Posted on 12/06/2008 9:43:59 PM PST by neverdem
By Rick Nauert, Ph.D. Senior News Editor Reviewed by John M. Grohol, Psy.D.
Tuesday, Oct 21 (Psych Central) -- In a groundbreaking study, Duke University physicians have developed a method to identify the risk of postoperative confusion.
Authorities believe the screening tool will help minimize or prevent what has become an increasingly serious medical problem among older adults.
Delirium, which is sometimes accompanied by confused speech and hallucinations, is known to leave patients in an acute confused state where they experience a serious decline in cognition and attention.
It is believed that up to 50 percent of older adults experience delirium and disorientation following general anesthesia. With the current looming increase in elderly patients, researchers have expressed significantly increased interest in identifying risk factors that will help identify older patients best suited for preoperative intervention measures.
Aside from the detrimental impact patients personally experience with postoperative delirium, the economic repercussions resulting from longer hospital stays, elevated rates of admission to long-term care institutions, higher death rates and related healthcare costs are staggering. In 2004 alone, it was estimated that nearly $6.9 billion Medicare dollars were spent treating delirium.
For purposes of this study, the team from Duke submitted 100 patients 50 years or older undergoing noncardiac surgery to a screening for geriatric depression and a battery of five preoperative tests designed to measure their ability to process information, concentrate and self monitor. Postoperative delirium occurred in 16 percent of patients after surgery.
The results of the study indicated that the most reliable independent predictors of postoperative delirium were the geriatric depression score and the time required to complete the Trails B portion of what is known as the Trail Making Test – a cognitive flexibility task designed to measure perception, judgment, memory and so on in a shifting environment.
According to Dr. Monk, “This study demonstrates that a short preoperative cognitive test battery consisting of a depression and an executive function test requiring less than 10 minutes may help identify patients at greatest risk for postoperative delirium.”
While these patients appeared to function normally prior to surgery, it is believed that they may have had some loss of critical brain mass that was not obvious without neurocognitive testing which may account for their predisposition for postoperative delirium.
Dr. Monk and her team view this study as an important first step in developing a practical and predictable screening tool that will help identify at risk patients for preoperative interventions and simultaneously reduce healthcare costs associated with the increased occurrences of delirium that might otherwise be expected with an aging population.
Source: American Society of Anesthesiologists
Metformin is an oral hypoglycemic agent that is associated with the development of profound and occasionally irreversible metabolic acidosis under general anesthesia. Discontinue it 48 hours prior to the surgery date.--snip--
Recent catastrophes under anesthesia have focused attention on the interaction between nonprescribed medications and anesthetic drugs, including interactions with vitamins, herbal preparations, traditional remedies, and food supplements. Good information on the exact content of these preparations is often hard to obtain.2
I tried to list all of them. BTW, they seem to use AHFS, American Hospital Formulary Service, one of my preferred sources.
Confusion was nearly always the elderly who have a more difficult time with absorption of nutrients.
There is a toxic overload of chemicals from the anesthesia delivered to the liver during surgery. Without B vits available as co-factors to neutralize the chemicals in the detoxification process, the body “robs” other area's of the needed nutrients.
The areas depleted could include the brain which is heavily dependent on the B vits for proper function. The B deficiency symptoms are recorded as psychosis, confusion, neurological impairment, etc.
It would be interesting to see if anyone has done research on this.
Can you get the B12, folate and red blood cell folate levels checked? That's part of a workup for a change in mental status.
"Recent catastrophes under anesthesia have focused attention on the interaction between nonprescribed medications and anesthetic drugs, including interactions with vitamins, herbal preparations, traditional remedies, and food supplements. Good information on the exact content of these preparations is often hard to obtain.2"
I'm sorry about the loss of your mother. Hip fractures have lousy mortality stats. 20 - 25 percent are dead within the next year. I was surprised to see that vitamins were included in the excerpt. I didn't check the reference.
For example, the reason why we have such a high incidence of osteoporosis in this country is because we eat a very high protein diet which tends to make the blood too acidic. The body compensates by removing calcium from the bone to buffer the pH of the blood. If you check women with osteoporosis, the blood work for Ca++ would be normal, but all the while damage is occurring.
Our population is horribly deficient in Magnesium and B vitamins due to these nutrients being farmed out of our soil (overuse).
Magnesium is a cofactor in 326 different body processes, as well as detoxification of poisons,pesticides,alcohol,etc.. B vits are used up quickly in stress.
Another thing I've often wondered. If soldiers were given heavy doses of the B vitamins when they are involved in battlefield conditions, would they have the same degree of Post Traumatic Stress Disorder. These symptoms are triggered by an overactive amygdala in the brain. Once the reaction is imprinted with no balance from the frontal cortex (logical cognitive portion of the brain)it is difficult to short circuit.
In both surgery and PTSD, it couldn't hurt to give heavy doses and evaluate the results. The RDA for vitamins is actually the minimum you must take to prevent disease and in no way assists with optimum health. There would be little to no risk.
Another thing, in recent research, high doses of B vits in rats with induced Alzheimer type symptoms, have been shown to “untangle” the damaged proteins and neurons in the brain and restore previous neurological function. Promising? I hope.
Sorry so verbose!
50 year olds in a geriatric study? The doctor is worthless, and the folks that funded the study are idiots.
I watched a ‘sharp as a pin’ elderly lady who underwent surgery on her leg = and came out greatly diminished, descending rapidly into dementia.
She took no OTC meds nor supplements.
She was tall and very thin, no ‘fat on the bones’ = I often wondered if the anesthesia, with little to no fat tissue for absorption, didn't go disproportionately to her brain.
This is a recent - last 2-3 decades - phenomena. Why wouldn't they look to the anesthesias as the causative factor?
It scares me silly. I am probably looking at surgery. It's not the operation that frightens me. It's the anesthesia. But anesthesia will be the very last looked at.
Protect the industry.
Great! My 44 year old wife is going into surgery Monday.
She had a rather severe reaction to her last test where she was sedated that was an EUS exam.
She has had half a dozen or so proceedures requiring sedation in the last three weeks so great thanks for giving me something else to worry about!
As if colon cancer and ovarian cancer is not enough!
Just kidding. I am a bit concerned about this however.
I’m over 50 myself but if 50+ are having trouble with anesthesia I appreciate the issue being researched, whatever you call the age group. They can call us twinkies or some other name; I really don’t care.
I didn’t know about the Glucophage caution before surgery; very good to know (for my wife).
Prayers for your wife offered. She’ll do fine!
I guess if emergency surgery is needed to save a life they go ahead and do it anyway? (with a diabetic patient on Metformin). Is the metabolic acidosis expected in every case or only some of them? Maybe there’s a way of suppressing the acidosis?
The body truly is it's own best pharmacy. It continually strives for balance and finds itself in a diseased state only after years of the onslaughts of heavy stressors that leave it unable to compensate.
I always suggest that people start on a quality multivitamin, some antioxidants and a reputable pro biotic prior to any kind of surgery. It helps the body deal with stress, maximizes the immune system function and promotes early healing.
If someone is a heavy drinker or is on prescription meds which tax the liver, there are some excellent supplements out there that are very safe and have been used for years that will assist in promoting the most effective liver function. This is extremely important because the liver detoxifies all the pharmaceuticals that we put in our bodies. A healthy liver will clear most drugs pretty quickly.
Unfortunately, people having surgery are sometimes in a lot of pain and tend to have taken a large amount of anti-inflammatory type drugs. These are very hard on the liver and it uses up a lot of it's enzymes during the process of breaking these chemicals down for excretion.
To go back to the point of my last post. Two of the co-factors used in the body's creation of enzymes are Magnesium and the B vitamins. Best to have a good amount of those to help the body function effectively.
Good luck, is it elective surgery?
There are people that theorize that those with high toxic lads also tend to accumulate more fat. So, perhaps with a lowered ability to store them, the chemicals kept circulating and causing oxidizing damage to the tissues, even in the brain.
Another point is that the brain is largely made up of neurons covered in fatty sheaths, so if she tended to be deficient in this, perhaps she was already close to an imbalance and it took very little for her to reach the “tipping point”.
dianed, many elderly folks are on medication for high blood pressure, and some of those medications have a negative impact on B-vitamins, that is they somehow deplete the person of some B vitamins, I think B-12 in particular. I have been surprised to see with my elderly mother and other seniors I know on these type of meds (like triamterine, etc) that their doctors do not bother to recommend they take a B-complex supplement, which is not very expensive and would not be harmful if at a reasonable level like B-50 once daily.
I had major kidney surgery in my 30’s, and was healthy and still suffered for MONTHS from the effects of general anesthesia. No doctor would take this seriously. When I had to have a hysterectomy in my 40’s, I refused a general anesthesia and requested a spinal tap and sedation instead. That is extremely unusual, but I was not taking a risk again of being a space cadet for months after surgery with a general.
‘If someone is a heavy drinker or is on prescription meds which tax the liver, there are some excellent supplements out there that are very safe and have been used for years that will assist in promoting the most effective liver function. This is extremely important because the liver detoxifies all the pharmaceuticals that we put in our bodies. A healthy liver will clear most drugs pretty quickly.”
And those would be what? Please?
bump
“The RDA for vitamins is actually the minimum you must take to prevent disease and in no way assists with optimum health.”
Thank you, thank you! It makes me nuts to see so many studies using the RDA, then coming to a conclusion that the vitamin in question failed to corroborate the hypothesis.
Talk on! Welcome to FR. It's great to read someone who can think and provide details like you can.
Thanks for all your info.
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