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Re: Surgery/Hospitalization Tips for E4s

Posted: Sat Feb 28, 2015 7:23 pm
by pgf54
Just a ps , hope the above doesn't read too negatively, its just a reality check I guess. Your advice re support person is very good and also that person would be able to help with bringing in decent food. Hospital food is generally a very sad affair.
The rest is assertion and challenging the system which if more people did , then we would all have an easier time.

Re: Surgery/Hospitalization Tips for E4s

Posted: Sun Mar 01, 2015 9:46 pm
by circular
Can't get the article, but it looks like it could help us when facing a hip replacement. Perhaps the results are also applicable to other joint replacements. I'd be very interested in reading this one

General vs. Regional Anesthesia for Total Hip Arthroplasty
Allan S. Brett, MD reviewing Helwani MA et al. J Bone Joint Surg Am 2015 Feb 4. Sharrock NE. J Bone Joint Surg Am 2015 Feb 4.

"In an observational study, most outcomes favored regional anesthesia." [NEJM Journal Watch Aging/Geriatrics Alert for March 1, 2015]

http://www.jwatch.org/na36989/2015/02/1 ... opic_aging

Posted: Mon Mar 02, 2015 2:01 am
by Stavia
Oh I intend to have spinal block if I need anything done below the diaphragm. If they can get a baby out under spinal a hip should be a cinch.
Above the diaphragm...I guess GA is better than a bottle of gin and a stick to bite on huh....seeing as alcohol is toxic to e4s....
Sorry, black humour tonight.

Re: Surgery/Hospitalization Tips for E4s

Posted: Mon Mar 02, 2015 7:50 am
by circular
I like your rule - makes it easy. But what about thyroid Stavia? Above the diaphragm but maybe not too complicated? I however may just be too chicken to stay awake during a surgery :shock: We'll see what I'm made of when the day comes.

Posted: Mon Mar 02, 2015 9:46 am
by Stavia
Hmmm thyroid - prolly gotta he asleep cos you can't be swallowing and bob the thyroid up and down as the surgeon is cutting....

Re: Surgery/Hospitalization Tips for E4s

Posted: Mon Mar 02, 2015 10:33 am
by circular
CONVINCED! thx

Re: Surgery/Hospitalization Tips for E4s

Posted: Thu Jun 04, 2015 4:06 pm
by circular
Gathering my materials for an "emergency kit". Found these:

Can General Anesthesia Trigger Dementia?
http://www.scientificamerican.com/artic ... print=true

and

Inhaled Anesthetics Bring Alzheimer’s Risk
http://psychcentral.com/lib/inhaled-ane ... mers-risk/

which references:

Alzheimer's alert over anaesthetics
http://www.newscientist.com/article/dn1 ... XDKSM5Edm4

and

Molecular understanding of Alpha beta peptide interaction with isoflurane, propofol, and thiopental: NMR spectroscopic study
http://eurekamag.com/research/012/994/0 ... .php#close

Re: Surgery/Hospitalization Tips for E4s

Posted: Fri Jun 05, 2015 3:45 pm
by karelena
Is there evidence that desflurane is not harmful? It is very similar to isoflurane.

I agree I would avoid general anesthesia when possible. If general is necessary then I might want to discuss blood pressure goals under anesthesia as they can let it run really low, but have drugs to bring it up (phenylephrine). Cerebral blood flow is autoregulated over a wide range of pressures (I was taught it will be pretty much the same with mean arterial pressure 50-150) but why take a chance?

I never thought about the glucose in the IV fluids. Usually what is ordered is 5% glucose (also called dextrose) plus electrolytes. That's 5 grams per 100ml and a typical adult rate would be 100 mls/hr. That's 120 grams per day but only 5 grams per hour, plus that's all the calories you may be getting (if you're not eating) so it's only 480 Cal/day. I would ask to stop the IV as soon as you are allowed to eat, and ask for some sugar free clears and broth instead of juice and sugary soda. Hospitals always have sugar free clears available for diabetics (sugar free jello, popsicles and diet drinks).

K

Re: Surgery/Hospitalization Tips for E4s

Posted: Fri Jun 05, 2015 5:07 pm
by Julie G
Thanks for resurrecting and adding to this, Circ & karelena. Unfortunately, it's something many of us will face.
Hospitals always have sugar free clears available for diabetics (sugar free jello, popsicles and diet drinks).

Good point, but nothing I'd want to eat; chemicals, artificial sweeteners- bleh :shock:

Re: Surgery/Hospitalization Tips for E4s

Posted: Sun Jun 14, 2015 8:21 pm
by LillyBritches
Welp, dear hearts - because I have a 6/23 upcoming surgery scheduled (fibroid removal, minimally-invasive) - this is topically near to my heart. :) My very astute gyny surgeon knows of my concerns re a general and suggested that I opt for conscious ("twilight" - IV) sedation with a local. AND I know that the best choice would probably be a local.

HOWEVER.

I most certainly do NOT want to be awake for this crap. And I found this:

http://anesthesiology.pubs.asahq.org/Ar ... id=1933714

Conclusions
There is a strong association between ApoE4 and transient POCD in patients undergoing inhalation anesthesia. Compared with inhalation anesthesia, TIVA is more suitable for elderly patients because it has no observable effect on cognitive function of elderly patients after surgery, especially those carrying the ApoE ε4 allele.


which states that IV sedation is just dandy for us.

Thoughts??? Sigh. Hope everyone is doing swimmingly!!!

P.S. I even queried Rudy Tanzi. I've not heard from him yet. lol

P.P.S. I recall my poor 3/4 stepdad who, after carotid surgery (for which I'm quite certain he received a general), developed full-blown delirium upon waking. I think he was in his latter-60s. And then he started having AD symptoms...and that was probably not a coincidence. Cascade firestarter, and all that. :( Perchance it's age- and 4-dose dependent? Because I had a general two-three times as a child.