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My MIL is 86 and is getting a hip replacement next week. She just recently (2 months ago) had back surgery. I am concerned about the cumulative effects of anesthesia. Is there anything I can do, as a caregiver, preemptively to 'pre-treat' or minimize the potential effects and/ or to mitigate the effects if she shows signs after the next surgery? She normally is very astute but I feel like she isn't quite herself since the back surgery. Nothing dramatic, but I am worried it might worsen next week.
In general, making sure the patient has good nutrition and actively
managing other health conditions.   Speaking with the surgeon
prior to the operation to understand the procedure and outcomes is
important. They should alert their
physician immediately if any changes or concerns about how they are after
surgery,
Other information that may assist the care providers include
but are not limited to: the patient’s current pain level, current changes to
medications that are on board, changes to sleep and mobility patterns.Â
The lack of sleep due to increases in pain can have an impact on cognition and
willingness to move. Movement within the parameters of a care providers
restrictions has also been shown to assist post-operative complications if done
with appropriate safety measures in place (example: assist from trained family
care providers).
The most worrisome aspect is that the patient is not yet
back to baseline yet from the prior surgery.  In such a case I would
anticipate that however confused she got after the last surgery - she is likely
to get at least as confused this time.
So, if she got very confused 2 months ago and had many days
or weeks delay before getting much done in rehab, then I might wait if possible
before doing the hip replacement. That may not be possible, but
having two under-rehabbed surgeries could be very difficult to overcome.
I would also suggest checking with her provider whether she
is on any new medication since the back surgery which might contribute to her
persistent "not quite herself" state ;Â in this case most likely
it would be something for pain or muscle spasm or bladder
control.  Even if she needs to go back onto it soon - holding it a
couple days to see whether her cognition improves might help the physician know
whether this is persistent delirium from her prior surgery or "just"
from the ongoing medication effect.
Assuming they proceed to surgery, the
"usual" things to help with delirium should be usually followed - try
to keep her bowels very regular, her sleep very regular (and at night), and
keep awake/engaged/active during the day light.Â
More information about this individual’s overall clinical
picture(i.e. type of back surgery, lifting restrictions, medications, prior
level of functioned, etc…) is required to further address their specific needs.
