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Columbo's fatal miscalculation

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You probably remember actor Peter Falk as the cigar-chomping TV detective Lt. Columbo, the cop who inevitably arrived at the scene of a high-society crime in a wheezing jalopy and a rumpled raincoat. But did you know that Falk, who had Alzheimer’s and died recently at age 83, couldn’t remember the role he made famous? And did you know that his mental decline has been linked to gum disease and general anesthesia?

Columbo was famous for being relentless. He caught smooth criminals off-guard with his signature “Ahh, there’s just one more thing … ” In this case, the “one more thing” we want to stick with you is that general anesthesia can be risky for older brains, and for very young ones, too. Handle with the same care Columbo handled his beloved old car.

There’s growing evidence that after age 65, repeated exposure to common inhaled anesthesia drugs can cause confusion and delirium that can last for days or weeks, and may push an aging brain toward dementia. General anesthesia has been linked with the death of brain cells and with Alzheimer’s-like brain tangles and plaques. But there’s reassuring news, too: A single procedure doesn’t seem to raise risk.

Infants and children under age 4 also are vulnerable. Early evidence suggests that repeated exposure to anesthesia during periods of rapid brain growth damages nerve cells and can result in a higher rate of abnormal behavior later. This isn’t a reason to postpone clearly necessary surgery for a child; that’s even riskier. Fortunately, a single operation that lasts less than two hours total seems safe. Good news, since the short, common operations kids often need (hernia repairs, tubes for chronic ear infections, tonsillectomies) usually take an hour or less.

Still, the less exposure the better. Both of us have spent countless hours in operating rooms and know how powerful anesthesia is. (Oz is a cardiac surgeon, and Dr. Mike is board-certified in anesthesiology as well as internal medicine, so this is personal.) If you or someone you love is scheduled for surgery, here’s how to up your safety or theirs:

  • Ask about regional anesthesia. While inhaling a general anesthesia puts you into a deeply unconscious state, an injection of regional (or “local”) anesthetic to a specific region or nerve that feeds the area of surgery makes the area pain-free. Regional pain-blockers often (not always) can be used for everything from knee replacements to cosmetic surgery.
  • Have to go with general anesthesia? Prep the hospital room. With age, the odds for post-surgery confusion go up. What helps? Reconnecting with the world as soon as possible. Have people you love on hand when you leave intensive care.
  • Get past dental fears without risky drugs. Plenty of dental-phobes rely on practices that offer “sleep dentistry” and “relaxation dentistry” to keep their teeth healthy. But as you get older, exposure to general anesthesia in the name of healthy teeth and gums can backfire. If you’re dental-phobic, work with your dentist to bypass general anesthesia. Try combining a local anesthetic with headphones streaming your favorite music; the combo can be amazingly effective.
  • Floss, will ya? Just two minutes a day at the sink and getting a dental checkup every six months virtually guarantee you won’t get inflamed, diseased gums (periodontitis), a leading cause of the arterial disease that sets up dementia.
  • Consider supporting the SmartTots foundation. This campaign is raising funds to drive research about the effects of anesthesia on kids.

    The YOU Docs, Mehmet Oz and Mike Roizen, are authors of “YOU: On a Diet.” Want more? See “The Dr. Oz Show” on TV. To submit questions, go to www.RealAge.com.

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