My mom just had a deep brain stimulation surgery done for Parkinson`s disease. She was given local anesthesia for the procedure. However, after the surgery, the nurse gave her morphine due to complaints of headaches and in addition, she was given Ativan because it was written in her chart that she normally took Ativan on a daily basis (which she did). Due to all these drugs in her system, she did not wake up for about a day. We tried everything to wake her up, but she was out cold. When she did finally wake up, she did not have any recollection of her family including her husband and children. She has been like this for 3 days now and we are not sure if it`s the mixture medications and anesthesia or due to the actual surgery. A CT Scan and EEG was performed and everything looked normal, but she still does not have her memory back. She is cognitively ok becuase she responses to everything we ask her to, but she just has no memory of her surroundings. IS this normal? If so, how long will she be like this? We are extremely worried that she will never remember her family. What can we do to help? Thanks. 

Thanks for your question. I am an anesthesiologist, not a neurologist, and can only offer some general comments about what is clearly a complicated, and distressing situation. Given that your mom was taking Ativan (lorazepam), presumably without ill effect, on a regular basis, it would seem unlikely to be responsible for her sustained amnesia. However, changes in drug metabolism, excretion and interaction can occur during and after major surgery, and so it could be causing a prolonged effect. Ativan is sometimes used deliberately to induce amnesia, for example as a pre-medication before surgery, but does not usually cause long term problems. Morphine, the other drug you mention, is not associated with amnesia. In fact, an old general anesthetic regimen, comprising large doses of morphine, together with oxygen and nitrous oxide, was notorious for a high incidence of awareness during the anesthetic! Obviously I cannot comment on whether the brain procedure itself might be causing the problems. Your neurosurgeon should be able to give you some information on whether this is a likely explanation. Keep in mind that immediately after any brain surgery there is a period during which tissue swelling occurs, that can result in worsening of neurological condition and which subsequently improves as the swelling goes down. If the CT scan is okay then there probably isn't any major localized problem like a bleed or compression of the brain. I hope you mother's condition improves over time and you should not lose hope for that improvement occurring in the next few days. 

WillﾠI experience slight memory loss after going through two general anesthesia? Will it affect my academic performance? 

If you are planning to have a surgical procedure on the same day as your exams it is certainly possible that your performance will not be optimal! Whether there is any impact will depend on the time available for recovery, theﾠtype of surgery (minor or major), your age and general condition, and possibly by the type and amount of anesthetic you receive. As far as memory loss is concerned, there is some evidence emerging that a significant number of elderly people experience difficulty with cognition for as long as 6 months after anesthesia and surgery. How and why this occurs exactly is not known. We also do not know exactly which factors we can alter to reduce the impact of surgery and anesthesia on the brain. 

Although the drugs available for use in general anesthesia today are quickly metabolized and excreted, and patients can awaken veryﾠrapidly, we are still not able with complete confidence to say you would beﾠ100% back to normal a day or two after surgery. Some studies have shown that the degree of impairment after outpatient surgery and anesthesia is not that different from persons who have had a few drinks of alcohol. But wouldﾠyou takeﾠyour exam while drunk? 

I am 4 weeks postop anterior lumbar disectomy and I only remember a little in the past 4 weeks sometimes even remembering what I did yesterday. What is wrong? 

Thanks for your question. Losing your memory is scary. You can be reassured however that being unable to recall much of what you experienced during the initial part of your treatment is fairly normal. But you should be seeing a gradual improvement over time. If not you should be evaluated and get an objective assessment so check in with your primary care doctor. There are a variety of simple tests that can be done. It is certainly possible that your anesthetic may have lingering effects on your mental function, including memory. Studies are revealing that, particularly in the elderly, postoperative cognitive deficit (POCD) isﾠprobably a real issue. Unfortunately it is hard to know whether it is the anesthetic medicines, or the stress of surgery that accounts for these changes. The stress of surgery involves things like nutrition, tissue breakdown and repair, sleep patterns, immune function and mood, pain, and interaction between medications. All these factors can in turn affect your thinking and memory and are all things that should be addressed now to make sure you have the best chance at a full recovery in mind, body and spirit. 

From time to time, when reading articles, in both journals and popular publications, I see mention of amnesia resulting from certain medications given with anesthesia, either general or regional. I get the impression that this amnesia is a desirable side effect, rather than an unfortunate effect incidental to the medication`s primary function or purpose. Is amnesia after surgery truly a sought-after result? If so, please explain the rationale. 

Great question! Amnesia is generally regarded as one of the goals of general anesthesia. Anesthetic drugs impair the acquisition and encoding of new information while leaving the retrieval of previously learned material intact. The degree and duration of memory impairment progressively increase as the dose of each drug is increased. Since surgery is really a permitted assault on the body, most individuals prefer to avoid awareness of the attack as it takes place! The sounds and sensations of oneﾒs flesh and bone being drilled, sawn, cauterized, sliced and stapled are usually regarded as unpleasant, although not universally so. It is possible to accomplish painless surgery, yet retain consciousness, awareness and recall of events by using regional anesthesia. Regional anesthetic techniques include spinal and epidural anesthesia. A few of our hardier patients do request regional anesthesia, without sedative drugs, in order to prevent amnesia and retain full control of their senses. One situation in which amnesia is generally regarded as undesirable is that of childbirth by cesarean section. In our setting we try very hard to avoid administering sedatives to women, who are usually operated on under epidural anesthesia, at least until the baby has been delivered and presented to the mother. This helps to preserve the motherﾒs memory of that precious moment.