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What you should know about anesthesia

A relatively common sequela to an operation with general anesthesia is delirium. The term “delir” comes from the Latin “de lira”, which means “out of the track”. For a long time, this cognitive dysfunction was also known as passage syndrome. However, because not only short-term, but also permanent damage can occur, the latter term is considered obsolete.

Patients are often confused after major surgery

Studies show: Depending on the severity of the intervention and the health of the person concerned, 5 to 50 percent of patients suffer from delirium after surgery: They are confused and disoriented, see distorted images, and delusions and hallucinations are possible. Some people have problems finding the right words and remembering things. Others get quick-tempered and want to remove their cannulas. Such extreme changes in mood usually come in waves. In between, the patient can be relatively normal again. In general, those affected appear apathetic or depressed.

These states of confusion can occur immediately after waking up from anesthesia, but also a few days after the operation. In most cases it is a temporary disorder with no long-term effects. However, around 25 percent of patients with delirium retain permanent cognitive dysfunction, for example their memory deteriorates.

Inflammation puts a strain on the nervous system

The exact causes for the development of delirium have not yet been conclusively clarified. "What is certain is that the anesthesia is not the only thing that puts a strain on the brain," says Michael Bauer. Delirium often occurs even in seriously ill patients who are operated on without anesthesia or who are in intensive care. The reactions of the brain to inflammatory processes in the body probably play a decisive role. The immune system itself, but also anesthetics, pain mediators and stress hormones can promote inflammation and disrupt communication between nerve cells. Nerve cells can be irreversibly damaged and die as a result.

"Similar to excessive alcohol, an operation with general anesthesia can leave traces in the brain," says Michael Bauer. How well the brain can regenerate depends on the patient's state of health. In a patient with severe dementia and thus a more sensitive brain, a urinary tract infection can be enough to trigger delirium. In general, older people, but also children, are particularly at risk because their brain metabolism is more susceptible.

Minimize the risk of delirium

There are various approaches to reducing the risk of delirium: Patients who already have cognitive deficits such as dementia should, if possible, not be given sleeping pills or sedatives before the operation, as these put additional strain on the brain. Instead, close care by a caregiver can take away the fear of treatment.

Adequate follow-up care after the operation can even cut the risk of delirium in half: early exercise and memory training, but also simple measures such as sufficient fluid intake, adequate sleep and a calm atmosphere in the hospital rooms are crucial. Hearing aids and glasses should be returned immediately after the operation so that the patient can orientate himself optimally in his environment again.