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Retrospective studies on the risk for developing Alzheimer disease and related dementias (ADRD) after surgery with anesthesia have yielded conflicting results. A new study using a Medicare database compared this risk in nearly 55,000 patients aged 68 to 77 years without ADRD who required an appendectomy for appendicitis (treatment group) versus nearly 275,000 patients matched for age and multiple other factors who had no signs of appendicitis and no appendectomy prior to matching (control group) [1]. After 7.5 years follow-up, the treatment group actually had a lower rate of ADRD (7.6 versus 8.6 percent). However, these reassuring findings may not be generally applicable to older patients undergoing larger and more invasive procedures than appendectomy.

Concerns that perioperative intravenous (IV) opioids may contribute to persistent postoperative opioid use have led to attempts to avoid or limit their use in this setting. A trial comparing postoperative outcomes in noncardiac surgical patients receiving balanced general anesthetic using desflurane plus IV infusions of nonopioids (ketamine, lidocaine, dexmedetomidine) versus those receiving desflurane plus ketamine, lidocaine, and opioids (remifentanil plus a morphine bolus at the end of surgery) was stopped early due to five cases of severe bradycardia and more postoperative hypoxemia in the dexmedetomidine group [2]. Other prespecified outcomes (ileus, cognitive dysfunction) did not differ between groups. Since all analgesics have potential adverse effects, the risks, benefits, and alternatives for each selected agent should be considered when planning a perioperative analgesic regimen.

, et al
Alzheimer's Dementia After Exposure to Anesthesia and Surgery in the Elderly: A Matched Natural Experiment Using Appendicitis
Ann Surg
, et al
Balanced Opioid-free Anesthesia with Dexmedetomidine versus Balanced Anesthesia with Remifentanil for Major or Intermediate Noncardiac Surgery

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