I am a board-certified anesthesiologist in Lake Tahoe, California. I write from the perspective of both a doctor and a patient.
What Is Postoperative Cognitive Dysfunction?
Most people realize that after surgery and anesthesia, they will be confused or "out of it" for a while. It has long been known, however, that some people remain confused or have mental slowing for quite some time after surgery. Some patients say, in fact, that they are never the same. Short-term memory loss, trouble with focus, and generalized slowness are the most common complaints.
Postoperative cognitive dysfunction (POCD) is a state in which a decline in learning, memory, and/or personality changes persist long after the surgery.
Researchers are beginning to study and define this phenomenon. It seems that we are a long way from being able to reliably predict or prevent it, though.
POCD occurs most often in elderly patients, but can be detected to a lesser degree in younger patients, as well, when using specialized mental function tests.
Before continuing, it is important to emphasize once again that POCD is different from the confusion that typically occurs right after surgery. Some confusion and mental slowing are expected. This postop "delirium" (this is the medical term) is not unusual and does not constitute POCD.
Risk Factors and Factors Influencing POCD
- Socioeconomic status
- Pre-existing mental status
- Preoperative state of health
- Type of surgery
Risk Factors for POCD
It used to be assumed that general anesthesia was the main risk factor for POCD. However, this has been shown not to be true.
Despite much speculation regarding the reasons for POCD, there are only two main factors that, so far, have been shown to predispose to this condition. The first—being over 70 years of age—is not really a surprise. Older patients are more likely to have issues with memory after surgery and anesthesia. Elderly patients who have pre-existing mental dysfunction may very well get worse, temporarily or permanently, after surgery and anesthesia.
Low socioeconomic status has also been shown to correlate with cognitive dysfunction after surgery for reasons that are not clear. Further studies may provide clarity on this or help figure out if there are other factors at play.
People who develop POCD have received all types of anesthetics. Some received none at all.
The most surprising findings that arise from studies on the subject show that the type of anesthesia does not necessarily influence the incidence of POCD to a significant degree. Despite the assumption by almost everyone that general anesthesia would be the cause of postop confusion and mental changes, this did not turn out to be true. Epidural, spinal and even local anesthesia have been given to patients in whom post-op cognitive dysfunction then developed. Different types of patients and surgeries DO affect the likelihood of having difficulty with mentation after surgery.
Of course, nothing in medicine is simple and other studies have variable results. For example, after having a surgery called a carotid endarterectomy, POCD occurred more often during the first day after surgery with general anesthesia compared to local anesthesia. By a week after surgery, though, there was no difference in function (the "fog" had lifted). That surgery is specifically to remove clots from the big blood vessels in the neck that supply the brain, so other factors are likely to be involved here as well.
Other factors that may play a role in POCD:
It may be the case that other factors are contributing to the decline. Surgery and anesthesia of any type are physiologic stressors on the body and brain. Other physiologic stressors, such as critical illness in the elderly, also cause the same type of difficulty with mental function. In addition, when the body endures these types of physical insults, chemical changes occur in the body. Stress hormones, inflammatory mediators, and other chemicals are released and influence the body's functioning. Substances, like the amyloid found in Alzheimer's patients, that are deposited in the brain may also be increased after surgical stress. It is likely that one or a combination of these chemical changes affect a person's mental ability after surgery.
Unfortunately, we are just in the stage where we are recognizing and defining POCD. Progress has been made, but we are a long way from understanding—and being able to prevent—this condition. Studies and research are ongoing. Stay tuned.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Rodney Eden on June 09, 2019:
My mother who was an avid reader and loved puzzles has lost the ability to do both after a back surgery. She can read but forgets and had to re-read shortly after a page. This has caused her great sadness. Please, can anyone tell me if there is treatment available for her?
Doug on October 11, 2016:
I had open heart surgery to replace my diseased aortic valve almost a year ago. I healed well, and can walk a mile no problem, mow my grass without grayouts, and breathing hard. Ever since my hospital stay I have been in a fog and am much slower than before the surgery. My ability to recall things has taken a big hit. I do have bipolar disorder and didn't take the meds on the day of surgery, Drs orders. After my surgery I went back on them. I still am slow and in a fog. Not as bad as the first couple months home but it really bothers me. I suspect the anesthesia, or the heart lung machine. But also I know preexisting conditions along with the anesthesia can prolong the fog or even possibly never be able to lift the fog. Any feedback would be greatly appreciated. Thanks for the web page on this topic.
Marcelle Bell on February 03, 2016:
Hi TahoeDoc - I love all your informative hubs. I recently wrote a hub on an illness I suffered with called Trigeminal Neuralgia. I had MVD surgery (a craniotomy where the surgeon decompressed two arteries from my trigeminal nerve - a more simple brain surgery essentially). My surgery was just over two years ago and I still experience mild cognitive difficulties, mainly loosing words from time to time and short-term memory issues. I am in my 40s so I don't fit the older age profile but I was under anesthesia for several hours and my brain was exposed and gently moved during surgery. Would this type of invasive and long surgery involving the brain area possibly lead to the cognitive issues I have? They are mild but noticeable. I kept hoping they would resolve but it's been over two years now. Thanks for any input you would have and thanks for your detailed hubs.
Nichol on January 16, 2016:
I have a four year old that seems to go through an on going emotional rage for weeks after surgery he has had 5 and each time he is unbearable for weeks is there anything associated with that and being put under ? It's not a pain issue its like an phycotic break down
HelpforPeter on October 18, 2015:
My friend, Peter, had surgery one month ago. He is still in the hospital. Should have been in overnight. He is very confused, has trouble finding his words. He not getting better. He has had 3 CAT scans, all normal. He is an alcoholic. He had the same thing happen 2 years ago following back surgery. It took him 2 weeks, but he completely recovered. He just woke up one day and he was back. He has been treated with Hadol, Zyprexa, and now they are going to put him on Seroquel. He is not detoxing. This is a 69 year old man who went in for a stent in his leg, an overnight procedure, and now he can't function. One month ago, he lived on his own, drove his own car and took care of his dog. Completely independent. Now, he doesn't even know where he is. What can I do? I visit him everyday. I make him read to me and we play card games. His attention span is short. Yesterday, he suffered a short seizure. Please help!
Barry L Friedberg from Corona del Mar CA on October 02, 2015:
As unpleasant as the ’tree’ of anesthesia awareness can be, there are no known deaths reported from it. Awareness pales in comparison to the ‘forest’ of daily routine anesthesia over medication death, the probable consequence of failing use a bispectral (BIS) index monitor as a real time device. Only this year has the maker changed the default setting on the free standing VISTA units to include the real time signal of the electromyogram (EMG) of the frontalis muscle. BIS data alone is 15-30 seconds behind real time and is not especially useful for drug titration. Titrating with BIS alone is akin to driving one’s car with rear view ‘mirror’ information only. Adding the real time signal of the EMG is more like looking through the ‘windshield’ to drive one’s car. Making BIS/EMG monitoring a standard of care is the primary goal of my non-profit, 501c3, Goldilocks Anesthesia Foundation. Only with universal BIS/EMG monitoring will we learn how much postoperative delirium is attributable to anesthesia over medication.
susan on September 10, 2015:
I am 52 yrs old. Had filling in tooth on July 30 and on July 31 ended up having an emergency appendectomy had anesthesia for both, different types. it's now September 11th. just left my second doctor visit since my surgery to find out why since the surgery, I feel like the anesthesia hasn't worn off yet. I feel kinda drunk, not dizzy, I feel disoriented somewhat, hard to focus and multitask as usual, and I feel like I have a slower reaction time, and get numbness in hands and face. this feeling comes and goes like waves throughout the day. dr thought it was labrynthitis on the first visit, put me on steroid, antihistamine, and Dramamine. it didn't work. she took blood work today, will get result tomorrow. do my symptoms sound like pocd?
TahoeDoc (author) from Lake Tahoe, California on January 27, 2014:
I'm so sorry to those who have asked a question here and not gotten a reply. The page was preventing me from using 'reply' for some reason. I'm working on fixing this...
T on January 17, 2014:
Hello. I had surgery in Sept 2012. It was cosmetic, so of course that means that I was in excellent health or they wouldn't let me have the surgery. I was 29. I ended up with an ectopic pregnancy 2 weeks later (I had an IUD), so I had to have a D&C. I have had so many problems since. I have had all sorts of tests including a colonoscopy :) So, lots of anaesthesia and then Methotrexate. Docs tell me that they can't find anything wrong. I even had testing with a Neuropsychiatrist. The issues that are described above are the issues that I'm having. All of my results were Superior, except for the above issues, which were Normal. My IQ dropped to 117 from the 131 that I had tested around 20. If there are any studies for relief, PLEASE, post here. Thank you for looking into this. Most docs are done with ideas to test for. They have no idea.
worriedaboutmom on January 16, 2014:
My 67 year old Mother had elective hip replacement surgery and was confused days following surgery. Nurses at hospital assured me this was not uncommon for ppl her age after surgery. I took her home and she became worse and would not allow me to help her so I took her to rehab. After they cut out her meds for 24 hrs she seemed to improve but still not back to normal. Catscan and blood tests came back negative ruling out UTI or brain damage. She is improving but is still, for lack of being able to describe better - "off".
With that being said, doctors feel it is dementia. But after researching online, seems more like either Delerium or POCD. I have three questions.
1. Do you think it's Dementia, Delerium or POCD?
2. Will it go away and her return to normal?
3. Is there a medication or treatment for this?
TahoeDoc (author) from Lake Tahoe, California on September 13, 2013:
Hi everyone & sorry for the questions above that I didn't see or get to answer...
Hi Pcardio- I'm sorry for your troubles. Start by seeing your regular medical doctor and asking for a mental status exam to see where you are. Unfortunately, it isn't quite as helpful as having a previous one to compare to BUT, there are standards by age and you can see just how you fare and what areas of weakness you may have.
Then, once that is identified, you know where to start. Ask the doc for specific recommendations. In addition, many researchers feel that the brain can be 'exercised' like a muscle to make it stronger. Do word games, crossword, sudoku, memory games, etc to force it to work hard.
Pcardio46 on September 13, 2013:
This has also happened to me. I am very interested in any research findings on POCD. I had cardiac bypass surgery (4 grafts) in 2008. I was only 46 at the time. Immediately after the surgery I had moderate to severe memory loss, low mental functioning, generally slow and even difficulty with sentence structure and names of people I know very well. General confusion. Thankfully, I improved after a couple weeks. However, it is now several years later and I have never fully returned to normal. It seems I have permenant cognitive decline, short term memory loss, disorganization, difficulty in planning and accomplishing slightly challenging tasks, and overall slowness. It is almost like I am mildly to moderately mentally impaired. This is very depressing, needless to say. It has dramatically changed my life in a very negative way. Is there any information out there to help me. I do not want to accept this for my life.
Ngail56 on July 06, 2013:
My brother in law had surgery for rectal cancer over a year ago and went from being a very neat and clean guy to depression, uncares about his appearance and no ambition. Please help us bring this great guy back to his old self. He has already seen many psychiatrists to no avail.
wolfj on August 13, 2012:
So glad that I stumbled across this page! I had surgery 3 weeks ago (2nd time in my life with the first being at 6 mos. old) and have struggled with dizziness and not feeling "right." This was something that worried me before surgery so I am wondering if somehow this was in me subconsciously? Any thoughts? Brain seems to be working…just equilibrium is off and really freaking me out…anxiety is out of control. As I said, I think that because this was my biggest fear going into surgery (I've read up about lasting issues before and was really freaked about it happening to me.)
Thanks again for all of your help!
MissingmygrandpaIt on August 11, 2012:
By the way, finally found your bio. Makes you seem more.....human? I don't know of that's the right word. I truly can't thank you enough for all the input you gave us over the last week, it did helps come to terms with some things, and strongly question others. (which, to question, is not a bad thing). On a totally, completely, off related topic; do you have much cause to work on Ehlers-Danlos patients? If so, I have a few weird questions about anesthesia vs. Ehlers Danlos patients. I personally have the hyper mobility type (thank god no vascular issues for me) and have now had 41 surgeries, 35 being orthopedic. Life gets crazy, especially when trying to be mommy to 4 great kids. Anyways, just need to pose a few questions to you if you have experience in dealing with people like me.
Missingmygrandpa on August 11, 2012:
It took me awhile to convince my mom, but yes, an autopsy is being performed this morning. I have a gut feeling that it will show something amiss. Something wasn't right during the whole ordeal. From day one of surgery, thru the past 8 days, it truly felt like the entire hospital staff had just given up on him before they started, because of his age. He was a vibrant, active, man, who still, at 91, lived independently, drove better than most people I know, could cook, bake, and take care of all his needs. Yes, he did have rapid weight loss in the end, but that was truly the only thing that was wrong with him. He went to his "lady friends" house everyday to help her, she was wheelchair and home bound. I was beyond amazed at his level of activity at his age, and I don't feel he was meant to go this way. With my grandma (his wife) her death was completely unexpected, and quick, in terms of date of admission, to diagnosis, and finally death. But, I accepted it. I am not one of those people who always refuses to accept death, I just don't accept HIS death at face value. Hopefully we will get answers thru the autopsy.
TahoeDoc (author) from Lake Tahoe, California on August 10, 2012:
I can't tell you how sorry I am to hear that. When older people get pneumonia, they often have pretty significant mental decline, so you have at least some explanation for that (in addition to just the stress of surgery, stress of illness after surgery is particularly detrimental).
It sounds like you have a pretty good idea about what the post op standards are and whether or not they were done. Did you opt for an autopsy to get further clarification or feel you have enough or don't want to go through that? Just curious.
Again, so, so sorry- Feel free to rant and rave all you want. You deserve it as you have had a bad feeling and been frustrated for a while now. Hugs to you and your family. Just because he was in his 90s doesn't mean his death is easy, especially if you sense it wasn't necessary at this time. I think people find it easier to write off if the person is very elderly, but it isn't right.
Missingmygrandpa on August 10, 2012:
I just wanted to let you know that my Grandpa passed away at 9:30 this morning. We still have NO idea the cause behind this. I do know that the hospital was negligent in many ways, the last and most severe was continuing to let him eat/drink even after they knew a week ago that he was aspirating his food. They should have immediately made him NPO until the could do a swallow test, but didn't make him NPO until last night. Even after finding the pneumonia they still let him eat. I am so frustrated at the lack of care he received during all this. When I saw him Monday, before I went to surgery, he had a mouth full of dried blood, drooling down his chin, and looked as if it had been there quite a while. It was completely dried. The nurses were "surprised" and claimed they didn't know. Well duh, when you don't check on the man, how could you know. They didn't have an IV running to help with hydration, he never had a pulse oximeter on, and those leg things they put on that inflate/deflate to prevent blood clots had not been put on him either. They didn't rotate him to prevent bed sores, they didn't x ray his lungs but once, the first day out of surgery, then once yesterday morning when they found his lungs covered in pnuemonia. It was a very frustrating situation. It feels like they gave up on him from the moment he came out of surgery. I can't thank you enough for giving me information on POCD, it truly helped in trying to figure out what was going on. And I am also sorry for ranting and raving on this message, I think I just needed to vent it out to someone I don't know. I can only hope that someday there will be answers to the whys and hows of POCD and have a better understanding to help prevent or treat someone with it. I only hope and pray that no one else has to go thru what we went thru with him on this. It was horrible. I will now forever be- missing my Grandpa. :(
TahoeDoc (author) from Lake Tahoe, California on August 09, 2012:
Oh, man. I am so, so sorry for you and your grandpa. Unfortunately, the very elderly, even if they are 'healthy' often have little reserve left to overcome the stress of major surgery. Sometimes, they do and like your grandpa, without a decent quality of life, they may be willing to take the chance. I've had people like him insist on it even when I've resisted heartily. I will respect their requests in the end because it is their choice.
Unfortunately, you haven't had much help since then in understanding or cooperation in your efforts to do what you feel is needed to optimize him. And, again, I'm so sorry for that. :(
And, I apologize for not seeing/responding to your last comment. I don't always see them when I'm tied up at the hospital when they come through. I was not ignoring you.
Big hugs to you and your family in this frustrating and sad time. Hopefully, he will turn around with treatment for the pneumonia. I've seen it happen…
Missinygrandpa on August 09, 2012:
Things have gotten much worse for my Grandpa unfortunately. He now has pneumonia and we feel we are fighting the hospital on every point of his care. I know it's the end for him, but I just wish he had been coherent when I was there on monday. Because of my knee surgery (which went ok, offending screw removed, nothing else majorally wrong) I am still not able to get over there. His delirium is so hit or miss. It's mostly there, and then he has moments of perfect clarity, it's the weirdest thing I have ever heard of. I thank you for your response from earlier, it definitely helped me understand this condition better. Waiting now for the inevitable phone call and will be forever- missing my grandpa
MissingmyGrandpa on August 06, 2012:
On my way to see him before my surgery. He DOES have a Hospitalist, they are the ones being evasive with the "breathing problems during surgery" and are refusing to call neuro for him, claiming, (I kid you not) that he has Hospital Acquired Dementia. I understand it is a legit thing, but to me should be a diagnosis of exclusion, not the immediate thought just because CAT scans were clear. I have been doing loads of research, and one thing I came across was Sundowners Syndrome. (and yes, I know you can't give a diagnosis) and would hold you to nothing more than throwing thoughts and ideas around to get to the bottom of this. He is DEFINITELY far worse at night. Last night, around 1030, my uncle was leaving the hospital, before he could get out of the hospital (a bigger hospital) they were paging him to come back. I was so bleary eyed by the time I read the words Sundowners Syndrome, I had to go to bed. I am going to look it up now, again, on the way to the hospital to see him, and hopefully the Hospitalist will be there like I requested. I personally hate this particular hospital, I have had them treat me with indifference when a patient, to the point of them taking 4 different hospitalizations with a lot (and I do mean alot) of seizures. Finally, after 4 months and at the 5th admission, we made them call a neuro (we didn't realize at the time that we needed one because they were saying the seizures were fake. How do you fake a seizure?) who immediately did an MRI, found a benign brain tumor in the left front temporal lobe. At the same time, I was slowing coming off the Fentanyl Patch (by my choice) after being on it for 9 years. It was figured out that every time I dropped, I seized. It was nuts. And that hospital kept telling me it was conversion disorder, I was "faking" them, blah blah blah. Interesting that I haven't had a single seizure since coming coming completely off. Anyways, sorry, no coffee of board here. ;) So I really hate this hospital. That's not the only time I have been mistreated there either. And there are other horror stories from friends. Anyways, any thoughts, from your experience, NOT a diagnosis? Oh, and they tried for 6 months to not do surgery, but he couldn't even lift his arm up, he was waking up 5-6 times a night in severe pain, it really was poor quality of living. He couldn't even ride his bike anymore. (my 91 year old grandpa could ride a bike further than me!) if you saw him, you would guess him more like a vibrant, youthful 70's, expect for the recent weight loss. I just feel like this is going downhill sooo fast for him, and I know I need to accept that this is probably not going to end well, BUT I would just like him back mentally, just to say I love you and goodbye. :( I will post after I have my surgery, with more info on him. Thanks for responding, I truly appreciate your insight and ideas, and I in no way hold you liable, expect a diagnosis, or am going to interpret anything you say as a diagnosis or anything more than very general thoughts. (required disclaimer ;)
TahoeDoc (author) from Lake Tahoe, California on August 05, 2012:
Wow. A shoulder replacement is a big, big surgery. All joint replacements are a huge stress on the body and brain, not just during the surgery, but for a long time afterwards too.
Personally, I would have questioned the wisdom of replacing a shoulder on someone who is 91 and has a cardiac history. Low potassium and being underweight with continued weight loss might also be reasons to have further evaluation before surgery. I cannot however, make that judgement call for another doctor without knowing the whole situation.
I agree that the confusion and mental decline sounds like postoperative cognitive dysfunction and his age, history, preop status and seriousness of his surgery put him at high risk of this disorder.
The inability to swallow, the speech difficulty- I agree with you, a neuro evaluation to make sure he hasn't had a stroke would be a helpful choice. Tell them you want one. Again. Some strokes don't show up on the CT right away, and some never do. A neurologist should see him unless someone else gives you a satisfactory answer. This is not 'normal' recovery, as you know.
The anesthetic is gone. That's not causing all of this, even though it's an easy thing to blame everything on when there isn't another explanation.
I wonder what the breathing issues were? Did they give any more info? If they put an interscalene block in for pain relief, that can sometimes make breathing more shallow and would be more likely in someone who was weakened preop (which may be indicated by his weight loss, etc). There can also be problems with interscalene blocks causing a near-spinal block. The effects would last longer than the surgery perhaps, but not days. This doesn't seem likely.
Or, its possible that he had some muscle weakness. This would not be surprising and might be the most likely cause. Because of his history of weight loss (he was underweight and lost more weight, so most likely lost a lot of muscle mass recently) and so on. You are right to wonder what could have caused that, and how this could affect him postop. You may not get a better answer than "he was weak".
I wish I could give you better answers. I can't ethically or legally make diagnoses or draw definite conclusions without a full history and physical and I have to make sure you understand that I can't possibly know anything for sure and you should treat my answers as general information of what COULD be possible in this or similar situations (required disclaimer)
I can't imagine how sad and frustrated you feel and hope you come back if you have other questions, want clarification or to update me on how he is doing (and you too, after tomorrow). Request neurology again. If the surgeon hasn't had a regular medicine doctor (internal medicine or hospitalist) see him, you could start there if neurology isn't readily available. But, you have every right to request further evaluation. You can also ask to talk to the medical director if you don't get anywhere that way.
Missingmygrandpa on August 05, 2012:
My Grandpa just had surgery on August 2nd. He had his shoulder replaced. He is a 91 year old man, who at his pre-op visit 10 days prior was found to be 134lbs (he is about 6ft tall, so clearly underweight) and a very low potassium level. They still cleared him for surgery. On the day of surgery, he was re-weighed at 123lbs. An 11lb loss in 10 days. And they STILL did the surgery. He went in he normal, sarcastic, spunky self, and came out an entirely different person. He does not know where he is (which is really bad seeing as he volunteered in the same hospital every Friday, for eight hours, for 14 years) he doesn't understand why he can't leave, to the point of small combativeness, and he is hallucinating. (tonight he saw dinner plates floating in the air above him). He knows who we are, he knows he has a dog, but does not know where he lives, when he is in his confusion state. He has very brief periods of being lucid (maybe 15-20 minutes every 6-8 hrs) and completely oriented. They have done a CAT scan, blood work, and urine-everything is perfect. We were told the anesthetic would be completely out by the 72 hr mark. They tried taking away his pain meds, this did not increase nor decrease his confusion, but significantly increased his pain, so we put him back on. Being back on, he is not any better or worse than before. We are beyond frustrated because they won't call in neurology to at least rule out other stuff (like having an MRI to look for a possible Transient Ischemic Attack. He had quadruple bypass surgery 15 years ago, no problems. He has had about 6-7 surgeries (orthopedic) in the last 12-14 years, and again, never had an issue, even as recently as last October. He is not capable of swallowing water that hasn't been "thickened" and we just found out that when he does swallow, it's going into his lungs, so no more anything by mouth. He is also talking as if his tongue is swollen (it isn't) or like he has a mouth full of, full of something. They want to ship him of to long term rehab care (he was never slated for that, he was to originally be going home on Monday) without first getting to the bottom of this. Some things fit with this condition, others don't. Just wondering if you have any thoughts. I am desperate to get answers, even if they are bad/sad ones. I want my Grandpa back. (by the way, I myself have had 40 surgeries, having number 41 tomorrow, I have Ehlers-Danlos hyper mobility type, and have NEVER had anything remotely close to this happen to me. I am only 34 though, not 91) Thats part of why none of this is making sense to me. Oh, one more quick note- he needed to be put onto the critical care unit immedietely following surgery (again, not planned, was supposed to go to ortho floor) due to, what the doctors called "breathing issues". Thoughts, ideas?!?!
jimislittlewing from Australia on August 01, 2012:
Thank you for yours also. My research is in HIV genetics so I know nothing of this topic really! But I always like to educate myself, it helps me go through it personally, and I hope it will make me a better doctor one day. I'm glad to hear you have felt no long lasting effects from your 5 surgeries, I do worry about my academic abilities in particular, because it does seem to take me such a long time to feel 'normal' again and in my particular career, my brain is the most important part of me! Thanks for sharing your professional and personal expertise, it is so appreciated and offers some comfort.
TahoeDoc (author) from Lake Tahoe, California on August 01, 2012:
I am also fascinated by this topic. I was as surprised as anyone when the results of the studies showed that surgical stress, not anesthesia alone, was associated with POCD. This is definitely an area that is quite poorly understood-- we only have a couple risk factors and associations to go, and they aren't that strong.
I have no idea what we will find in the future about anesthetics- IV or inhaled. It stands to reason that medicines that work by (presumably) changing or interacting with the cells or their membranes in the central nervous system, could potentially cause some damage or slow-to-repair changes in those cells - who knows? I am also fascinated, but am not a researcher. Now a neuroscientist with an interest in POCD-- that sounds like the makings of a future anesthesiologist who will help unravel this mystery (hint, hint) :D
This is really a rather newly described or at least a very likely under-reported issue. It will be interesting to see what we learn in years to come. For now, I just tell my patients that we don't know what the long term effects could be from the anesthetics.
I've had 5 surgeries myself in a relatively short time, so I get why this is concerning. But so far, no long term effects for me (although I guess, I could use it as an excuse).
Thank you for your insightful comments. It is valuable to have experience as both patient and doctor. Keep in touch and let me know how things go for you as both :)
jimislittlewing from Australia on August 01, 2012:
Thank you for this post. I underwent an attico antrostomy 6 days ago and I'm still feeling quite disoriented. The surgery took 5 hours, and though they say the length of surgery doesn't matter from an anaesthetic point of view, I agree with you that the other combined factors such as stress and invasiveness of the surgery, do have a large impact. This is my 3rd surgery in 12 months..the other 2 were short, grommets and tonnsillectomy..but it still took a good week or two to clear my head. My background is Neuroscience and I am currently finishing a PhD in Medicine, then going on to do my Medical degree. So from a personal and professional point of view this topic really interests me. How likely is it, that in 10-20 years from now we will find out that the IV anaesthetics we are using actually do cause impairment in brain function? As someone who will require more ENT surgeries in the future..this concerns me. It also concerns me that anaethetists often tell patients they will feel 'fine' in a couple of days. That has never been my or anyone else I've known, experience. Your thoughts on this would be appreciated. Thank you :-)
TahoeDoc (author) from Lake Tahoe, California on July 04, 2012:
Hi Lillian- Hope you start to feel better soon :( Sorry you are having problems. Interestingly, surgeons still blame the anesthesia and don't think to tell patients of the toll the surgery can take on their entire body and mind. Anesthesiologists are just working out who is at risk and why, and don't mention most side effects if they don't happen to a significant number of people. Might be worth mentioning before surgery, although we don't have a good way to prevent it and it seems unlikely that telling people this is possible would stop them from having their surgery. Still, it might help people know what is going on and that it is not entirely unexpected in some cases.
LillianB on July 04, 2012:
This has helped me realize what is going on with me. 3 days in the hospital, I had every test possible and all were ok still have all the symtoms . I hope this does is temporary. Their should be warnings given to patients.
TahoeDoc (author) from Lake Tahoe, California on July 02, 2012:
Dale- did he have surgery? Have you talked to the surgeon who took care of him or his regular medical doctor? You should start there.
If he had surgery and is still taking pain meds, that can definitely do it- some medications cause hallucinations and delirium in older people.
Talk to those who are taking care of him first. See if there is a medicine that could be contributing. Ask if there is any bloodwork (like a chemistry panel) that will help make sure something there isn't off. Then, do all the things suggested above to keep his mind active. Keep as much familiar around him as possible. Talk to him and keep up the interaction.
I hope it gets better- that has to be very frustrating and sad for you.
dale from flat on July 02, 2012:
my dad is 76 years old in great health we all thought. he has been confused not knowing family members,talking about old people that are not around anymore ,,hallicating its been 6 days now. what can we do.
TahoeDoc (author) from Lake Tahoe, California on June 06, 2012:
Wow, you are right, she has certainly been through a lot. Unfortnately, this type of decline is not uncommon after such physiologic trauma and stress in her age group. It's really sad and I'm sure, hard to watch.
You are definitely on the right path. You have given time to see what would clear in the immediate aftermath of surgery and recovery. You are thinking about other causes like her meds that may be contributing.
It seems that you need an advocate- a doctor or therapist or someone on the 'inside' to listen to your concerns and perhaps, seek further testing or treatment. If she is really not improving, have her seen by her regular doctor or the facility's doctor. Sometimes, a CT scan or MRI can help reveal whether certain changes are based on structural changes in the brain. Not sure if you want to go down that path with imaging studies, but it's a possibility (if it shows small areas of decreased blood flow, for example, that shows she was already prone to this happening and recovery may be more difficult or incomplete vs. finding no structural changes, in which case other causes and treatment can be sought). I honestly don't know how accurate these studies would be. By this, I mean, that it's possible that even if something is found, it's not going to be entirely clear that it is related to relatively recent changes or that it is necessarily cause and effect. It may cause more confusion for you than it solves. Does that make sense?
So, first step is to have her evaluated by her primary doctor or a neurologist. They can sometimes help sort out the type of dysfunction she is having. Also, the meds may need to be looked at and selected carefully for her.
For your part, other than requesting the above evaluation, keep interacting with her. Stimulation is good for her. Doing things like word games, crossword puzzles, sudoku or whatever when she is able is good 'exercise' for the brain. Movement increases blood flow and should be good for her as well.
Good luck- I can't imagine how frustrated you are and your love for her and desire to help her definitely come through. She's lucky to have you.
CindyL on June 06, 2012:
I am most certain my 88 year old mother is suffering from POCD. she has a history of being very sensitive to pain medications. She had emergency hip fracture surgery on March 22 and experienced confusion and hallucinations for about 8 days after surgery, but returned to reading newspaper, conversing with family, etc. Because of improper handling at rehabilitation facility had to have a second major hip replacement surgery on May 7 (only 6 weeks after first operation). This second surgery required her to be under anesthesia for a 5 hour difficult surgery. She took 6 days for hallucinations to stop (this time .hospital knew not to administer pain meds that cause her trouble). She is currently in a different rehab center to learn to walk, but has days of confusion, then appears back to her intelligent self, then a few days of confusion. The next few weeks are crucial. In rehab as decisions about her future care are being made, and they may be based on a "temporary" condition. How do I help her now? What steps should I take to help "cleart the fog" if we can so she can enhance physical therapy? I also wonder if massive changes to her list of meds she has been on (changes made by two hospital visits and two separate rehab centers in the span of 3 months) are intensifying the POCD. It is crucial that I seek help now.
TahoeDoc (author) from Lake Tahoe, California on June 05, 2012:
Hi Bob. Depending on how much colon was removed, this could be related to dehydration. Also, many medications can cause lightheadedness. As always, the stress your body takes from illness, surgery, anesthesia and recovery often takes A LOT longer than we think it will.
From personal experience, I had my entire colon removed and it took several months to feel better. It was so hard to maintain hydration and to get enough rest to make my body happy.
First thing is to make sure there isn't some easily discovered and treated reason, so let your doctor know that you still feel this way. He/she may or may not want to see you to check your heart rate, blood pressure or lab studies. These reasons must be ruled out or discovered and treated first.
If it's leftover effects from surgery, then time and hydration with extra rest will help.
I know how you feel and really hope you start to feel better soon.
Bob on June 05, 2012:
I had surgury a month ago to remove a tumor in my colon was under the knife for 3 hours
I feel very lightheaded and its not going away and ideas?
TahoeDoc (author) from Lake Tahoe, California on April 20, 2012:
Thank you tirelesstraveler. This is exactly why I write. I know it's hard to get the whole story when going through something like that. Also, it's difficult to get reliable medcal info online (or at least, to know what is and isn't reliable). I'm glad this helped.
Judy Specht from California on April 19, 2012:
Thank You, Last year Dad (79) had three surgeries within a 3 month time. One surgery on each leg to relieve neuropathy then a pacemaker. Your writing and the video fit together the missing pieces. Dad had delirium after one of the surgeries and has had memory difficulty since.
Don Simkovich from Pasadena, CA on April 16, 2012:
Yes, it's interesting to hear her perspective on "detective work" on the patients and histories, etc. Our daughter had some years earlier been on psychotropic meds before her surgery ... the ensuing two weeks after she came home were quite odd.
TahoeDoc (author) from Lake Tahoe, California on April 16, 2012:
Don- I like your wife. I say that EXACT quote all the time. I thought I was being original ;) Sometimes I say "Science is not an exact science" just to change it up.
I think this is going to be a very active area of research. We saw the effects for a while, but I think everyone just assumed it happened to certain patients after certain procedures (heart surgery, carotid artery surgery). Then, it was assumed to just be a side effect of general anesthesia and wasn't investigated very thoroughly.
Now, we know that POCD is so much more than that. Thanks for reading.
Don Simkovich from Pasadena, CA on April 16, 2012:
My wife is a nurse practitioner and she has always said, "medicine is not an exact science." I haven't heard of POCD. But I think I saw the effects one time in our daughter after a surgical procedure.
Marcy Goodfleisch from Planet Earth on April 16, 2012:
It makes so much sense that this sort of thing can happen - so many other things are affected after you have surgery. I will be interested to see what further research uncovers in the future.
Voted up, useful and interesting.
TahoeDoc (author) from Lake Tahoe, California on April 16, 2012:
Thank you Pamela. This complication was first noted and studied in patients undergoing bypass surgery, so you are right. There are a lot of proposed mechanisms for the issue. It seems that the more we study complications and postoperative effects, the more complicated we realize those issues are. There are many things that contribute and hopefully, more understanding will lead to prevention or cures.
Thanks for reading and commenting!
Pamela Oglesby from Sunny Florida on March 28, 2012:
This is a very interesting hub. As a critical care nurse in the past, there was the thought that the heart-lung machine could cause this problem. I will be interested in what further research reveals.
TahoeDoc (author) from Lake Tahoe, California on March 27, 2012:
I think we don't know the answer to your question yet, but I certainly don't rule out injury, especially at the microscopic or micro-vascular level. I agree with you that there might be low-grade brain damage done and this may cause temporary or permanent changes in the brain- both physically as damage and functionally.
So the answer is: There is no definitive answer but you and I (a couple of pretty smart cookies, if I do say so myself) and some other researchers think that yes, this type of change may be due to a type of brain damage. Hope that answers your question a bit more clearly, even if it's not yet a complete answer (medically) :)
Lucia on March 27, 2012:
Thank you so much for your help so far, you've put a lot into perspective. I'm just trying to understand this. My interpretation is that any physical stress related to surgery and illness produces chemical shifts in the body which may lead to the decline in mental functioning, and POCD. I understand that contolling inflammation might decrease the stress on the body and therefore this decline. I think my question is mainly whether or not the chemical changes and stressors are actually 'damaging' to the brain. I'm trying to understand if this could be in that regard a brain injury, or whether it's just a temporary natural repsonse in some people. But thank you so much for the information.
TahoeDoc (author) from Lake Tahoe, California on March 27, 2012:
Lucia- I think your train of thought is right on. And you are correct that you clearly don't fit into ANY category of known increased risk for this, which just shows that we haven't even begun to understand all of the factors involved.
There are studies ongoing to determine the changes that we now know occur in the brain after serious illness, surgery, anesthesia and other insults to the body that stress it physically.
So far, researchers have discovered that amyloid (the chemical found in brains of Alzheimer's patients) and other chemicals like brain-specific enolase are increased or altered in people who suffer from POCD.
Some studies have focused on inflammatory mediators and ask if using inflammatory medications (where the risk of increased bleeding is not limiting) will help.
This area of research is so new that I'm sorry to say that we still have more questions than answers.
I wish I knew of a clinical research trial for you to be part of, although the time elapsed probably precludes your participation. I'm sorry you have anxiety related to this. I know it doesn't help at all, but just know that I absolutely believe your experience and am sorry for your distress and frustration. Is there anything else I can try to research the literature for that would help you?
Lucia on March 27, 2012:
Hi, Tahoedoc, having experienced this myself at such a young age, and with good health, I've started to question other causes. It's had such a big influence on my life and naturally there is a lot of anxiety involved. The surgery I had was relatively minor, and the only hint I've had from a doctor face to face was that the modern G/A used was supposed to be out of my system in 'a few hours.' My understanding is that the anaesthesia is reversed and therefore should seize to be affecting brain function once it is metabolised, and therefore absolutely no cognitive decline should remain as a result of the general anaesthesia. None of the risk factors of POCD you listed above actually applied to me, and I'm also well educated at a tertiary level. Yet, I suffered from short term memory loss, and would describe it as feeling like someone with alzeimer's or having mild brain damage. I've explored and found a lot of similarity between symptoms of POCD and with other forms of mild brain injury. Is this perhaps a subtle brain injury caused by numerous factors involved with any given operation, or do you think this theory is incorrect?