecessary surgery that puts the patient "under". This is why falls with a hip injury or head trauma are so very, very, very, important to avoid. I certainly would not do elective surgery where the patient was put "under". Just my thoughts.

Jimbo

[jimandsharynp]

Here's some internet sites that might help you. Jimbo

medscape.com/viewarticle/82...

medicalnewstoday.com/articl...

stardem.com/article_a7b4207...

[Motts in reply to jimandsharynp]

Good Morning Jimbo

I just checked out this information and I Thank You So Much!

I was totally unaware of 'postoperative cognitive dysfunction'.

With a possible surgery in my future . . . I marvel at the timing of your post.

Sending Hugs - Granni B

[Sawa]

Hi easterncedar. I had this discussion with my hubby's neurologist just a few weeks ago. He said it was best to avoid putting PSP patients under general anaesthesia because it more often than not knocks them back and there is noticeable decline after the procedure. I also suspect that my husband may have had slight symptoms for years but that we really started noticing the problems after he had sinus surgery under general anaesthetic a few years ago. Of course, you should do what is necessary and right for both of you. My attitude with PSP is 'better safe than sorry', so perhaps consult your neurologist or a neurosurgeon first?

[easterncedar]

Thanks to everyone for the feedback. What a gift it is to have this community! My sweetheart is going to take the discomfort this time, although the doctor has said if it gets to be too much, he'll stop it and book him into the surgical unit for anesthesia. The thing is, although it may seem that my dear man is choosing, I am the one making the decision since he really can't make the calculations for himself, and he follows my lead. I don't WANT to be the one in charge! It's a sometimes frightening responsibility. I know all the carers here know the feeling. Thanks again!

[Heady]

Hi Easterncedar, when does your husband have his operation? We are all wishing him well.

I agree with you totally about the responsibility of this " job" thrust upon us. I think that is one of worst aspects. S, being a successful business man, naturally made most of our decisions, certainly looked after the money side of life. My first husband did nothing and wouldn't let me either, so it was fantastic having someone who knew what they were doing and more importantly did it. Thankfully, he did teach me a lot, so I am not completely in the dark. Thinking back, he did start getting very cross with me, if I did not pay attention to anything to do with our financial affairs. Thought it very strange at the time! It's almost as if he knew he was starting to lose control, perhaps he did.

Also, when I first met him, he started up another business that I was very much part of and that taught me how to make decisions quickly.

BUT, I HATE MAKING THEM ON MY OWN!!!!!! I may have the ability, but I have lost the confidence to know if they are right. Who knows, S isn't able to tell me, like your husband he just goes along with what I say. He seems happy enough, but is not able to express any opinion these days. Except what he wants to eat!!!

So, well done on making your latest decision, the doctors are obviously supporting you. Don't forget, it was the right one, because YOU made it and therefore the only one you could!

We are all behind you and thinking of you!

Lots of love

Heady

[easterncedar in reply to Heady]

Oh, thank you, Heady. I do appreciate the encouragement and camaraderie no end. The operation is really pretty minor and won't be for two weeks. It's the sort of thing even I might decide I would rather not go under for, but I purely hate signing my sweetheart up for pain. Thanks again, Easterncedar