The Whitworths of Arizona, bringing science to you in everyday language.

Friday, July 26, 2013

LBD and Surgery Drugs

Last week was about drugs in general. This week is a closer look at anesthetics. Surgery is a scary proposition for LBD caregivers. Any drug strong enough to use for surgery will likely have the risk of being Lewy-dangerous. However, some are worse than others:

Inhaled anesthetics are gases such as isoflurane or enflurane used to induce a controlled coma and allow surgery. They can make any elderly person confused for several months afterwards. The confusion may last much longer or be permanent if Lewy bodies are present.

Intravenous (IV) drugs such as midazolam (Versed) or propofol (Diprivan)   are not as Lewy-dangerous as inhaled drugs. Many LBD caregivers report successful surgeries using these drugs. That said, Versed is a strong benzodiazepine and Diprivan is a strong sedative—both classes of Lewy-dangerous drugs.

Regional anesthetics are used with spinal or epidural blocks. These drugs “deaden” the area of the surgery and tend to be safer than either of the above general anesthesias. Some major surgeries such as knee replacements can now be done with spinal or epidural blocks using low amounts of drugs like propofol or a combination of regional anesthetics boosted by opiates or narcotics. There appears to be less drug danger and less need for postoperative drugs with these procedures.  Limitations include:

  • This method does not work for upper areas of the body, such as dental work.
  • Because a person is awake during the procedure, cooperation is required. If your loved one has a history of agitation during stress, this might not be an option.
  • It requires an anesthesiologist skilled in the procedure. Most problems with this type of surgery result from it being done incorrectly.

Sometimes a person’s first introduction to drug sensitivity occurs after surgery:

Luke had very mild Parkinson’s and his balance wasn’t the best. When he tripped, he fell and broke his leg. The doctor told us Luke would need surgery if he ever hoped to walk again but that with his PD, there was a possibility of dementia. Luke hated the idea of being bedfast, but even more, he was in extreme pain, and so we agreed to the surgery. He started hallucinating in the recovery room, seeing bugs crawling on the walls. I hoped that over time, he’d improve. He did, some. But he still gets very confused and still has hallucinations now and then. Nevertheless, we’d make the same decision again. He was in such terrible pain.   –Cindy

For Luke and his wife, there was only one way to go—have the surgery and stop the pain, while hoping that Lewy didn’t show up. For others it isn’t that simple—there may be other choices, such as medical treatment, physical therapy, or even learning to live with the problem.

Annie had experienced active dreams for years before she had an elective surgery in the late 1990’s. Annie’s dementia showed up not long after afterward. If she had known, as we do today, that active dreams are a strong risk factor for LBD, she would have opted against the procedure. She had lived with this problem most of her life and she could have continued to do so.   –Jim

Sometimes the choice is between quality and length of life.

Bill’s pacemaker battery was getting low and needed replacing. I asked the cardiologist if the pacemaker had been triggered. It hadn’t, which made a decision against surgery easy. But then I found out his defibrillator battery was getting weak. It had been activated several times, making that decision harder. If it quit, so would Bill’s heart. I still decided against the surgery, opting for quality of life over quantity. About six months later, that battery stopped working and Bill died in his sleep. If I had it to do again, I’d make the same decision.  –Marla

Some of the danger from surgery can be avoided if the anesthesiologist understands that geriatric patients are similar to children who require much smaller amounts of drug for the same effect. A person of any age at risk for or with LBD can expect similar or even more severe responses.

Consider all other options first. If you do decide surgery is necessary,

  • Request a geriatric anesthesiologist who understands LBD’s drug sensitivity issues.
  • Well ahead of the surgery, send a letter to the surgeon outlining your concerns. Include the LBDA wallet card and any examples you have of how drug sensitive your loved one is.
  • Arrange to meet with the anesthesiologist prior to the surgery to discuss your concerns about LBD and drug sensitivity again.
We are not physicians and anything we say here is informational only. Always check with your physician about your individual personal concerns.

1 comment:

  1. Exceptional, useful post! Used this as a reference directly from the hospital where LO was in emergency. Very reassuring -- thank you for your great work!