The risk of general anaesthesia and sedation in the older people
Temporary memory problems and aggravation of pre-existing memory disorders may occur after treatment under general anaesthesia. A frequency of postoperative cognition disorders between 10 and 50% has been identified in the literature. Risk factors for the occurrence of postoperative memory disorders are advanced age, low level of education, intellectual comorbidity, the onset of dementia and other neurodegenerative disorders, existing sleep disorders and the experience of postoperative pain. The morphological changes seen in the brain after general anaesthesia are similar to the changes occurring in Alzheimer’s disease. In addition to metabolic changes, general anaesthetics directly enhance the apoptosis of brain cells. Older people are already familiar with a decrease in the number of neurons, which provides them with a limited spare capacity. Moreover, older people are often known to have the risk factors for the occurrence of postoperative memory disorders as mentioned before. Caution and restraint in the indication for dental treatment under general anaesthesia or sedation is therefore required.