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General Anesthesia – Chemical Concussion?

After being ignored for years, including by the medical profession, we have finally woken up to the huge brain damage that can be caused by concussion. Now there’s even a movie about it.

We’ve woken up to what a sensitive plant our brains actually are. I think we have another such sleeper in our midst about whose dangers we will soon wake up too. It’s general anesthesia.

Millions of people throughout the world have surgical procedures every year. A large proportion of those are under general anesthesia (GA). What if GA were to cause long-term impacts on your brain, including memory loss, reduction of your IQ and for some, a type of dementia? If so, could you call this chemical concussion? Would that motivate us to change when and how we use it? Let’s check it out.

Unfortunately it seems like we are there already. We already know that anesthetics cause prolonged memory loss, especially in older people but not limited just to that group. It’s not fun being old – 75% of older patients develop memory loss after surgery, And it’s not as if the effects are short-lived, say 3 months or so, as was once believed. We now know that these effects can last years or are permanent.

OK so GA can cause memory loss and adverse cognitive impacts. Sometimes there’s no choice but to have GA and often the operation is needed for survival purposes, so that’s just the way the world is right?

“Fraid not. Recent research shows that GA in young kids (under 4 years old) reduces IQ, apparently permanently by changing brain structure. If it does it in young kids, what about the still developing brains of teenagers?

And now we know that even adult brains can develop new neurons, another new and surprising finding, we can’t even assume that the adverse impacts of GA are to be found in the very young and the very old, which has been the recent (strained) rationale for defending the adverse cognitive impacts of GA.

There’s even worse. There’s now emerging evidence that GA can trigger or even cause dementia. At the very least it doubles dementia risk. As it does this it can also change personality in ways that resemble the types of personality changes that occur with Alzheimer’s. Could GA be an unrecognized factor in causing Alzheimer’s? Doesn’t that have certain similarities to concussion and its trademark TBI (traumatic brain injury)?

I have personal experience here. A few years ago I had minor surgery that had to be done twice in a short time. Foolishly I allowed my doctor to talk me into GA even though I had expressed misgivings about it. My memory was affected for about a year and I had balance issues. They are gone now but I will never have GA again unless there is absolutely no alternative.

Yet another scary problem; GA adversely affects balance, especially amongst older people. Falls are one of the most serious health issues in older people and can drastically reduce both life span as well as quality of life. Yet another reason to avoid GA if at all possible.

Why do doctors recommend GA at all? Probably in many, if not most cases they are simply unaware. In others they may be aware but their modus operandi is based on GA even though it could be done in other ways – that’s what happened in my case. It was simply more convenient for the doctor because that’s the way he usually did it and anything else would throw him off his comfort zone. And most surgeons and doctors are much more interested in whether the operation worked rather than any cognitive impacts. How often has your memory been tested following an operation?

Here’s another factor in the decision as to whether a doctor recommends GA. Maybe you choose to have a local anesthetic via a nerve block. But sometimes these don’t work because the anesthesiologist doesn’t get near enough to the nerves to be blocked. Then you might have to go to GA anyway. I know. It’s happened to me.

Now how about the link to concussion? I’ve already mentioned the link with dementia. Until recently concussion was regarded as being something minor, actually kind of manly. Every footballer should get it as a coming of age proof of manhood. Now we know differently. Is this like general anesthesia? It’s always been regarded as innocuous; just something everyone goes through, with no after-effects. But now we know there are effects, and then some.

Concussion’s effects can be subtle at first. The same is true of general anesthesia. But as we now understand more fully, the brain is a complex and delicate instrument. Just because you don’t see any damage doesn’t mean it hasn’t occurred. General anesthesia is coming to look more like a form of chemical concussion – the assault is not physical this time but chemical. That’s far from meaning that it doesn’t have less serious impacts.

Now I have just outlined what we do know about the impact of GA on your mental functioning. But it’s precious little. What else don’t we know? These chemicals we use for our GA are powerful and haven’t been examined for these sorts of impacts. Or to the extent they have, the drug companies that make them are certainly not giving us what we need to know.

I really do understand that in many cases there is simply no choice but to use GA. So it’s not a case of banning it. On the other hand, what steps would we take if we formally recognized that GA has such enormous adverse impacts on mental function?

It looks like we need to formally recognize that GA is generally bad for your mental capabilities and cognitive functioning. We should avoid it wherever possible in medical practice unless there is absolutely no choice. It should be routine practice for all patients who have undergone GA to be tested both before and after its use for cognitive and memory impacts.

GA is a massive and looming issue in public health. It clearly affects the aged disproportionately so as the population ages the problem will worsen. Its impact on young children is major and it’s almost certainly a major problem in other age groups. It could be a major factor in inequality and other social issues about which we have been sublimely unaware. And this is what we just know about now.

The Federal and State governments and the medical profession need to face up to this issue squarely. There needs to be a lot more research in this area, especially alternatives to GA. If not, then citizens need to force it, for all our good.

 

 

 

 

 

 

 

 

 

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Monday, 06 July 2020

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