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The involvement of caregivers of patients with dementia during mastoid surgery under local anaesthesia

Published online by Cambridge University Press:  27 October 2021

C Swords
Affiliation:
Department of ENT, Ipswich Hospital, Ipswich, UK
S Patil*
Affiliation:
Department of ENT, Ipswich Hospital, Ipswich, UK
M Jog
Affiliation:
Department of ENT, Ipswich Hospital, Ipswich, UK
M Yung
Affiliation:
Department of ENT, Ipswich Hospital, Ipswich, UK
*
Author for correspondence: Mr Sachin Patil, Department of ENT, Ipswich Hospital, Heath Road, Ipswich IP4 5PD, UK E-mail: Sachin.patil6@me.com

Abstract

Background

With a growing ageing population, there is a higher prevalence of dementia in patients with conditions that can be managed surgically. Patients with dementia undergoing surgery under general anaesthesia often have poorer outcomes than those without. Therefore, local anaesthesia can be an option.

Methods

Two patients with severe dementia and advanced cholesteatoma were identified for operative management. They were deemed too high risk to proceed with general anaesthesia. This article describes our experience of performing mastoid surgery under local anaesthesia in the presence of a primary carer in the operating theatre.

Results

The complete extirpation of cholesteatoma was achieved in both cases. The carers reported that local anaesthesia helped to facilitate communication and aid patient co-operation.

Conclusion

Our experience, albeit limited to two cases, illustrates an alternative individualised peri-operative strategy in the surgical management of patients with dementia and concurrent advanced cholesteatoma.

Type
Short Communications
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Mr S Patil takes responsibility for the integrity of the content of the paper

References

Funder, KS, Steinmetz, J, Rasmussen, LS. Anesthesia for the patient with dementia. J Alzheimers Dis 2010;22:129–34CrossRefGoogle ScholarPubMed
Neumann, C, Yung, J, Carroll, PH. Mastoid surgery under local anesthesia for medically unfit patients: techniques and outcome. Ann Otol Rhinol Laryngol 2013;122:613–18CrossRefGoogle ScholarPubMed
Waller, S, Masterson, A. Designing dementia-friendly hospital environments. Future Hosp J 2015;2:63–8CrossRefGoogle ScholarPubMed
White, S, Griffiths, R, Baxter, M, Beanland, T, Cross, J, Dhesi, J et al. Guidelines for the peri-operative care of people with dementia: guidelines from the Association of Anaesthetists. Anaesthesia 2019;74:357–72CrossRefGoogle ScholarPubMed
Alcorn, S, Foo, I. Perioperative management of patients with dementia. BJA Educ 2017;17:94–8CrossRefGoogle Scholar
Hu, CJ, Liao, CC, Chang, CC, Wu, CH, Chen, TL. Postoperative adverse outcomes in surgical patients with dementia: a retrospective cohort study. World J Surg 2012;36:2051–8CrossRefGoogle ScholarPubMed
Mason, SE, Noel-Storr, A, Ritchie, CW. The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. J Alzheimers Dis 2010;22:6779CrossRefGoogle ScholarPubMed
Jefferis, J, Clarke, M, Taylor, J-P, Brittain, K. Challenges for the cataract surgeon treating people with dementia: a qualitative study exploring anesthetic choices. Clin Ophthalmol 2014;8:1993–9CrossRefGoogle ScholarPubMed
Sugimura, M, Kudo, C, Hanamoto, H, Oyamaguchi, A, Morimoto, Y, Boku, A et al. Considerations during intravenous sedation in geriatric dental patients with dementia. Clin Oral Investig 2015;19:1107–14CrossRefGoogle ScholarPubMed
Yung, MW. Local anaesthesia in middle ear surgery: survey of patients and surgeons. Clin Otolaryngol Allied Sci 1996;21:404–8CrossRefGoogle ScholarPubMed