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Archive May 2018 XIX, No. 5

Anesthesia Alert

Prevent Post-op Brain Fog in Older Patients

Lee Fleisher

Lee Fleisher, MD


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DRUG PAYMENT Medicare won't pay surgical facilities separately for drugs that "function as supplies."

Anesthesia and surgery affect everyone differently, but there is evidence that aging brains are more vulnerable to post-operative cognitive decline (POCD), which may include post-operative cognitive dysfunction, confusion or delirium. Post-operative delirium is the most common surgical complication for older adults, but it's preventable in up to 40% of all patients. Here are 4 tips from the American Society of Anesthesiologists' Brain Health Initiative to screen for and diminish confusion after surgery.

Brain Health

Who's at Risk for Cognitive Decline?

The incidence of post-op delirium ranges from 5 to 15%. However, with certain high-risk groups such as patients with hip fracture, the range can be between 16 to 62%. Can you predict who's at risk for cognitive deficit after surgery? Go to for a list of pre-op screening questions you can ask your elderly patients.

1Screen for cognitive deficit. The goal is to help your geriatric patients return to their pre-op cognitive baseline. Assessing your patients' mental function not only gives you a baseline to compare to after surgery, it also alerts you to patients who may have mild cases of cognitive impairment.

Your cognitive test can be as simple as asking 1 or 2 questions to assess the patient's mental function, or as involved as a neurocognitive test. A negative response to the question "Can you remember things you did 10 years ago?" warrants further cognitive testing. But if your patients are still doing The New York Times crossword in ink, they're probably not experiencing any cognitive impairments.

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