Follow These Steps to Help Prevent Post-Anesthesia Confusion, ASA Says

There are general risks when it comes to going under the knife, many of them related to general anesthesia—side effects from shivering to vomiting. Perhaps more unsettling for the patient, however, can be states of confusion in the minutes and hours after surgery, or even the long-term memory loss sometimes seen in senior patients.

“The aging brain is more vulnerable to anesthesia, but there is research that provides guidance to decrease these risks,” James Grant, MD, MBA, FASA, the president of the American Society of Anesthesiologists (ASA), said in a press release.

To coincide with Patient Safety Awareness Week, the ASA has compiled the latest research and recommendations into a list of best practices to help circumvent confusion. It aims to apply to all cognitive conditions after anesthesia, whether it’s short-term postoperative delirium or the more serious, long-term postoperative cognitive dysfunction, most commonly seen in patients with heart disease, lung disease, Alzheimer’s disease and other conditions. While some suggested practices aim to make surroundings more familiar, the main takeaway is to find out the patient’s history, especially of any memory loss or confusion, well before any anesthetic administration.

“Older patients should talk with their physician anesthesiologist prior to surgery about their entire medical history and any memory problems they’ve had in the past, so an anesthesia plan can be developed that ensures their safety and reduces the chance of side effects or complications,” Dr. Grant continued.

The tips below are a result of the Perioperative Brain Health Initiative, launched by the ASA in 2016 to help reduce these side effects in patients aged 65 years and older. This is the list of tips for patients from the ASA:

• Ask your physician to conduct a presurgical cognitive test—an assessment of your mental function. The physician can use the results as a baseline for comparison after surgery.
• Be sure your caregiver, a family member or friend stays with you as you recover, carefully observes your physical and mental activity after surgery, and reports anything troubling to your physician.
• Check with your physician before taking medications after surgery that can affect yournervous, such as those for anxiety, seizures, muscle spasms or sleep aids.
• If you wear hearing aids or glasses, ask that they be made available as soon as possible after the procedure.
• Request a recovery room with a window if possible, so you can tell whether it’s day or night.
• If you will be staying overnight in the hospital, pack a family photo, a clock and a calendar, or other familiar objects from home, to help you readjust.