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Anesthesia

Side effects after anesthesia

06/22/2007

Question:

My father had open heart sugery. After the surgery he now has slurred speech that comes and goes. One day his speech is fine, but 2 days later it may be slurred. Can this be a prolonged effect of anesthesia?

Answer:

The incidence of brain impairment after open heart surgery is fairly high. Stroke is the most serious outcome (1.5 to 5.2%); postoperative delirium (confusion)(10 to 30%) and short-term (33 to 83%) as well as long-term cognitive (thinking) changes (20 to 60%) are more common.

Neurological problems like slurred speech are associated with several factors including cerebral microemboli (small particles of arterial plaque that are dislodged into the circulation and go to the brain), global cerebral hypoperfusion (not enough blood flow to the brain), inflammation, and genetic susceptibility. Older persons and those with diabetes and severe arterial disease are at higher risk.

The role of anesthesia in these syndromes is still being investigated. Clinical studies are cannot differentiate between the effects of illness, hospitalization, surgery, and anesthesia.

Depression of brain and nerve function is a part of anesthesia but this is expected to be reversible. Short-term impairment of cognitive and psychomotor performance is common after general anesthesia and is typically attributed to incomplete removal of drugs from the body. Postoperative pain is also a possible factor. However we now know that general anesthesia affects brain function at all levels, including nerve membranes, receptors, ion channels, neurotransmitters, cerebral blood flow, and metabolism.

Surgery alone also activates immune mechanisms and inflammation. Neurocognitive dysfunction also occurs frequently in noncardiac surgery patients, indicating that some element of surgery and/or anesthesia contributes to this condition.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University