-
Level of Conciousness in Open repair.
I have just finished a pretty comprehensive view of the literature at pubmed.gov on anesthesia choices in hernia repair. I did not find ONE study that recommended spinal or general over local based on time to ambulation, post-op pain, and recovery in general.
One factor I have not searched yet is the level of consciousness between spinal block methods of anesthesia-there are 3 types I found VERSUS the level of consciousness – Wikipedia with local+sedation. The sedation I have gathered is rather deep with local, so the question arises in my mind for those who are seeking to avoid the well known documented effects of cognitive decline, especially in elderly patients which type, spinal or local+sedation results in the lowest level of awareness or wakefullness.
I have it on good word from neurologists who study this that putting the brain to sleep in any way is definitely NOT GOOD for the brain. If spinal has a higher level of awakeness, then I may reconsider and go with spinal. Any info much appreciated, thanks. -
3 Replies
-
It is possible to do local only with no sedation, and it’s possible to do local with light sedation. You need a surgeon who is extremely good with local anesthesia, and even then it can hurt sometimes.
The no sedation or light sedation options are offered only by very few surgeons in the developed world. The standard these days is deep sedation, typically using propofol. There are some rare exceptions like the Shouldice Hospital where they tend to use lighter sedation with Versed (midazolam). However, patients are complaining about being awake and being in pain during surgery. Things get confusing with Versed because you may be awake and in pain, and then not remember it because Versed causes amnesia. I heard that Dr. Chen at UCLA also offers little or no sedation (for Lichtenstein procedures).
-
Chuck the bulk of the review research on this is on the side of cognitive decline. There are a few studies that say it does not happen but most say it does. Elderly are particularly at risk especially from gen. anesthesia. But my original question remains unanswered.
To Watchful, you are not alone, without giving personal identifiable info on the internet I can tell you that yes, it does in some cases accelerate dementia. There were many studies showing cog decline in the elderly especially in the first month post op but who knows what the long term effects are.
The “sedation” with local anesthesia seems to be varied from sleep to mostly awake. As I said previously I remember the Desarda video of an 80+ patient being asked to cough to test the integrity of the repair.
-
Anesthesia and sedation are known to cause delirium and cognitive dysfuction in some patients, particularly elderly patients with a low cognitive reserve. There are many papers about this. I researched it when it happened to my mother. We had to put her in a nursing home due to her rapid cognitive decline after the surgery. Her surgery was a “minor” orthopedic surgery. The anesthesia caused the problems. It causes some brain damage and inflammation, and rapidly accelerates dementia.
Sedation has such bad effects as well. It doesn’t need to be general anesthesia. I don’t think local anesthesia does it, but sedation does.
Log in to reply.