Main Category: Pain / Anesthetics
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Memory loss after anesthesia is a common adverse event upon awakening from surgery. Unfortunately the cause of such memory loss is unknown and there are no known treatments or prevention strategies. A study published in the November 2010 issue of Anesthesiology indicates that this memory loss could be prevented by blocking a receptor thought to contribute to memory deficits. Such a treatment may be able to solve the feeling of mental confusion that surgical patients so often feel shortly after coming out of anesthesia.
Memory impairment is an especially common occurrence in the elderly. Around 47 percent of elderly patients who underwent general anesthesia for minor surgical procedures exhibit memory deficits for at least 24 hours after surgery. Some of these deficits can linger: cognitive impairment, including memory loss, is present in 31-47 percent of patients at the time of hospital discharge.
Why memory loss happens, how severe it is, and how long it takes to recover remain poorly understood.
In the current study, Beverley A. Orser, M.D., Ph.D., F.R.C.P.C. and her research team at Sunnybrook Health Sciences Centre and Mount Sinai Hospital looked at two groups of anesthetized mice - one treated with a drug that inhibits a known memory-blocking receptor, and one treated with a control solution.
"When tested 30 minutes and at one day after anesthetic exposure, the mice in the control group exhibited a memory deficit that was not observed in the mice treated with the blocking compound," said Dr. Orser. "We found that the memory deficit in the post-anesthetic period could be completely prevented by treatment with a drug that inhibits the memory-blocking receptor."
Studies in patients involving anesthetics and their effects on memory are especially difficult, said Dr. Orser, because of the inability to disentangle the effects of anesthetics from other factors that can cause memory deficit. Therefore, animal models are important for helping to identify types of learning and memory susceptible to impairment and to identify certain molecular mechanisms.
Dr. Orser's study underscores the need for human clinical trials that will assess memory performance soon after surgery.
"In practical terms, our study suggests the need to re-evaluate and study the assumption that patients will remember important information given to them after surgery," said Dr. Orser. "Until such studies are performed, it seems prudent to use strategies such as written information or sharing information with family members to ensure that instructions are learned and remembered."
Source:
American Society of Anesthesiologists
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Skip to main page content home current query previous queries CME subscribe ONLINE using send to (A) and (A) activate my account search go advanced search? user name password characters in Antiplatelet drugs: A review of their Pharmacology and management in the perioperative Period of Richard Hall, MD, FRCPC, FCCP * and c. David Mazer, MD, FRCPC ? ?From the *Departments of Anesthesia, Medicine, Surgery, and Pharmacology, Dalhousie University/Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; ?Keenan Research Center/Li Ka Shing Knowledge Translation Institute, Saint Michael's Hospital, Toronto; and ?Departments of Anesthesia and Physiology, University of Toronto, Toronto, Ontario, Canada. Address correspondence and reprint requests to C. David Mazer, MD, FRCPC, Department of Anesthesia, St. Michael's Hospital, 30 Bond St., Toronto, ON M5B 1W8, Canada. Address e-mail to mazerd{at}smh.ca. Abstract In the normal course of the delivery of care, anesthesiologists encounter many patients who are receiving drugs that affect platelet function as a fundamental part of primary and secondary management of atherosclerotic thrombotic disease. There are several antiplatelet drugs available for use in clinical practice and several under investigation. Aspirin and clopidogrel (alone and in combination) have been the most studied and have the most favorable risk-benefit profiles of drugs currently available. Prasugrel was recently approved for patients with acute coronary syndrome undergoing percutaneous interventions. Other drugs such as dipyridamole and cilostazol have not been as extensively investigated. There are several newer investigational drugs such as cangrelor and ticagrelor, but whether they confer significant additional benefits remains to be established. Management of patients who are receiving antiplatelet drugs during the perioperative period requires an understanding of the underlying pathology and rationale for their administration, pharmacology and pharmacokinetics, and drug interactions. Furthermore, the risk and benefit assessment of discontinuing or continuing these drugs should be made bearing in mind the proposed surgery and its inherent risk for bleeding complications as well as decisions relating to appropriate use of general or some form of regional anesthesia. In general, the safest approach to prevent thrombosis seems to be continuation of these drugs throughout the perioperative period except where concerns about perioperative bleeding outweigh those associated with the development of thrombotic occlusion. Knowledge of the pharmacodynamics and pharmacokinetics of antiplatelet drugs may allow practitioners to anticipate difficulties associated with drug withdrawal and administration in the perioperative period including the potential for drug interactions. Footnotes Conflict of Interest: See Disclosures at the end of the article. Accepted October 1, 2010. Copyright ? 2011 International Anesthesia Research Society ? Previous | Next Article ?Table of Contents This Article Published online before print January 6, 2011, doi: 10.1213/?ANE.0b013e318203f38d A & A February 2011 vol. 112 no. 2 292-318 ? Abstract Full Text Full Text (PDF) CME Classifications Series: Review Article Cardiovascular Anesthesiology Services Email this article to a colleague Alert me when this article is cited Alert me if a correction is posted Similar articles in this journal Similar articles in PubMed Download to citation manager Request Permissions Citing Articles Load citing article information Google Scholar Articles by Hall, R. Articles by Mazer, C. D. PubMed PubMed citation Articles by Hall, R. Articles by Mazer, C. D. Related Content Cardiovascular Blood Coagulation Pharmacology Load related web page information Current Issue July 2011, 113 (1) 
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