My father had a significant cognitive decline after two surgeries within 6 months of each other (Cardiac Ablation). The second surgery resulted in septicimia so the inflammation is definitely a factor but both me and my mother also noted decline after the first surgery.
It was very obvious in term of decline, my father had trouble with doing some tasks on his computer (when he never did before having been an early adopter and programming some educational software for schools in the 80s), he no longer could concentrate enough when reading and became more extreme in his politics (he went from voting from the parti socialiste and being mostly center left to being very left wing). He also had less control over his emotions and would sometimes explode in a rage unlike anything he had before.
He himself felt diminished mentally and that greatly bothered him during the last years of his life.
On my side, I've refused general anaesthesia as much as I can because it scares me deeply. When I was a kid, I had an operation under general anaesthesia and I woke up with a very strong asthma attack, completely unable to breathe. Reading this, it does give argument towards my stance to asking for local anaesthesia as much as possible.
I've had two ablation's myself. After the 2nd one I suffered a stroke. It had no lasting effects I'm aware of, but that's just luck.
Heightened stroke risk is a well know is a side of ablation's. In the week or two after they are done tend to spin off clots, and that's when mine happened. However, to put that risk into perspective, stroke is also a well known side effect of the thing ablation's treat - arrhythmias. Unlike the risk from ablation's, the risk caused by arrhythmias goes on for life, and goes up as they get worse over time - which they almost inevitably do.
Have you had much luck convincing doctors to go with locals? A doctor who did colonoscopies said that they needed to use a general for their own convenience. Everyone just went along and so that became the standard.
Not OP, but I have convinced a surgeon not to use a general for shoulder surgery. I was fortunate to have had a previous surgery with a doctor that avoided general when he could, so I knew it could be done and that it worked well for me. To bolster my case, I found research papers showing that recovery from the surgery I was having was faster and better with a local nerve block + sedative instead of a general. The nurses tried to convince me I was wrong and making a bad choice, and the doctor would not do the surgery unless I agreed that he could use general if he felt he had to in the middle of the surgery. But then he did the surgery, did not have to use the general, and thanked me, because he said he was going to start doing more surgeries without general.
I don't think it's common to do general anesthesia for colonoscopy (or gastroscopy). Doctors do a minor anesthesia (intoxication) so you sleep while the operation in performedbut that's not a general anesthesia.
In a general anesthesia you can't breath on your own so they stick a tube in your mouth. And it needs a special doctor (anesthesiologist) to perform the general anesthesia.
I am curious: I had both my colonoscopy and gastroscopy while I was asleep. (On one procedure I woke up in the middle of it however. It felt like beeing drunk :-)) After the hospital I was happy and relaxed for the rest of the day.
There was no anestesist (extra doc) present in the procedure, so I assumed it was no general anesthesia. But I dont know. Was it?
I have had some gastroscopies done. For me they used some lidocaine (intravenous) and then propofol. This was done by a certified nurse anesthetist.
I don’t know the distinction between that and “general” anesthesia (they called this general), but I know there are different levels (and there was no need for breathing assistance at that level).
No it was not general anesthesia. I've had general anesthesia for a hemmorhoids surgery and it was a completely different thing than the intoxication I got for colonoscopy/gastroscopy!
General anesthesia is a big deal both for the patient and for the doctors/hospital.
I had a colonoscopy a few years ago. I didn't need any anaesthesia at all. It was merely intermittently rather uncomfortable. I got the impression that this was perfectly normal and that Norwegian medics are much more reluctant to use anaesthesia of any kind and especially total anaesthesia than in many other countries.
I had no problem getting my colonoscopy without drugs, and I recommend considering this route. It's very cool to see what's going on—how often do you get to see your appendix? Discomfort was minimal; I get more pain from my abdominal workout at the gym. (Although I suspect my doctor was unusually good.) For the most part, it was kind of like watching a procedure on TV, with occasional reminders that I was the subject: "You're watching in Cramp-O-Vision!" It was nice to have zero recovery time and drive home.
I have actually refused to do a colonoscopy with a doctor who insisted on general and went to a different doctor who agreed to it. It's definitely a wasteful use of general anaesthesia.
This article suggests that inflammation in response to the surgery is the problem, but as far as I know, anesthesia itself is very dangerous. It can reduce the amount of oxygen the brain is getting for several hours, and if the brain doesn't get enough oxygen, neurons can die. Some of the cognitive changes following anesthesia could be brain tissue death due to the anesthesia itself. Careful dosage and monitoring is required, and you should probably get local anesthesia if possible.
IIRC there are still post-operative cognitive problems in major surgeries done without general anesthesia, suggesting that there's something else going on too. (I don't doubt that anesthesia plays some role, though.)
"More convincingly, a recent study demonstrated that open abdominal surgery under local anesthesia caused increases in hippocampal IL-6, TNFα, and memory impairments (71), suggesting that anesthesia per se is not necessary for the production of neuroinflammation and subsequent development of POCD."
"As seen in observational studies, a prospective randomized clinical trial comparing the use of general vs. spinal anesthesia in extracorporeal shock wave lithotripsy showed no significant difference in the incidence of POCD defined by a neurocognitive battery (142), suggesting that surgery and not anesthesia causes POCD."
Don't forget that most surgery also involves antibiotics which can be another cause of trauma, particularly to the microbiome. Changes to the microbiome have been shown to have cognitive effects recently.
You're right, of course. It's just much less clear to me why local anesthesia would be implicated in cognitive impairment. But the brain is a complex thing, so I suppose my intuitions don't count for much!
Are all types of general anesthesia equally dangerous? I believe that some of them work in different ways. I suspect we could find a less dangerous way.
I agree. It's a bit tricky to study these things because you can't necessarily (ethically) assign people to different trial groups and use different dosages, but just recording data on what type of anesthesia was used and doing a subsequent followup a few months later could already be valuable.
I believe the culprit is "Pump Head". Not the inflammation thing they mention, not the anesthesia.
Heart lung bypass machines, ECMO systems, they all use non-pulsatile continuous flow pumps. These pumps do not have the same pressure curve and higher pressure pulses that the native circulation does. This causes blood to not make it all the way down to the capillaries, and therefore starves brain tissue that is fed by the smallest of the capillaries.
To solve this problem, a company I helped called Ventriflo has been working to build a pulsatile pump that can be used for both ECMO and cardiopulmonary bypass uses.
Sure, but you have to put things in context. ECMO is used as a last recourse for life preservation when death is highly likely. I wouldn't be too worried about cognitive impairment if the alternative was to die.
I have a genetic phenotype which make the use of propofol dangerous for me (partial CPT1A deficiency). I found this out the hard way while getting an endoscopy. It affected my serum glucose levels for a week and they had to give me glucose during the procedure.
So yes, besides the inflammation, anesthetics are a problem.
My father definitely suffered after recent vascular surgery. They had to put him under a second time because of a bleed and do the whole procedure again. Hasn’t been the same since.
Anecdota: I am in my 20s and got turbinate reduction surgery under general anaesthia about two years ago. While difficult to isolate from the effects of the pandemic, I observed a significant reduction in my ability to recall memories and the level of detail.
Still, it's worth being able to breathe through my nose at night — and the benefits that brings (including to my dental health, as I was getting cavities multiple times a year despite me trying keeping my dental health impeccable; which now have stopped after a year post surgery).
Similar anecdata: Mid-40s here. Following a colonoscopy in my 30s, I have incredible trouble with dates and orders of things, finding words for things, and I lose my place when I'm speaking. Mid-sentence, just draw a blank. I end up yielding the floor so someone else can speak, I might pipe up later if my thought comes back to me.
Also, this happens constantly and it's maddening, I'll be a few thoughts deep and can't backtrack to how I got here; I used to be able to unwind my whole train of thought.
I make a lot more typos and I also miss seeing a lot of them to correct them so they slip out in my writing, which used to be impeccable. There are even unique types of typos that I've started making -- if a word has repeated letters, I'll jump the letters between, so for instance "cognition" becomes "cognion". I never made this sort of typo before the procedure.
It's all gotten even worse since the pandemic which I've been told is stress-related, and absolutely nobody will take me seriously as a result.
What's worse, is the standard of diagnosability doesn't take into account how you used to be. So if you started off smart and now you're just sorta average, no problem here, why are you wasting our time? It's like if your Bugatti now accelerates like a Yugo, sorry, that's technically street-legal so according to this book there's nothing wrong with it. It has to perform worse than a Yugo before we can take a look. What a shitty mechanic, you know? But that's where medicine seems to be.
I'm 41, and you are describing me to a tee. I had surgery about 4 years ago, and was under for less than an hour. The language issues, writing and spelling, etc. Most importantly for me is that writing software has gotten a lot more difficult. I attributed it to aging, but after reading some of this research, I'm questioning that. It feels like the issues have popped up in the last several years.
However...
I feel like this is how we got into the false causal relationship between autism and vaccines. Kids get a lot of vaccines in the first 4 years of life, and are diagnosed with autism then as well. So, you work backwards from a diagnosis and say, "oh the problems started a few weeks after the 3 year check-up, and they got shots, so the shots caused it!!" I would be worried we are doing the same here.
There is likely cognitive decline in men in their late 30s due to stress from work and kids, lack of sleep, reduced activity + weight gain, etc. We also get colonoscopies (or other procedures) around then as well. So, it is easy to say, "well I started having memory problems a few years ago, right around the time I had a hernia repair under general anesthesia, so they MUST be related."
I'm not a hypochondriac, but from time to time I will become preoccupied with health related things. It has never occurred to me that anesthesia might in some way be harmful or potentially result in cognitive decline. I'm now afraid I might get a false positive feeling that my mind isn't as sharp after my next surgery (whatever it may be).
My opinion is that in most cases the side effects are going to be less awful than the thing that you were put under for is.
Further, I'm willing to bet most people have no side effects from anesthesia, since most of the time they are only sedating you enough for you to be unconscious.
how did you identify your breathing issues? My new dentist referred me to an ENT due to thinking I may have sleep apnea, and I've been hesitant to go as I have no idea whether this is serious or some ploy to charge me for more stuff. I generally fall asleep within a few minutes, have energy throughout the day and never use caffeine, and get a full night's sleep on a typical night. I also have almost perfect dental health (knock on wood). I would be happy to resolve breathing issues but I'm skeptical of how serious it is given my circumstances.
It’s an insidious illness. I was mostly like you: no issues getting to sleep, no issues with teeth, no coffee. I was diagnosed with mild sleep apnea. My symptoms were lethargy and having major trouble studying. It caused me to drop out of university, not knowing the cause. It’s something that can slowly erode your heart health and actually starve your brain of oxygen each night. Get it checked!
Jeez, thanks so much for sharing your experience. I genuinely thought the worst consequence would be trouble sleeping or dental health, so since I (knock on wood) don't perceive myself to have those issues, I totally shrugged it off. Again, thank you; I'm definitely going to get it checked.
What an ENT will likely do is scope your sinuses (costs a chunk of change, but pretty cool and informative), and send you home with a self-administered sleep study that may catch sleep apnea if it exists.
I do, though not every single morning. I've interpreted it to happen when the climate is drier, but I guess if we're even having this kind of discussion, I might as well just go to a professional and have them clear it up.
That's also helpful to know, thanks for sharing. I think my mouth generally defaults to being open, and I always assumed that was just the natural consequence of gravity once I'm asleep and my face/mouth muscles relax. All the more reason to get that sleep study done lol
Had no idea. I haven't thought of myself as having sleep issues, but if the potential consequences can be as bad as heart problems, then that's definitely worth investigating. Thanks a lot for the info, I'll find a time to make an appt now.
“Sleep apnea can really jack up your heart if left untreated”
Maybe that will finally work to get my husband to discuss his painful-sounding snoring (with sudden stops) with a doctor and push to get sent for a sleep study!
It effects your heart, brain and general health. It makes it harder to lose weight, store memories and generally live a fulfilling life. It sapped all of my energy for years. I had it as a young guy, starting at 18, only slightly overweight. I treated it by working towards a healthy BMI, getting rhino-septoplasty, using a CPAP machine and finally mouth-taping. Mouth-taping has replaced CPAP for me. It’s discussed more in James Nestor’s book ‘Breath’. Good luck to you and your husband.
Hopefully :). If it is long and severe enough snoring can physically damage all sorts of stuff (nerves, blood vessels, airway) similar to occupational vibration exposure. Changing sleeping position can help and can sometimes be enough in less severe cases (both apnea and snoring).
An opposite data point, I had significant back surgery and the only cognitive decline I dealt with was a mild opiate addiction that I had to kick a month post-op. But that was on me.
It took three operations under GA for me to realize that general anesthesia and I do not get along (seems to trigger or exacerbate depression for me). I had two more surgeries that used general anesthesia and I made a point of monitoring my mental health (and recruiting friends/family to help) and I had a definite decline after both of them (but with awareness I immediately resumed therapy and had better recoveries). I had wrist surgery a couple years ago that used a lower level of sedation, versus general anesthesia, and I had no adverse mental health impact from it that I or my wife could discern. If you're given a choice (and a local isn't an option for some reason), this might be something to consider.
From what I’ve read and experienced, it has not been worthwhile, especially in light of these concerns about anaesthesia. Turbinate reduction is temporary and wears off in the order of magnitude of years. I read that the same effects may be achieved by exclusively nose-breathing and never mouth-breathing. At night you can control this by mouth-taping. Pick up James Nestor’s book ‘Breath’, he’s got a good discussion on all of this.
Essentially, get some 3M micropore tape, cut a 3-4cm long strip and place it on the middle of your lips. Half of the tape on the top lip, half on the bottom. If you’re really struggling to get airflow, try to get ‘breath right’ nasal strips and use those for a few weeks. You can re-use those if you’re careful, 2 nights usually. Good luck. Please reply if you have questions.
A variation of this has had me preoccupied a few days already, on account of a study making headlines recently (
https://www.thelancet.com/journals/lanres/article/PIIS2213-2... ) finding that a mere ~29% of hospitalized COVID-19 patients consider themselves fully recovered a year later.
No doubt some of that really is due to the virus, but it would be interesting to know for reference how many perfectly healthy people would be in that state just from going though the treatment.
Anesthesia requires massive doses of drugs we normally consider unconscionably dangerous in public discourse: Fentanyl, propofol, Xanax, ketamine. The anesthesiologist's job is to use a slurry of these drugs to bring you to the brink of death, and then hold you over the abyss by your ankles. All of this is done to perform gross physiological trauma on your body, which your CNS responds to readily as we know from the phenomenon of people waking up during surgery. We seem to think surgery under general anesthesia is not a life changing event because we don't remember it.
> Anesthesia requires massive doses of drugs we normally consider unconscionably dangerous in public discourse: Fentanyl, propofol, Xanax, ketamine.
Recreational, unsupervised self-administration of those drugs in recreational contexts is nothing like carefully measured and monitored administration in a hospital context.
An Anesthesiologist carefully administering calculated doses of Fentanyl to a fasted patient who is being directly monitored and surrounded by professionals capable of emergency resuscitation has almost nothing in common with an opioid addict taking a random dose of what they've been told is Fentanyl.
Don't get unnecessary surgeries, obviously, but don't confuse surgical intervention with drug abuse.
I'm sorry, but even though anesthesia seems to impair cognition, it's nothing like you describe. One can certainly die from anesthesia, but it is incredibly rare. Anesthesia is very safe when dosed correctly.
I also want to say that Anesthesiologists don't always "bring you to the brink of death, and then hold you over the abyss by your ankles". That would be silly.
Maybe for open heart surgery or brain surgery or some other extremely dangerous surgery where if you were to wake up the shock could kill you, but that would be overkill for a broken arm that needs pins to heal or for an appendectomy done with endoscopic tools.
Knocking you out and keeping you under would be more than enough for that.
The point of anesthesia is to shut down all the conscious parts of your brain and many of the unconscious ones. It's a fundamentally difficult task, and by a lot of standards you are in real trouble during it.
"I am an anesthesiologist. To an anesthesiologist, fentanyl is as familiar as a Philips screwdriver is to a carpenter; it is an indispensable tool in my toolbox. It is the most commonly used painkiller during surgery. If you’ve had surgery, it is more likely than not that you have had fentanyl. Fentanyl is used to blunt airway reflexes and to place the breathing tube into the trachea with minimal coughing. It is the potent analgesic that prevents pain from the surgeon’s scalpel while your body sleeps under anesthesia."
Fentanyl is commonly used to induce general anesthesia. Diacetylmorphine was used before the introduction of fentanyl. Diacetylmorphine is also known as heroin.
I am in dire need of back and ankle surgery, but I don't ever want to go under anesthesia again. When I had emergency surgery on my cervical spine years ago, I nearly died during the process of waking from anesthesia. As I was waking, I had a swarm of nurses yelling over me that I'm not breathing and my heart rate being dangerously high. They kept yelling for me to breathe, but I could barely understand their words due to the anesthesia grogginess, let alone force some biological function that should be involuntary to occur. After several injections of god knows what into my IV line and several minutes of frantic people gathering around me trying to figure out how to keep me from dying, I luckily started stabilizing.
From that moment on though, my heart has never been the same. I developed an arrhythmia which they intially told me was due to the anesthesia and should go away within a week, but it has never gone away. Pre-surgery I had a stable idle heart rate - around 65 bpm - and now it fluctuates randomly between 50 and 115 every minute; again that's just sitting and doing nothing. My holter monitor tests showed many many episodes of both tachycardia and bradycardia as well as PVCs and PACs (palpitations).
I've been looking into "awake" surgeries lately for my back, so hopefully that will be a reasonable option for most things in the near future.
Shouldn't there have been an anesthesiologist there to make sure you can breathe? They can stick tubes down your throat and mechanically "breathe" for you, if you need it. Don't know why it wasn't done in your case, if you really couldn't breathe for yourself.
That's a great question, I'm not sure. Could it be because I just had neck surgery and they didn't want to risk infection or damage to the area? I don't have the medical knowledge to know if incompetence factored into the situation at all, but I suspect it did.
I’ve been under general anaesthesia four times and I felt absolutely awful all but one of those times. The dosage in the most recent one was so perfect that I actually remember every moment after waking up from surgery, and I was awake enough to thank the anaesthetist for having a light touch.
It really is a crapshoot and/or an art. It’s not surprising that people are having long term cognitive complications from having our brains forcefully shut down.
> Operations can have cognitive side-effects, particularly in the over-65s but also in the very young
I’m going to need every medical professional to define “young” at the beginning of their articles, abstracts and research papers from now on.
It was about 2 years ago today when I realized this isnt the same word or context as the general population and the communication skills of that entire industry is inadequate for ever saying anything to the public.
"can cause degradation of the cholinergic system in the brain, which is involved in learning and memory – but it has proven hard to study this in humans."
Why is it so hard? I would think a citicholine supplement could be administered to examine this hypothesis, unless the hypothesis is that utilization of choline is somehow blocked.
This is a bit of an anecdote, but my mother-in-law had some back pain, and she came home one day and said that she was going to have a spinal fusion surgery. We ended up doing a little bit of research on the surgery, and it turns out is unbelievably invasive, you were literally bolting your vertebrae together, and we recommend that she got a second opinion. The second doctor she went to was literally horrified that it was suggested and she ended up getting a cortisone shot (I think?) that dramatically reduced her symptoms to a manageable level and she’s been low-pain for half a decade.
A close relative in their early 70s had a relatively safe (3 in 1000 have complications) laparoscopic organ removal. All looked well until the massive stroke (from a blood clot) an hour later. No chance of recovery.
Every time I've been under general anesthesia it's been a horrible experience. I usually have a severe asthma attack during recovery and have uncontrollable nausea for 3-5 days afterwards. I have certainly noticed that there are mental effects as well, but I believe they subside within 30 days. This does concern me though, because I have chronic health issues and likely will need more work as I get older.
Many detransitioners are raising the concerns about the psychological effects of more and more surgery on young people to actualize their true selves. This is counter to the prevailing narrative that every surgery that a young person might have is reversible down the line through more surgery.
I honestly think that people in the future are going to view gender reassignment surgeries in the same way that we view FGM today. There doesn’t seem to be any possible evidential basis for gender reassignment surgery on non-intersex individuals, compared to the alternative of non-surgical intervention, and it seems that it should be considered unethical for surgeons to offer it.
> This is counter to the prevailing narrative that every surgery that a young person might have is reversible down the line through more surgery.
Indeed and it's a very harmful narrative even without detransitioner concerns. Once you've had your breasts lopped off, or womb removed, or - if male - penis and scrotum fashioned into a pelvic cavity, no amount of further surgery can reverse this. Those organs are gone permanently.
Very interested in the papers and the discussion happening with general anesthesia being used on young kids.
Relatedly: had ~15 surgeries before the age of seven back in the 90's when there was zero notion of these nuances, and there's not a small part of me that wants to slide in a mention of "Hey, a lot of this could be second-order effects of medical/ICU CPTSD". Typically the kiddos coming in for multiple surgeries already have a few major medical issues - and so bouncing back from "multiple" operations paints a lot different picture than just one clean-and-done one.
Honestly, Modern Medicine doesn't provide good evidence or reasoning for people around risks like surgery. From the systemic point of view, frequentist statistics permit doctors and policy-writers to consider risks, but an individual doesn't get to re-play the experiment 1000s of times to get results that represent the statistics. You don't get to try again if you get a complication or die on the table but your doctor and the system do. The very human desire to regain "health" and comfort combined with a not unreasonable pitch from a doctor tend to override that rationale hesitance. Risking death or further disability to be freed of pain and discomfort is an oddly acceptable risk.
I agree with you overall but going after statistics as the problem is a flawed way to make that point. If you commute to work on the road you're taking accumulated risks equal to many surgeries, and if you aren't making those decisions based on statistics you're making them based on what people around you consider normal. 1% risk that everybody takes is just as dangerous as one only taken by yourself.
The statistics don't actually tell you YOUR risk. They tell if the risk a population has on average collectively.
Your personal risks could be much higher or lower, and quantifying them is basically impossible. It only makes sense to use the "average" risk level for reasoning if the sampled population is particularly representative of you, which is vanishingly unlikely due to the "curse of dimensionality".
It makes a lot of sense to decide public policy of how driving should be managed based on those statistics, but is hilariously inappropriate to base your decision to get in a car and drive based on them.
>It makes a lot of sense to decide public policy of how driving should be managed based on those statistics, but is hilariously inappropriate to base your decision to get in a car and drive based on them.
Driving and surgery both involve a lot of risks you can do nothing about, making statistics (selected for your demographic, of course) the most you can know. Statistics are not a good way to predict whether one's self will buy a red shirt or a green shirt (when you can know exactly what you will do because you are deciding), but you have no say in whether or not your anesthesiologist will guess the right dose or whether your surgeon will put the sutures in exactly the right positions to stop a post-op bleed. The same goes for most accidents, which are called "accidents" because culpable negligence is actually pretty rare.
I'm not really sure I understand your point. Isn't this true of all statistical findings? Sure for some things you can repeat a similar action, but you can never go back and change that you took a specific action. Besides health research is done on a population level. The goal is improvement of healthcare as a whole. It sucks that some people end up on the wrong end of the stick, but that's just a fact of healthcare and life.
It's a problem of different goals. In the variants of "Maximize net good/minimize net harm" frequentist statistics are appropriate to reason with. From a individual "maximize my personal quality of life" perspective, I am likely member to many intersectional groups and complexities that render that statistical reasoning meaningless. You can only generalize the results of a study to those represented by it's sampling and the cold hard reality is that a nontrivial amount of people are not represented.
Public health reasoning is entirely self consistent and rational given it's goals (minus perversions due to capitalism and rent seeking).
The problem is that it is actively hostile to most people who are disabled, a minority, or dealing with any long-tail health problem.
After you suffer some years, dealing with enought pain that you can't sleep, discomfort of having pills that will take out all your basic common sense (to the point that you get into crazy risky situations you can't even explain), you'll prefer to die - or, even better, to take a chance on a surgery where the worst outcome is already your daily life, and the best one is getting your life again.
Yep. I live there too. It led to the above insight.
Some successes (Heart surgery helped with chronic migraine pain). I'm currently turning off large swaths of my immune system in hopes that Celiac, Crohn's and Psoriasis get better.
It was very obvious in term of decline, my father had trouble with doing some tasks on his computer (when he never did before having been an early adopter and programming some educational software for schools in the 80s), he no longer could concentrate enough when reading and became more extreme in his politics (he went from voting from the parti socialiste and being mostly center left to being very left wing). He also had less control over his emotions and would sometimes explode in a rage unlike anything he had before.
He himself felt diminished mentally and that greatly bothered him during the last years of his life.
On my side, I've refused general anaesthesia as much as I can because it scares me deeply. When I was a kid, I had an operation under general anaesthesia and I woke up with a very strong asthma attack, completely unable to breathe. Reading this, it does give argument towards my stance to asking for local anaesthesia as much as possible.