HoldsUp

Sandra Bargeron

Sandra Bargeron is a physician assistant and anesthetist. Her work focuses on surgical preparation and the neurological impacts of anesthesia on the brain. She also addresses how factors such as metabolic health, frailty, and muscle mass affect recovery from surgery.

23 claims checked on air: 3 context 3 overstated 11 supported 6 unverified

What they said on air - supported

0:17:45supportedhighHow to Prepare Your Brain for Surgery: What No One Tells You

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.

0:19:44supportedhighHow to Prepare Your Brain for Surgery: What No One Tells You

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.

0:20:10supportedhighHow to Prepare Your Brain for Surgery: What No One Tells You

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.

0:25:30supportedmoderateHow to Prepare Your Brain for Surgery: What No One Tells You

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.

0:26:54supportedmoderateHow to Prepare Your Brain for Surgery: What No One Tells You

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.

0:29:05supportedhighHow to Prepare Your Brain for Surgery: What No One Tells You

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.

0:30:28supportedmoderateHow to Prepare Your Brain for Surgery: What No One Tells You

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.

0:37:20supportedmoderateHow to Prepare Your Brain for Surgery: What No One Tells You

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.

0:44:02supportedmoderateHow to Prepare Your Brain for Surgery: What No One Tells You

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.

1:02:20supportedmoderateHow to Prepare Your Brain for Surgery: What No One Tells You

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.

1:06:23supportedlowHow to Prepare Your Brain for Surgery: What No One Tells You

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).

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