Question re Post-Op Amnesia - page 2

I am 3 weeks post-op from abdominal hysterectomy with BSO. I had an excellent surgical outcome, despite nothing going as planned and lots of surprises. My only complaint is that the gas passer... Read More

  1. by   Homesick Gypsy
    No disrespect intended. I only used gas passer because it's easier to type on a laptop than a-n-e-s-t-h-e-s-i-o-l-o-g-i-s-t.... And I think one of the allnurses participants actually uses it as his/her user name.

    My RN friend actually couldn't understand why I did so much research on my surgery before hand. She said I should just put myself in the doctor's hands and not ask any questions. Sorry, but I'm just not wired that way. I need to be an informed consumer. And with all my prior problems with drugs - lots of allergies, serious adverse reactions - I wanted to learn as much as I could.

    Once the anesthesiologist explained his reasons, I agreed with him. He was correct under the circumstances.

    I appreciate all your comments, it has definitely made me feel better about the whole situation. Thanks for your input.
    Last edit by Homesick Gypsy on Oct 31, '05
  2. by   athomas91
    there's the problem... it was an ologist......

  3. by   rn29306
    Quote from athomas91
    there's the problem... it was an ologist......


    I started to take bait and run with this. I wondered who else would go for it. hehe.
  4. by   CrohnieToo
    How did you get pictures of your surgery? Do they often or usually take pictures during surgery?

    Your learning at the last minute that you could not have the regional and would have general is just the reason I HATE this bit about not seeing or talking to the anesthesiologist or anesthetist until just before the surgery. I don't have that much confidence or trust in doctors to begin with. I most likely would have cancelled the surgery and walked out in a huff. Makes no difference that he is right, I don't LIKE doctors springing surprises on me. I've walked out on a colonoscopy because I was promised no sedation and then they tried at last minute to insist.
    Last edit by CrohnieToo on Nov 17, '05
  5. by   athomas91
    i think you need to look first at who is "promising you" this and that - if you didn't hear it from your anesthesia provider then you have no right to "huff" because it is anesthesia who must determine what is safe and appropriate to use for ANESTHESIA

    likewise - you can always request a consult w/ anesthesisa prior to a procedure to discuss these things days/wks in advance - so if that is a major issue for you - take some initiative and ask.
    sorry if it sounds harsh - was not intended that way - but i do not believe in complaining about things that are absolutely within your power to control.
  6. by   Homesick Gypsy
    CrohnieToo - my surgeon didn't promise an epidural, but he recommended it and I had spoken to one of the doctors in the anesthesiology group about it. Neither of them mentioned my weight might be an issue. That's why it was such an unexpected bomb dropped in my lap. He explained it that morning in pre-op and I agreed, once I understood. I didn't know before-hand that the table would be tilted. When I came back to work I found that he had indeed called me the night before, but at my work number. Don't know why he didn't have my home or cell number in his records. I had consulted with another doctor in their group who ended up with an ob delivery case, and not my hysterectomy. All I had discussed with the other doctor was about the epidural. I didn't have a chance to discuss allergies, problems relatives had with surgery etc. I can only guess that the anesthesiologist I had the morning of surgery "assumed" if it wasn't on the record, I didn't have any other concerns. The records also showed that we did not, in fact, finish our pre-anesthesia interview after the Versed took away my memory. The fact that I was anxious was not a reason to sedate me without telling me. I would be more worried about a person about to undergo major surgery who was not anxious.

    I was pleasantly surprised that they allowed pictures during surgery. The pictures went a long way to ease my mind that the very large incision I ended up with was indeed warranted by the huge uterus they removed. Because of having to go with general instead of regional, and because of my memory issues and not being able to remember anything explained to me in the hospital, I took the pictures with me to my six week checkup and wrote down what he told me. I feel like I didn't miss out on so much and now understand everything that took place. As my grandson says "All better".

    I checked my medical records and the anesthesiologist used Forane. When I looked up Forane in the drug digest, it says "...may cause diminished intellectual capacity for 2-3 days and mood/personality changes for six days". I assume this could also apply to memory loss. If it can cause effects in the body for up to six days, it disputes that drugs used in anesthesia go out of the body quickly.

    I've talked to several other people who have had memory issues after general anesthesia who said it took up to six months for their memories to get back to where they were pre-op.

    I'm not blaming anyone, or upset - I just want to understand. I am now 8 weeks post-op and still having memory issues. It's better, but still troubling. I thought I was able to remember things I've learned since the surgery, but now I'm finding that I remember it for a few minutes, then it's gone.

    Back to the original question - Is this something even fairly normal for post-op anesthesia, or should I be consulting a doctor to see if something else is wrong?

    Thanks for any thoughts you may have.
  7. by   Pete495
    Those who say with absolute certainty that memory trouble is not related to anesthesia are just wrong. Anesthesia is always indivudualized, and patients often do experience memory problems post-op for weeks, or even months. Myself has experienced such problems after general anesthesia for shoulder surgery. This may be related to dosages of drugs or anesthetics intra-operatively. For one reason or another, some people are more sensitive to anesthesia and pharmocological interventions. i.e. post operative nausea and vomitting. In some cases, you can give patients antiemetics intraop or pre-op, and they will still have post-op N/V. Believe it or not, I am also one of these persons too, so I can sympathize. A lot of times, it just depends on the patient. This is part of the reason I am getting involved in the profession.

    With that said, It is definitely not fair to say this was the fault of anesthesia. It seems like you had a lot of post-operative narcotics, and this could also be an included explanation. There may be some explanation that would require more extensive testing than what it is worth to investigate. From what you said, I don't think you should be concerned too much about having anesthesia in the future. What you described is mostly normal. If anything, you can mention the next time you need anesthesia that you experienced some memory problems last time, assuming these problems continue for a long time. From my point of view, anesthesia is the combination of mostly science and little bit of art. Even if you were given a little too much, how do you personally know that any less would have risked anesthesia awareness, and other post-operative complications? My suggestion is that it is probably a combination of factors, since you have not had memory difficulty for GA prior to this surgery. It sounds as if your anesthesia was done well though overall, despite portions of the pre-op assessment.
    Last edit by Pete495 on Dec 2, '05
  8. by   SproutRN
    Quote from Homesick Gypsy
    I've talked to several other people who have had memory issues after general anesthesia who said it took up to six months for their memories to get back to where they were pre-op.

    I'm not blaming anyone, or upset - I just want to understand. I am now 8 weeks post-op and still having memory issues. It's better, but still troubling. I thought I was able to remember things I've learned since the surgery, but now I'm finding that I remember it for a few minutes, then it's gone.

    Back to the original question - Is this something even fairly normal for post-op anesthesia, or should I be consulting a doctor to see if something else is wrong?

    Thanks for any thoughts you may have.
    I'm sorry, but I don't think there is anything normal about "memory issues" 8 weeks post-operatively. And I don't think that it could be anesthesia related this far out. A follow up with your medical doctor would probably be a good idea!

    Sprout
  9. by   onconurseRT
    :uhoh21: I have also had some experiences that are related to the "OR event".. I had emerg.surg. in Feb 2001 from a leg bone fx (trauma.) I don't recall 2 weeks of my hospitalization. Since then, oddly my balance is shot! I noticed it when I got home a week or 2 after my hospitalization. I attributed it at that time as "part of the deal" with a broken leg, however, now years later walking up/down stairs is a major challenge and getting on step stools and a ladder is now completely out of the question due to a weird feeling of "spinning" and eventual loss of balance. (I had no head injury at all at the time of surg). It has taken me years to get my balance back on my bike, which is a big deal for me, and I still have not regained a lot of that. I was a gymnast for many years prior and had no issues at that time. ???:uhoh21: ???? I have no idea exactly what caused it, but I know that it did occur during the hospitalization because it was a clear, immediate, significant change from how I had been prior.
  10. by   Homesick Gypsy
    Thanks for your replies. I had morphine the first 20 hours after surgery, then one dose of Darvoset to which I am highly allergic. After two doses of Benadryl to reverse it, all I had post-operatively (even in the hospital) is Advil, which is what I was taking before surgery.

    I do remember that the right side of my neck seemed to hurt more than my incision for the first couple of days post-op. I assumed it was due to positioning on the table. My daughter has told me that she cleaned a small amount of blood out of my right ear for three days. I have a vague memory of that. Don't know if any of this is related or not. Also, when they removed the air stockings, I had a very large "spidery" bruise on my left calf. My surgeon told me that the stockings did their job by breaking up a clot, but didn't seem otherwise concerned. It made me wonder if perhaps I had a problem with clots during the immediate post-op and if that could have caused something in my brain. I've tried to think of anything and everything that could be the cause.

    I knew that being off work for six weeks would cause me to forget a few things but I'm worried about keeping my job at this point. Back to work for two weeks and I still can't remember half of what I'm supposed to do. I"ve even written some of it down but forget to check my notes. Can't remember my door code to get in.

    I've had general anesthesia before and hadn't had these issues. Maybe I'll give it another week or so and then see if my primary care physician thinks I should follow up.

    Thank you for discussing my concerns, I appreciate your input.
    Last edit by Homesick Gypsy on Dec 3, '05
  11. by   apaisRN
    Emotional stress is hell on your memory, too. I hardly remember any of my wedding. The combo of anesthesia, pain, narcotics, physical and mental stress might have been enough to scramble your synapses. I am sorry it was such a frustrating experience for you.
  12. by   Homesick Gypsy
    Me again. I've been doing some research and found a term that describes what I've been experiencing: "Postoperative Cognitive Dysfunction". Apparently it's more common than I knew and quite a few studies are being conducted. Even though I have no other symptoms of menopause, my doctor has placed me on 1 mg. estradiol tablets to see if it helps. Can't tell much of a difference.

    Although this seems to affect elderly (age 60 and above) patients more often, it has been seen in patients of all ages (I'm 50 and in good health). In also reviewing my medical records and itemized bill, I'm wondering if part of it might have to do with my hemorrhage and subsequently being given hetastarch..... One guess is as good as another.

    Here's is the ASA Newsletter, February 1999 (emphasis mine):

    ASA NEWSLETTER February 1999 Volume 63 Number 2

    Does Anesthesia Leave Some of Our Patients With Prolonged Postoperative Cognitive Dysfunction?

    Joachim S. Gravenstein, M.D.

    We begin the era of the brain. The stage was set last year by two important publications that focused on cognitive dysfunction after anesthesia and surgery in the elderly. A clinical study by Moller and coworkers appeared in The Lancet1 and Dodds and Allison published an excellent review article in the British Journal of Anaesthesia.2

    Because cognition may decline with advancing age, Moller et al. studied some 1,200 patients who were 60 years of age and older, assuming that if anesthesia and surgery did indeed affect mental functions, it should be most readily detected in the elderly. The investigators administered psychological tests before the operation, within a week postoperatively and again approximately three months later. In all patients, general anesthesia lasted at least two hours. Cardiac and neurosurgical patients were excluded as were patients who failed to meet the study criteria. Volunteers of comparable age, but not undergoing surgical treatment, were given the same psychological tests at the same intervals to serve as controls.

    The investigators detected new cognitive dysfunction in the first postoperative week in some 25 percent of patients. After approximately three months, close to 10 percent of patients showed measurable cognitive dysfunction. This differed significantly from the 3-percent decline in cognitive function observed in the control population over the same time span. The data confirmed the hypothesis that older patients were at greater risk; patients over 70 years of age were twice (14 percent) as likely as those in their 60s (7 percent) to show prolonged cognitive difficulties. The authors rejected the hypotheses that hypoxemia or hypotension during surgery or during the first three postoperative days can be linked to postoperative cognitive dysfunction.

    The review article by Dodds and Allison brings this study and many others into focus. The authors cite 89 papers and discuss the history of published concerns about cognitive difficulties after anesthesia. Remarkably, such concerns were expressed with growing frequency only in the last 50 years, perhaps triggered by Bedford's report in 1955 in The Lancet that some elderly patients develop dementia after general anesthesia.3 Dodds and Allison examined publications exploring the mechanisms that might contribute to cognitive dysfunction after anesthesia, among them: drug effects; physiologic changes during anesthesia such as hypoxemia, hypotension and hypocarbia; neurotransmitters; the cholinergic system; and genetic factors. They also reviewed studies that failed to find prolonged postoperative cognitive problems or that compared regional with general anesthesia. Dodds and Allison concluded their review with the following categorical statement: "There is no debate as to whether or not postoperative cognitive deficit exists. It is common and persistent ..."

    We may accept as inevitable the frequent psychological disturbances that affect elderly patients in the early postoperative period. Too many mechanisms come to mind: the slow elimination of central nervous system-active drugs used during and after the anesthetic, the effects of metabolic and hormonal disturbances, sleep deprivation, pain and the disorienting effect of the strange hospital environment. The observation, however, that many elderly patients and presumably some younger adults as well show signs of cognitive disturbances three or more months postoperatively present us with new and urgent questions: How many of these disturbances fail to resolve with time? Can such problems push some elderly patients prematurely into dependency? Can we preoperatively identify patients at risk for late postoperative cognitive disturbances? The literature and common sense suggest that patients with pre-existing psychological dysfunction are at higher risk. Can we prevent the problem with the help of different perianesthetic measures? Are the problems even related to anesthesia, or do they have to do with the impact of hospitalization, drugs unrelated to anesthesia, disease processes or changes in living brought about as a consequence of the surgical disease? Whatever the answers to these questions, we should recognize that there is no postoperative complication more frequent and of longer duration than postoperative cognitive dysfunction in the elderly.

    Anesthesia is not limited to "putting them to sleep and waking them up again." Over the years, anesthesiologists have assumed responsibilities in the intensive care unit and for pain management for all hospital patients. It is time for the specialty to become actively involved wherever possible in preventing and treating postoperative cognitive dysfunction. Such involvement will call for research and active care of the affected patient.

    We may draw a parallel to pain management. While we started out treating only wound pain, we now treat pain of many different origins. While we started out worrying only about early postanesthetic confusion, we now should recognize that late postoperative cognitive dysfunction demands our attention. At this time, the ASA standards for care and monitoring do not even mention the brain, the very organ we depress so skillfully to relieve anxiety and pain. In the future, it is likely that ASA's standards for care and monitoring will include statements about our responsibilities in preventing postoperative dysfunction of the central nervous system and, where that fails, in monitoring and caring for patients with postoperative dysfunction of the central nervous system.

    References:
    Moller JT, Cluitmans P, Rasmussen LS, Houx P, et al. Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998; 351:857-861.
    Dodds C, Allison J. Postoperative cognitive dysfunction in the elderly surgical patient. Brit J Anaesth. 1998; 81:449-462.
    Bedford PD. Adverse cerebral effects of anaesthesia on old people. Lancet. 1955; 2:259-263.
    --------------------------------
    Joachim S. Gravenstein, M.D., is a Graduate Research Professor Emeritus, Department of Anesthesiology, Shands Teaching Hospital, University of Florida, Gainesville, Florida.
    Last edit by Homesick Gypsy on Dec 30, '05
  13. by   mwbeah
    Quote from Homesick Gypsy
    I am 3 weeks post-op from abdominal hysterectomy with BSO. I had an excellent surgical outcome, despite nothing going as planned and lots of surprises. My only complaint is that the gas passer slipped me something in pre-op before I finished my pre-anesthesia interview. I have very little memory of my four days in the hospital, and lots of memory lapses since being home.

    I know that low estrogen can cause "brain fog" but at this point I have no other menopausal symptoms. I don't feel like I'm in a fog, just can't form a memory. I had an adverse reaction to the Vivelle patch put on at the hospital so am waiting for surgery drugs to clear my system, and also waiting for menopausal symptoms to appear. I have a lot of "belly fat" so assume I am receiving adequate estrogen from that at the moment.

    Can the after effects of anesthesia last this long, or should I be concerned? I saw my surgeon one week post-op to remove staples and he brushed off my concerns. I don't want to be a drama queen, but am concerned that maybe I have a problem with what was given me, and possibly should be aware of it in case of future surgeries.

    Any and all thoughts are welcome.
    If I were you I would research the literature involving the effects of hysterectomy on memory (some sources quote 67% of women have memory deficits after this procedure).

    Mike

close