People’s Pharmacy: Which anesthetic is less likely to cause post-op confusion?

Q. Recently, two family members underwent surgery. Although the surgeries were different, the family members experienced similar unexpected complications upon awakening. They suffered hallucinations, memory impairment and cognitive difficulties after anesthesia.

I did some independent research and found that this can happen. Sometimes the memory is regained and the person completely recovers. Other times the person never completely regains full cognitive function. Are some anesthesia drugs more prone to cause this than others?

A. Doctors have an acronym for this condition: POCD (post-operative cognitive dysfunction). It is most common in the days and weeks immediately following surgery, but even months later some people have measurable cognitive decline (Clinical Interventions in Aging, online, Nov. 8, 2018).

A recent prospective randomized controlled trial of 164 patients found that propofol was less likely to cause post-operative cognitive dysfunction than either midazolam or dexmedetomidine (China Medical Journal, Jan. 30, 2019). A review of the available research compared intravenous propofol with inhaled anesthetics (Cochrane Database of Systematic Reviews, Aug. 21, 2018). The authors concluded that there is a lack of high-quality research, but propofol appears to offer an advantage for reducing POCD.

Q. My doctor has prescribed a number of statins to lower my cholesterol. Simvastatin caused pain on top of pain. Lovastatin was OK for several weeks, but it, too, eventually caused both muscle and joint pain.

I cannot exercise when I hurt like this. I am ready to give up on statins because I think I am sensitive to all of these drugs. What else can I take to make my doctor stop prescribing statins?

A. Consider adopting a diet that includes almonds or other nuts, soy protein instead of red meat and viscous fibers from plants like okra, eggplant, barley, oats and psyllium. Canadian researchers found that such a diet is as effective as lovastatin for lowering cholesterol (American Journal of Clinical Nutrition, February 2005). What’s more, it lowers C-reactive protein, a measure of inflammation (JAMA, July 23, 2003). A meta-analysis of seven trials shows that this dietary approach works well to lower LDL cholesterol and other cardiovascular risk factors without side effects (Progress in Cardiovascular Diseases, May-June 2018).

Q. I have read your warnings about quinine, and I think you are totally off-base. For years, I have taken quinine a few times a month for leg cramps. Nothing else my doctor recommended worked.

When the Food and Drug Administration banned quinine for leg cramps, I was really in a jam. The leg cramps were very disruptive.

There are some low-dose over-the-counter quinine pills in Canada. Why can I buy quinine pills there but not in the U.S.? The amount of quinine in tonic water is not nearly enough for me.

A. The FDA banned the use of quinine for leg cramps more than a decade ago. That was because it can cause life-threatening blood disorders.

It is possible to purchase quinine tablets in Canada, but we would advise you to discuss your plan with your physician. Quinine also can cause digestive upset, ringing in the ears, headache, blurry vision, skin rash and irregular heart rhythms.