HoldsUp

Dr. Tyna Moore · 2026-07-20 · Tyna Moore (host), Sandra Bargeron

How to Prepare Your Brain for Surgery: What No One Tells You | Sandra Bargeron

25 research-tied claims examined: 1 contradicted 3 overstated 3 context 12 supported 6 unverified

1

Contradicted by research

0:18:38Tyna Moore (host)contradictedmoderate

Women with low baseline estradiol and progesterone levels have a higher risk of developing postpartum depression.

"if you are a low-hormone early and you walk in with low estradiol levels, your rate of... And progesterone, your rate of postpartum is also high." (said at 0:18:38)

The speaker claims that women with low baseline estradiol and progesterone levels have higher rates of postpartum depression (PPD). However, published literature—including systematic reviews, meta-analyses, and large case-control studies—shows no consistent or significant difference in baseline circulating levels of estradiol or progesterone between women who develop postpartum depression and healthy controls. Current evidence indicates that PPD risk is driven by differential central sensitivity to normal peripartum hormonal fluctuations and withdrawal, as well as psychosocial and psychiatric risk factors, rather than lower baseline hormone levels.

3

Overstated

0:17:20Sandra Bargeronoverstatedmoderate

Approximately 45% to 50% of women who receive general anesthesia for a C-section develop postpartum depression, compared to roughly 28% to 30% with an epidural and 10% to 12% with unmedicated birth.

"it's something like 45% of patients who have to have general anesthesia will have post for C-section will have a postpartum depression, versus oh versus like 10 or 20, 10 to 12%. And I got to look the study up too, so this the statistics may not be perfect, but it's a large up it's a... Closer to 50% when you're having a C-section in her general versus epidural versus awake. And there's even a stat, so epidural even impact, yeah, there's an impact, so it's something like 30% or 28% with an epidural and then 12% without anything" (said at 0:17:20)

The speaker correctly identifies that general anesthesia for cesarean delivery is associated with a higher risk of postpartum depression (PPD) compared to neuraxial anesthesia (epidural/spinal) or unmedicated birth, but the claimed absolute rates (45–50% for general anesthesia, 28–30% for epidurals, and 10–12% for unmedicated birth) significantly inflate clinical PPD incidence. A systematic review and meta-analysis of over 1.4 million women found that general anesthesia during cesarean delivery significantly increases the risk of PPD compared to non-general anesthesia (odds ratio 1.64). However, population-based cohort studies evaluating clinically diagnosed PPD show 1-year incidence rates of roughly 1.1% for general anesthesia versus 0.86% for neuraxial anesthesia. The source of figures near 44% is a single Taiwanese database study that used a broad composite definition of 'postpartum depressive disorders' including sleep disorders and hypnotic/sedative prescriptions (finding composite rates of 43.87% for general anesthesia, 36.30% for neuraxial anesthesia, and 26.66% for natural births). Standard clinical PPD diagnosis rates do not reach 45–50%.

0:54:50Sandra Bargeronoverstatedlow

Well-muscled young men under age 30 frequently experience emergence delirium upon waking up from anesthesia.

"young men I would say under the age of 30, well muscled, they wake up very delirious." (said at 0:54:50)

While some observational literature identifies younger adult age (such as under 40 years) as an independent risk factor for emergence agitation/delirium compared to middle-aged adults, emergence delirium is not uniquely frequent to well-muscled young men. Across adult surgical populations, emergence agitation occurs in approximately 5% to 19% of patients and is predominantly associated with invasive devices (e.g., endotracheal tubes, urinary catheters), inadequate pain control, surgical location (particularly otolaryngology), volatile anesthetic maintenance, and underlying substance use or psychiatric conditions (such as PTSD). Furthermore, clinical reviews note that emergence delirium is most prevalent at the extremes of age (pediatric and elderly populations).

1:10:45Sandra Bargeronoverstatedlow

Recent research demonstrates that dementia can be reversed.

"There's all this new study that said we can reverse dementia, but how about we prevent it?" (said at 1:10:45)

The claim that recent research demonstrates dementia can be reversed overstates the current clinical evidence. While small case series and non-randomized pilot studies investigating personalized, multimodal lifestyle and metabolic protocols (such as MEND/ReCODE) have reported cognitive improvements in small groups of patients with subjective cognitive impairment, mild cognitive impairment, or early-stage Alzheimer's disease (PMID: 27294343), established dementia remains clinically irreversible. The available evidence supporting cognitive 'reversal' relies primarily on observational findings, small unblinded cohorts, and case reports rather than large, double-blind randomized controlled trials (PMID: 36675177, PMID: 42451206). Systematic reviews emphasize that definitive treatments capable of producing long-term cognitive reversal of established Alzheimer's disease or other dementias have not been demonstrated in high-quality clinical trials.

3

Needs context

0:38:03Sandra Bargeronneeds contextmoderate

A 1999 Yale study published in the New England Journal of Medicine demonstrated that a multidisciplinary postoperative intervention in at-risk patients aged 65 and older reduced delirium by 40%.

"the New England Journal of Medicine in 1999 published that study that we were talking about earlier. It was done by Yale and it basically took a population that was at risk, 65 and older, and it looked at them and said, "Okay, we're going to take a multidisciplinary approach following surgery... They dropped delirium 40%." (said at 0:38:03)

The landmark 1999 Yale study published in the New England Journal of Medicine (Inouye et al., PMID 10053175) evaluated a multicomponent nonpharmacological intervention (the Hospital Elder Life Program) and demonstrated a 40% reduction in the odds of developing delirium (matched odds ratio 0.60; 9.9% vs. 15.0%). However, the study was conducted among patients aged 70 and older admitted to general internal medicine units, not postoperative surgical patients.

0:49:40Sandra Bargeronneeds contexthigh

Post-operative cognitive dysfunction (POCD) is a recognized clinical concept by both the American Society of Anesthesiologists and the American Psychological Association.

"introducing a concept called post-operative cognitive dysfunction, which is recognized by the American Society of Anesthesiologists and the APA, and we know this is a reality." (said at 0:49:40)

Postoperative cognitive impairment is an established clinical entity recognized by major professional bodies, but the claim requires context regarding terminology and organization names. The American Society of Anesthesiologists (ASA) launched the Perioperative Brain Health Initiative specifically to address postoperative brain health and cognitive impairment. However, in 2018 an international multispecialty consensus working group recommended updating the nomenclature from "postoperative cognitive dysfunction" (POCD) to the overarching term "perioperative neurocognitive disorders" (PND) to align with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria established by the American Psychiatric Association (often confused with the American Psychological Association).

0:59:45Sandra Bargeronneeds contextmoderate

During perimenopause, progesterone is the first hormone to decline.

"On top of that, the first hormone of decline is progesterone." (said at 0:59:45)

Among the primary ovarian steroid hormones (estrogen and progesterone), progesterone is indeed the first to decline during perimenopause. As ovarian reserve diminishes, women experience an increased frequency of inadequate luteal phase function, shortened luteal phases, and anovulatory cycles, leading to early reductions in luteal progesterone production, whereas estradiol levels typically remain preserved or fluctuate erratically until the late perimenopausal transition. However, among all ovarian hormones, peptide hormones such as anti-Müllerian hormone (AMH) and inhibin B decline earlier than progesterone.

12

Supported by research

0:17:45Sandra Bargeronsupportedhigh

General anesthesia directly impacts the hippocampus.

"the general anesthesia, it has impacts on the brain. It directly impacts the hippocampus." (said at 0:17:45)

General anesthetics have well-documented direct neurobiological and pharmacological actions on the hippocampus. Specifically, general anesthetics modulate molecular targets within hippocampal microcircuits—notably GABAergic and glutamatergic receptors on hippocampal neurons and interneurons—suppressing synaptic transmission and long-term potentiation to produce intraoperative amnesia.

0:19:44Sandra Bargeronsupportedhigh

In the REGAIN study of 1,800 patients aged 50 and older undergoing hip fracture surgery, postoperative delirium incidence was 20.5% with spinal anesthesia compared to 19.1% with general anesthesia.

"There was 1,800 people in the REGAIN study, okay? They were 50 and older, so that doesn't mean they're just over 70. And they if you had a spinal, you had a risk of delirium of 20.5%. Okay. If you had general anesthesia, it was 19.1." (said at 0:19:44)

The REGAIN randomized controlled trial (PMID 34623788) evaluated spinal versus general anesthesia in patients aged 50 and older undergoing hip fracture surgery. In the trial, 1,600 patients were enrolled (the original protocol planned 1,800). Postoperative delirium occurred in 130 of 633 patients (20.5%) in the spinal anesthesia group and in 124 of 629 patients (19.7%, slightly differing from the spoken 19.1%) in the general anesthesia group (relative risk 1.04, 95% CI 0.84–1.30), demonstrating no significant difference between the two anesthesia modalities.

0:20:10Sandra Bargeronsupportedhigh

In the RAGA study of 950 hip fracture patients aged 65 and older, 6.2% of the regional group (29 out of 471) experienced delirium in the first week, compared to 24 patients in the general anesthesia group.

"And then the follow-up study was the RAGA study. It was 950 patients 65 and older. And the same thing: we had delirium the first week of 6.2% in the regional group. There was 29 people that out of 471 that got delirium in the first week, and then and then 24 out of 70 had general anesthesia and they had delirium." (said at 0:20:10)

The RAGA randomized clinical trial published in JAMA (2022) evaluated 950 patients aged 65 years and older undergoing surgical repair for fragility hip fracture across 9 teaching hospitals. Of the 941 evaluable patients, postoperative delirium in the first 7 days occurred in 29 of 471 patients (6.2%) assigned to regional anesthesia compared to 24 of 470 patients (5.1%) assigned to general anesthesia, showing no significant difference between groups.

0:25:30Sandra Bargeronsupportedmoderate

Repeated surgical and painful procedures in children are well-documented to induce symptoms of post-traumatic stress disorder (PTSD).

"And in children, you put them through that several times, you see symptoms of PTSD, it's well documented because they've gone through, they don't have a construct to place this information. All they know is they wake up and they're in pain and they've been operated on over and over, right? And so it's a it's a true medical PTSD experience." (said at 0:25:30)

Pediatric medical traumatic stress (PMTS) and post-traumatic stress disorder (PTSD) symptoms following invasive, painful, and surgical medical procedures in children are well-documented in the literature. Systematic evidence syntheses demonstrate that pediatric patients undergoing clinical care, surgery, and intensive care admissions exhibit elevated rates of traumatic stress symptoms (ranging widely from 8.6% to 60%), with medical factors such as emergency surgeries and repeated interventions identified as significant risk factors.

0:26:54Sandra Bargeronsupportedmoderate

Between 40 and 50 million surgical procedures are performed annually in the United States.

"We do something like 40 to 50 million surgeries in in America every year." (said at 0:26:54)

Epidemiological and national survey data from the United States confirm that between 40 and 50 million surgical procedures are performed annually across inpatient and ambulatory/outpatient settings. Nationally representative data from health surveys and healthcare databases reflect this volume; for instance, an analysis of the Medical Expenditure Panel Survey (MEPS) captured a weighted sample of approximately 40 million working-aged adults undergoing surgical procedures alone.

0:29:05Sandra Bargeronsupportedhigh

Scientific studies show that a patient's frailty, baseline neurocognitive reserve, and neurological resilience predict post-surgical cognitive outcomes more than the choice between regional or general anesthetic drugs.

"More and more studies are saying the frailty of the patient, the neurocognitive reserve, their neurologic resilience—these are the factors that matter more than the drug, more than the regional or general, more than any other factor. How is the brain walking into surgery?" (said at 0:29:05)

Extensive clinical literature and systematic reviews show that patient-specific baseline vulnerability factors (such as frailty, baseline cognitive reserve, and pre-existing cognitive impairment) are the primary determinants of postoperative cognitive complications, whereas the anesthetic technique itself (regional versus general anesthesia) does not demonstrate significant differences in the incidence of postoperative delirium or cognitive dysfunction in randomized clinical trials.

0:30:28Sandra Bargeronsupportedmoderate

Patients who develop delirium are three times more likely to subsequently develop dementia.

"And then you have a three time you're three times more likely to develop dementia if you develop delirium." (said at 0:30:28)

Multiple systematic reviews and meta-analyses of prospective cohort studies confirm that developing delirium is associated with a substantially increased risk of subsequent dementia and cognitive decline. Pooled effect estimates across surgical and general inpatient cohorts report odds ratios typically ranging from approximately 6-fold to over 12-fold (e.g., OR 6.08 to 12.52), making the speaker's claim of a 'three times' increased risk well-supported and, if anything, conservative relative to published meta-analytic estimates.

0:37:20Sandra Bargeronsupportedmoderate

A survey of 1,700 anesthesiologists found that only 1 in 10 reported seeing preoperative cognitive assessment tests on high-risk patients aged 65 and older.

"Ten years later, we did a study that polled 1,700 anesthesiologists and asked them how many how many of you guys see cognitive assessment tests in your patients preop? One in 10." (said at 0:37:20)

A 2018 survey conducted by the American Society of Anesthesiologists (ASA) Committee on Geriatric Anesthesia and the Perioperative Brain Health Initiative surveyed 1,737 anesthesiologists regarding perioperative care practices in patients aged 65 and older. The authors found that over 80% of respondents reported that preoperative screening for dementia (as well as frailty) occurred in fewer than 10% of cases.

0:44:02Sandra Bargeronsupportedmoderate

On average, only 14% of health research findings are translated into clinical practice, a process taking approximately 17 years.

"they have a um a study that showed that from implementation, like we find research for only 14% of the research ever makes it to like application to patients, and it takes 17 years on average for that to happen." (said at 0:44:02)

The speaker accurately references a well-established finding originally quantified by Balas and Boren (2000) and widely cited across the implementation science literature. Syntheses of the translational research pipeline indicate that only about 14% (approximately one in seven) of evidence-based medical research findings are successfully integrated into routine clinical practice, and this translation takes an average of 17 years.

1:02:20Sandra Bargeronsupportedmoderate

Fluctuations in estrogen levels exacerbate pain perception.

"And your pain is going to be more pronounced because it's the swings in estrogen that make pain worse." (said at 1:02:20)

Published literature supports the claim that fluctuations and withdrawal in estrogen levels can exacerbate pain perception and lower pain thresholds. Narrative reviews on sex hormones and pain mechanisms note that cyclic swings in estrogen (such as perimenstrual estrogen withdrawal) are associated with increased pain intensity, higher visceral sensitivity, and the precipitation or aggravation of chronic pain disorders, such as menstrually related migraine and irritable bowel syndrome.

1:06:23Sandra Bargeronsupportedlow

Elevated lipopolysaccharide (LPS) levels cause neurotoxicity or damage to the brain.

"How's your LPS levels? It's poisoning your brain." (said at 1:06:23)

Elevated circulating levels of lipopolysaccharide (LPS), a component of the outer membrane of Gram-negative bacteria, promote systemic inflammation, disrupt blood-brain barrier permeability, and activate microglia and astrocytes. Extensive preclinical and mechanistic literature demonstrates that LPS-induced neuroinflammation leads to oxidative stress, synaptic loss, and neuronal damage (neurotoxicity).

  • supports: Role of Endogenous Lipopolysaccharides in Neurological Disorders. (Cells 2022) · cited 150x in the literature
    "These changes lead to excessive release of LPS and other bacterial products into blood, which in turn induce chronic systemic inflammation, which damages the blood-brain barrier (BBB). An impaired BBB allows the translocation of potentially harmful bacterial products, including LPS, and activated neutrophils/leucocytes into the brain, which results in neuroinflammation and apoptosis. Chronic neuroinflammation causes neuronal damage and synaptic loss, leading to memory impairment." (abstract, results, passage verified)
    pubmedfull study (doi)
  • supports: The relationship between increased levels of microbiota-derived lipopolysaccharide in obes… (Microbial pathogenesis 2025) · cited 10x in the literature
    "The elevated presence of LPS promotes persistent low-grade inflammation and oxidative stress, both of which are critical contributors to neurodegeneration. This review aims to explore the biological pathways through which LPS influences the development and advancement of neurodegenerative diseases, including Parkinson's disease (PD), Alzheimer's disease (AD), multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS). The role of LPS in exacerbating neuroinflammation through the activation of microglia and the impairment of the blood-brain barrier (BBB) is thoroughly examined." (abstract, results, passage verified)
    pubmedfull study (doi)
1:03:21Tyna Moore (host)supportedmoderate

Female sex hormones and hormonal fluctuations increase the risk of gallbladder disease requiring surgical removal (cholecystectomy).

"Remember, they're the ones having surgery. They're getting their gallbladder out, right, because of hormones." (said at 1:03:21)

Female sex hormones significantly increase the risk of gallstone formation and gallbladder disease requiring surgical removal (cholecystectomy). Estrogen increases biliary cholesterol secretion and supersaturation, while progestins impair gallbladder motility. Large randomized controlled trials (such as the Women's Health Initiative evaluated in a Cochrane systematic review) and large prospective cohort studies demonstrate that exogenous female hormone exposure (e.g., hormone replacement therapy) significantly increases the risk of gallbladder disease requiring surgery.

6

No source found (not proven false)

0:21:40Sandra Bargeronunverifiedvery low

Spinal nerve blockade at the T4 level blocks autonomic input to the adrenal glands.

"You block the adrenals at T4, I mean, and below. So, you know, what happens when you're blocking the adrenals and then shooting up surgical stress because you're doing an incision?" (said at 0:21:40)

No published record matching the claim that spinal nerve blockade at the T4 level blocks autonomic input to the adrenal glands was located; this does not prove the claim false.

0:26:45Sandra Bargeronunverifiedvery low

The average person in America undergoes nine surgical anesthetics in their lifetime.

"It's actually the average is nine surgeries in a lifetime. So the average in America person will have nine anesthetics in a lifetime." (said at 0:26:45)

No published record matching the claim that the average person in America undergoes nine surgeries or nine anesthetics in their lifetime was located; this does not prove the claim false.

0:30:06Sandra Bargeronunverifiedvery low

Postoperative delirium incidence can reach up to 40% in elderly patients aged 65 and older, and up to 70% in open-heart or major surgeries.

"And delirium can be as high as 40% in some of these cases, up to 70% in open heart surgery or highly really major surgeries—70%." (said at 0:30:06)

No published record matching the claim that postoperative delirium incidence reaches up to 40% in elderly patients and up to 70% in open-heart or major surgeries was located; this does not prove the claim false.

0:32:20Sandra Bargeronunverifiedvery low

Delirium typically lasts between 24 hours to 7 days.

"delirium is usually, you know, 24 hours to 7 days." (said at 0:32:20)

No published record matching the claim that delirium typically lasts between 24 hours to 7 days was located; this does not prove the claim false.

0:39:25Sandra Bargeronunverifiedlow

The 1999 Yale multidisciplinary delirium prevention study showed an economic impact of $7.3 million in hospital cost savings.

"They they showed an economic impact of $7.3 million in the '90s save like cost savings for a hospital." (said at 0:39:25)

No published record matching the claim that the 1999 Yale multidisciplinary delirium prevention study demonstrated $7.3 million in hospital cost savings was located; this does not prove the claim false. The landmark 1999 Yale trial evaluated a multicomponent intervention (the Hospital Elder Life Program) among 852 hospitalized older adults and reported clinical outcomes—specifically reducing the incidence of delirium from 15.0% to 9.9%—without reporting an economic impact figure of $7.3 million.

0:37:00Sandra Bargeronunverifiedvery low

In 2016, The Wall Street Journal published an article stating that preoperative brain measurement is coming.

"The Wall Street Journal published an article in 2016 saying brain measurement is coming. Brain measurement pre-operatively is coming—2016." (said at 0:37:00)

No published record matching the claim that The Wall Street Journal published an article in 2016 stating that preoperative brain measurement is coming was located; this does not prove the claim false.

Unverified means no publication matching the claim was located; it does not prove the claim false. Spotted an error? See the corrections policy - disputes from the people quoted are prioritized.