Reference: White et al.
Anaesthesia. 2019 Mar;74(3):357-372. doi: 10.1111/anae.14530. Epub 2019 Jan 11
Take home messages:
- Screen – ‘do you have any concerns about your memory?’
- Prepare patient, carers and MDT approach
- Grant carer/relative access to anaesthetic room and recovery if needed
- Minimum dose and duration of anaesthetic agent as needed. Titrate to BIS. Personally I’d take this as avoidance of GA if possible e.g. using spinal/regional likely to be preferable if it can be achieved safely and effectively
- Try to avoid: benzos, opioids, cyclizine, tramadol.
- Cholinesterase inhibitors e.g. rivastigmine: theoretical benefit of stopping day before surgery when neuromuscular blockers may be used… However balance this against risk of worsening cognitive / neuropsychiatric function. My anecdotal experience is of discontinuation causing more harm than good in general, though each case should be judged on an individual basis.
- Similarities to principles of anaesthetic management of frail and elderly patients in general.