Category Archives: guidelines

Guidelines for peri-op care of patients with dementia

Reference: White et al.

2019 Mar;74(3):357-372. doi: 10.1111/anae.14530. Epub 2019 Jan 11

https://www.aagbi.org/sites/default/files/perioperative_care_of_people_with_dementia.pdf

 

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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.