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Tuesday, October 21, 2014
Mental function after anesthesia
Hi, I recently had general anesthesia twice in 14 days (50 minutes each time) I coincidentally had my appendix and gall bladder both go bad at the same time. I am usually good under pressure and wasn`t worried about the surgeries at all. Yet I have had an exacerbation of symptoms related to my mental illness. (Schizo-affective disorder) My physician and psychologist both told me that my symptoms were related to the anesthesia, pain medication and fact of going through two major drudgeries (both physical healing and natural stress). My psychiatrist echoed that anesthetics can remain in your body for months. I am very frustrated and anxious most of the time. And my performance at work is being disrupted. Anyway, how do these factors (anesthesia, pain meds, and physical healing) play into mental function. And what is the likelihood of prolonged brain chemistry problems for me vs. peoples general recovery time from anesthesia and these types of surgeries? I am 31 years old if that helps.
Thanks for your question.
It's a common question these days - can anesthesia have persistent effects on mental function? Unfortunately, we don't really have good science to answer that question. We can show that the drugs themselves are eliminated from the body in a period of hours to days. There is some evidence, primarily in very young animals, and in elderly people and animals, that despite the elimination of the drugs from the body, anesthetic agents can have unexpectedly prolonged effects on brain function. This might be due to effects at a cellular level that run their course over time, and is manifested in elderly humans by a syndrome sometimes known as postoperative cognitive dysfunction.
There are ongoing studies to try to identify who is most at risk for these kinds of problems, and whether particular anesthetic agents are the culprits. So far it seems that there aren't any particular drugs that in clinical practice are worse or better than any others. It also seems that the only group at clearly increased risk are elderly patients with early signs of dementia. I don't know of any evidence that persons with schizophrenia or schizo-affective disorder, or anxiety disorders, experience persistent problems after anesthesia. In addition, it is difficult, impossible really, to separate out the effects of the surgery, recovery from surgery, stress and so on which accompanies major surgery, from the effects of anesthesia, pain medications, and other pharmaceuticals. And, as I've pointed out before, there are very few people today willing to undergo major surgery without anesthesia!!
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University