Here is something off the LBDA site: Written by Jan a volunteer
CONCERNS OF SURGERY
I would like to
preface my comments by saying that the statement you heard, "surgery
is NOT an option for an LBD patient," may be a bit strong. However, I
understand that it is based on the experiences of many LBD caregivers,
which cannot be totally ignored.
It appears we only find caregiver reports of warnings
about the negative impact of surgeries, like this one at
http://brain.hastypastry.net/forums/arc ... 72015.html
We have not yet found a reliable written source explaining the
specific dangers of surgery to an LBD patient.
Below is a Conclusion (see article at
patients with Parkinson's showing that guidance for such a well-known
disease is also unclear.
"The anesthetic management of Parkinson's patients is critical to
patient safety and satisfaction. However, it continues to be
controversial as it relies largely on anecdotal reports. The
medication schedule must be ascertained and routes of administration
planned. Patients should be evaluated for respiratory dysfunction
while anticipating cardiovascular and neurological complications.
Lastly propofol should be avoided during stereotactic frame placement
for surgical Parkinson's therapies, with the use of midazolam and/or
diphenhydramine for sedation."
HOWEVER, I found that the warnings of using diphenhydramine (as
mentioned above) is covered in this Editorial Comment at
http://www.parkpub.com/abstracts/abstra ... y02.html#6
"Cognitive impairment and delirium caused by anticholinergic
medications is well recognized. In a prospective observational study
by Agostini et al, the effect of diphenhydramine, a commonly used
over-the-counter antihistamine, was assessed in elderly hospitalized
patients. Diphenhydramine increased the risk of delirious symptoms,
urinary catheterization and length of stay significantly, leading the
investigators to recommend caution when using this drug in the elderly"
Perhaps you can discuss the anesthesia options with the physician, do
some research, and then discuss the possible negative impacts of each
option. At some point most caregivers become more interested in
quality of life over length of life. What becomes difficult is when
our loved one or their doctor wants surgery, for example, and doesn't
understand our concerns because we cannot express them with any
certainty. Even we cannot say for sure that it will have a negative
impact. Doctors are also in a tough spot. They must consider their
medical oath, the wishes of the patient, the patient's family, and
their legal liability. It makes it easier if there is only one
caregiver making these decisions and one who has a good working
relationship with the doctors. But if the doctor has conflicting input
from a spouse, the patient, and/or adult children, then it will be
very difficult for them to base a medical treatment decision on
unsubstantiated reports brought forward by one party.
I hope this helps!