Anesthesiologist Questions Dementia

Is anesthesia safe for older people with dementia?

My grandpa (he is only 67) is undergoing a minor dental procedure and he's supposed to be going under. However I am nervous that he's showing early signs of dementia or Alzheimer's, so would anesthesia be okay?

14 Answers

The anesthesia is safe, but it may be one factor in temporarily accentuating his dementia
A minor procedure would also be a short, uncomplicated procedure. Patients with dementia tend to have more issues with long, painful and complicated procedures. For short procedures short acting anesthesia meds can be used so the patient will be back to their preop status quickly.
As long as the person doing it has everything they need and is competent. I would suggest no Versed and simply proprofol sedation. Ideally if he has dementia local alone, but should do well with carefully administered Propofol.
Age and mental status are factors in considering the interactions of medications used in anesthesia. Usually, if the patient does not have other major co-morbidities such as coronary artery disease, diabetes and uncontrolled hypertension to name a few, they should not have any problem undergoing anesthesia in a normal setting. If the procedure seems to be short, the morbidity is usually less. The duration of the anesthesia is also a factor meaning if it is a longer procedure, then the morbidity is also higher. In general, dental anesthesia procedures are safe if done in the right way.
There is some evidence that general anesthesia will make dementia worse. If it is a minor dental procedure I would suggest not to use general anesthesia but just local anesthesia.
It is safe but it may aggravate dementia, a condition called post operative cognitive dysfunction (POCD). This is a phenomenon difficult to eliminate but can be reduced by using regional anesthesia when possible, limiting narcotics and benzodiazepines, and providing familiarity to those older patients.
Most dental procedures are done with IV sedation and local anesthesia or small amounts of IV anesthesia if done at a hospital. Although sedative medication could cause some brief temporary confusion provided he is otherwise in good health there is no known contradiction to use of sedative local anesthetic or IV anesthesia.

Marc A Morales MD
First verify with the dentist the need for grandpa to go under for a minor dental procedure, since that is uncommon. Local anesthesia alone is usually the norm. If grandpa has already early signs of dementia but needs a dental procedure, general anesthesia will not likely be a danger for what seems to be a brief exposure.
Older patients with dementia have shortened life expectancies with or without anesthesia. A brief surgery with an anesthetic that does not decrease the patient's blood pressure should have no detrimental effect.
Every day patients with senile dementia and Alzheimer's undergo all kinds of surgical procedures. If they are stable cardiovascularly, I don't see any problem. In my practice, I don't have major problems with them. But I recommend to perform procedure in hospital setting with adequately trained anesthesia personnel, because they need sedation and monitoring and sometimes need better control.
That's a very good question. Make sure your primary care physician knows about your concerns, so that they can perform tests to solidify a diagnosis. Typically, the anesthesia for minor dental procedures would not exacerbate his symptoms, as short acting medications and/or volatile anesthetics are used.
There's a lot of debate about this. For a minor dental procedure, the amount and duration of anesthesia is not going to cause any harm.
Anesthesia is safe for elderly people undergoing surgery; however, it is important to note that people with dementia are more susceptible to the effects of the anesthesia. Their period of confusion can be prolonged and be profound. I am careful to choose anesthetics that are short acting and have the minimum mind-altering effects. This is something that your anesthesia care provider needs to take into consideration.

Good luck,

Dr Ketch