It’s a fact. The older you get, the more likely it is you will require some form of anesthesia in the near future.
That anesthesia could be for a simple out-patient diagnostic test or it might be for a serious heart or respiratory procedure. Maybe you’re looking at a knee or hip replacement or perhaps a life-saving cancer surgery.
Whatever the reason, at the Indian River Medical Center, a full-time team of physician anesthesiologists headed by Dr. Geoff Wolf takes the reins to control patient pain while carefully monitoring each patient’s reaction to the drugs involved.
“We have physician anesthesiologists,” Wolf says. “Somewhere between 10 and 13 anesthesiologists are here every day, providing services from the operating room to CAT scans, to MRIs, to radiology, to our gastro-intestinal GI suite, to the emergency room and critical care.”
It’s obviously a busy crew. Wolf continues by pointing out, “We provide all types of anesthetics in all different places in the hospital. Anesthesiologists are on the go. We start our day probably about six in the morning and on average we won’t finish our day until about 6 p.m.”
On-duty anesthesiologists interview patients, review medical histories, advise, prescribe, administer, monitor and supervise all anesthesia-related procedures. They also work with other physicians to prepare patients for surgery and are in the operating room for the entire operation.
“Part of the preparation,” according to Wolf, “Includes reviewing your medical history, your medications and reconciling those medications so you can be on the proper medications before surgery.
“There are a lot of herbal medications out there that we suggest patients not take,” before going into a procedure and certain blood pressure medicines may also be temporarily withheld.
The object is to avoid any complications so that the anesthesia does its job with a minimum of side effects.
A more surprising part of patient preparation Wolf and his crew may undertake is putting patients through a stress test.
Yes, a stress test.
As Wolf explains, there’s a good reason. “When you think about it, surgery is a marathon. It stresses the body. If we can go ahead and stress you before surgery in a controlled environment rather than on the table when you’re being operated on, we can intervene if the patient has a medical condition that can be improved. Anesthesiologists don’t like surprises. Better pre-operative preparation leads to better outcomes. This has been well proven.”
Wolf adds, “If you’re given at least six to seven days before surgery, that gives us a little bit more time to optimize your medical care. We may add an antibiotic for a cough. We may give you a bronchodilator for worsening of obstructive lung disease and we may perform [that] stress test if we’re thinking that you could be at risk for ischemic heart disease.”
Wolf’s and his team of anesthesiologists, working with surgeons and patients, make recommendations on the type of anesthesia to employ. That could mean a local, regional or general anesthesia.
In cases where general anesthesia is used, the most publicized problems patients may face come after surgery.
According to the American Society of Anesthesiologists, these problems include post-operative delirium and post-operative cognitive dysfunction or POCD.
“Delirium,” according to Wolf, “is more of an acute type of confusion that occurs usually immediately after anesthesia and can continue for days or maybe up to a week at most. Usually by seven days it’s gone.”
Patients with POCD, may show signs of “memory loss, attention deficits, concentration difficulties, learning difficulties and slow responses to both motor and sensory functions,” which can last much longer.
A number of factors come into play here, according to Wolf. Often the surgery itself causes major inflammation throughout the body and when that happens, the brain is also affected. Additionally, many seniors are long-time users of a variety of pain medications which also affect the brain and can contribute to post-operative problems.
The chair of the IRMC anesthesiology department says, “Getting the patient out of the hospital and into a familiar environment is a known factor that helps reduce both cognitive delirium and post-op cognitive dysfunction.”
The normally jovial Wolf has some harsher words for those who post unsubstantiated claims online that anesthesia “causes” dementia, Alzheimer’s or Parkinson’s disease. Those postings, he says, are inaccurate.
“There is no evidence,” Wolf states flatly. “No evidence that anesthesia of any sort causes dementia or Alzheimer’s or Parkinson disease.”
The Fisher Center for Alzheimer’s Research Foundation backs Wolf’s claim to the hilt. It says that extensive studies at major healthcare facilities including the Mayo Clinic have found “no link” between Alzheimer’s or other forms of dementia and anesthesia.
Moreover, the Agency of Healthcare Research and Quality, a federal agency researching health care quality, reports that “the presence of a physician anesthesiologist prevents 6.9 deaths per 1,000 cases,” in which anesthesia is involved.