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Lunaroo2020 Asked March 2021

What is the best general anesthesia for a patient with Dementia and cognitive dysfunction who needs a hip replacement?

Geaton777 Mar 2021
Another question to ask is, "What is the likelihood this patient will actually cooperate with the rehab and PT?" Your patient is pretty young at 71 but the dementia thing can throw a roadblock into best-laid plans. This may be a separate discussion with the doc and rehab team so there are reasonable expectations for this person.

lealonnie1 Mar 2021
I had a total hip replacement with an epidural and then chose Propofol to knock me out during the 90 minute procedure. This was instead of using general anesthesia, and the difference was HUGE. I woke up immediately with no cognizance issues, no respiratory issues, nothing. The epidural numbs the body from the waist down, the Propofol is optional; some people choose to stay awake during the procedure. Or another IV med can be used to sedate the patient so s/he is unaware of sounds going on during the surgery.

Good luck!

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GardenArtist Mar 2021
You're wise to want to address this before the surgery, but unless you're a medical personl, I rather doubt that the anesthetist would defer to a patient's caregiver to choose the appropriate anesthesia.

I would assume that all the available medical records would be reviewed before a decision would be made.   And all the conditions, medications being taken, and justification for hip replacement would be factored into consideration.

I would offer a few caveats though:   If the individual facing surgery has any allergies, especially to chemicals, make sure the anesthetist knows.   I learned from one that my allergies to sodium nitrate and nitrate (as well as MSG) could be a factor in choice, and after being advised of these allergies, he changed the anesthetic he had planned to use.

Another experience which was much worse was that after making changes to the anesthesia consent form, the anesthetist apparently (a) ignored them or (b) changed her mind, and doped me up with meds to which I had had reactions.   I was sick for several days afterward, and furious when I got my medical records and found that I was administered meds to which I had had reactions.

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