My Grandma, who has AD is going to need a new pacemaker sooner or later, probably sooner than later. I know that they can do them with a local anesthetic, but she's going to need something to calm her down as well and I don't want anything that could make her AD worse. I was thinking/hoping that an ativan might work? She doesn't normally take ativan, just namenda and aricept.
Has anyone had any experience with any type of surgical procedure and avoiding any anesthesia that could worsen AD? How could I arrange to speak to the anesthesiologist prior to the day of her scheduled procedure? The surgeon and the anesthesiologist are usually separate and the anesthesiologist usually makes his/her own decisions on what to use without a whole lot of input from the surgeon.
I don't want to wait until the day of the scheduled procedure and hope that the anesthesia team is knowledgable about AD and anesthesia. I'd like something set up in advance, but I've never heard of an appointment with an anesthesiologist.
I'd never consider not getting her a new pacemaker, that's not the issue. (Actually, she'd feel pretty crummy without a functioning pacemaker, so it's really a quality of life issue).
Thanks for any input/advice.

Jellybean I have worked pre-op surgery and there was always an anesthesia visit. Just ask for it ASAP in out patient surgery. Shouldn't be a problem.

Thanks, Meeko. I know they "stop by" before the surgery and get papers signed. They just usually seem so rushed and there's not much conversation. ASking for it ASAP is a good idea.
I'm just worried that I'm going to get someone really unfamiliar with anesthesia in AD patients. I remember someone here posted about getting an anesthesiologist who "really got" AD. Hopefully, I'll luck out and get someone who knows what they're doing. The anesthesia team really never sees the aftermath of anesthesia on AD patients, except perhaps some post-surgery delusions.
I'm supposed to avoid propofol and inhaled anesthesia, right? Anything else to avoid?

jellybeans, those are the two biggies. Any form of surgical sedation could have an effect but much smaller than from inhaled anesthesia.

Since there is no option NOT to replace the pacemaker, ask the surgeon for a special consult with the anesthesiologist.

This is usually done as part of the pre-op workup done at the hospital a few days ahead of time, but in our case, we got the anesthesiologist's NURSE. I asked for clarification on what anesthesia would be used.
RN: "That's up to the doctor to decide."
Me: "Will it be inhaled general anesthesia?"
RN: "Probably not general."
Dad pops in: "I want to go to sleep. I don't want to know what's going on."
RN: "Then you would prefer general?"
Me: "Dad, you will be asleep with the other anesthesia as well if you want to be. NO, we definitely do not want general anesthesia."
RN: "What do you have against general anesthesia?"
Dad is sitting right there, diagnosed by his PCP as demented but we are waiting for more definitive tests to tell him. He looks at me inquisitively.
Me, winging it: "There have been several studies that show inhaled anesthesias may lead to memory problems in people over 70. Why take the chance?"
Dad: "I'm glad you told me that. I definitely do not want that."

Then the morning of the surgery I had to go over the whole thing again after he told the nurse repeatedly he wanted to go to sleep and she asked about switching to general. I had to explain again that with the spinal block they were doing he would not feel anything. They would also give him a sedative, and if he wanted to close his eyes and go to sleep, he would.

Next time I would demand to see the anesthesiologist himself and I would bring copies of the studies with me.

Thanks, Carolina.
At the hospital we use, I think the pre-op anesthesia stuff happens the same day, minutes before the procedure, in my experience.
I am going to have to get the healthcare power of attorney paperwork, I don't see my Grandma agreeing to this, actually, I see her throwing a fit about it. Her regular doctors don't seem to care at all that I sign everything and they talk to me about her health issues and not her , but they might and actually should probably care about this for a procedure.

Does anyone have any links to articles from a medical journal about this? I read in the other thread by scubadiver and it looks like some of the articles are from forbes and I don't think that an anesthesiologist would really give that much thought and another article just mentioned one or two specific inhaled anesthetics. The only thing I've found is something saying that it warranted further study.