How to Prepare Your Brain for Undergoing General Anesthesia

General anesthesia includes the types of medication, given via IV or inhalation, that are used in major surgeries. Without general anesthesia, many life saving surgeries would be unable to take place. While under general anesthesia, you are completely unconscious, and are being monitored by an anesthesiologist to ensure that you stay unconscious and safe during the surgery. Without a doubt, the development of general anesthesia was an important and necessary medical advancement; however undergoing general anesthesia comes with significant risks. 

Experiencing some memory problems immediately after undergoing general anesthesia is very common, and is known as postoperative cognitive decline (1). However, many people suffer from prolonged cognitive impairment after undergoing general anesthesia. Observational studies investigating the relationship between anesthesia and dementia have had mixed results, but some studies have shown increased cytotoxicity and build up of amyloid plaque following general anesthesia (2). The exact reasons for this are still being investigated, but it is believed to occur through multiple mechanisms. Based on clinical observation it is clear that older adults and those at risk of developing dementia should take care to protect their brain prior to undergoing general anesthesia. 

How does general anesthesia contribute to cognitive decline? 

General anesthesia can contribute to the development of cognitive decline in multiple ways. Primarily, the medications used during general anesthesia are highly toxic. Much research has demonstrated the cytotoxic and neurotoxic effects of the medications used for general anesthesia (3). These medications exhaust the body’s antioxidant systems, including glutathione, and stress the body’s natural detoxification systems. Additionally, common side effects of general anesthesia such as hypoxia and hypotension, or poor oxygenation and low blood pressure, exacerbate the effect of these toxic agents on the body. Finally, surgery in general is traumatic, highly inflammatory and requires much of the body’s resources to heal and repair in a timely and effective manner. The body requires higher than usual amounts of anti-inflammatory and antioxidative compounds following surgery. When it doesn’t receive these compounds, the cells are left damaged, despite the fact that major wounds heal. As a final insult, physicians often recommend antibiotics after surgery to prevent infection. Though these are often necessary, they wreak havoc on the gut microbiome, which can have long lasting implications on health. 

How to protect your brain from the toxic effects of general anesthesia

The best way to protect your brain from the toxic effects of general anesthesia is to clear the drugs from your system as rapidly as possible. Most of the drugs used for general anesthesia are metabolized through the liver, kidneys, and to a lesser extent through the lungs. Thus, the primary ways to allow for a quick recovery from general anesthesia is to optimize the health of your liver and kidneys. In addition, creating an environment where the cells have adequate anti-inflammatory and antioxidative compounds both pre and post surgery expedite the healing process. Below is an outline of what can be done to prepare the body and brain for the effects of general anesthesia and surgery and to recover post surgery. 

Two weeks before surgery

Stop drinking alcohol

It’s well established that alcohol is neurotoxic and should be avoided for those with cognitive decline or wishing to optimize their brain health. Beyond that, alcohol stresses the liver’s natural detoxification system. Alcohol should be avoided for two weeks before (and at least two weeks after surgery) to optimize liver health and upregulate your body’s capability to process toxins.   

Eat at least 3 servings of cruciferous vegetables per day

Cruciferous vegetables contain many compounds that support the body’s natural detoxification pathways. Different varieties of these vegetables contain different compounds, all of which are necessary in supporting these critical pathways. For example, broccoli sprouts, broccoli, cauliflower, kale, cabbage, and radishes contain a compound called glucoraphanin, which is converted into a compound called sulforaphane. Sulforaphane induces detoxification through the activation of Nrf2 (4). 

You can maximize your nutrient intake from cruciferous vegetables if you eat them raw or lightly steamed or sautéed. This allows you to absorb the highest amount of glucosinolates, a class of detoxifying phytonutrients. Aim for a variety of the cruciferous vegetables you choose, such as arugula, bok choy, broccoli, cauliflower, red cabbage, collard greens, horseradish, purple kale, daikon radish, rutabaga, turnips, and watercress. 

Increase intake of antioxidative foods 

The medications used for general anesthesia are highly oxidative. You can counteract the harmful effects of oxidation by increasing your intake of antioxidative foods. Some of the best foods in this category include extra virgin olive oil, pomegranate, blueberries, acai, hibiscus, oregano, mint, basil, and other brightly colored plant foods. Include several bright colored plant foods and at least one spice or herb with every meal. 

One week before surgery

Continue with all of the recommendations listed for two weeks before surgery and: 

Add protective supplements

Start taking a good quality multivitamin and 500mg vitamin C for basic cytoprotection. Additionally, take either 500mg N acetyl cysteine or 250mg liposomal glutathione twice per day to support the clearing of the medications from your body. You can also consider taking milk thistle (70mg three times per day) as an additional support for your liver. You can find a complete list of the supplements recommended here. Make sure to discuss any new supplements with your doctor before you take them. 

Stop certain supplements

Contact your anesthesiologist to review all of the medications and supplements that you are taking because they may want you to stop certain medications or supplements prior to surgery. 

Stop taking supplements that cause blood thinning such as fish oil or omega 3 supplements, vitamin E, garlic, turmeric, aloe, and ginkgo biloba (5). You should also avoid supplements that may prolong the effects of the anesthesia such as valerian root and St. John’s Wort.  

Through 2 weeks after surgery

Continue with all of the interventions listed above, but add in the supplements you have stopped taking per the recommendations of your doctor. Add in the following recommendations:

Increase your dietary fat intake

Once you are able to resume eating a normal diet, increase your intake of healthy fats such as extra virgin olive oil, avocados, nuts, and seeds. Many of the medications used for general anesthesia are fat soluble, meaning they require fat to be metabolized and cleared from the body. However, it's imperative to ensure that you only increase your intake of healthy fats such as those listed above. Foods high in saturated fats or trans fats can be highly problematic after surgery. For example, a side effect of Propofol, one of the common general anesthesia medications, is elevated levels of triglycerides. This can lead to pancreatitis and other metabolic issues if left unresolved. Coupling healthy plant based fats with the antioxidant rich foods is the best way to create an environment that can clear toxins while protecting your cells. Make sure that you eat these fats with every meal. 

Increase your protein intake

While this recommendation is not specific to recovering from general anesthesia, the body has increased protein needs following major surgery. It is beneficial to slightly increase your intake of protein through healthful foods such as pasture raised eggs, wild caught fatty fish, and plant based proteins such as beans, tofu, and tempeh. If you are unsure how much protein is appropriate for you, contact us to schedule a one on one appointment with a dietitian. 

Add an inflammation resolving supplement

Major surgery is highly inflammatory. While the body has balanced built in systems to both initiate and resolve inflammation, excess inflammation can overrun these systems, leaving the body in an inflamed state. Supplements known as pro resolvins can help the body resolve the inflammation more efficiently. You can find this supplement here. 

Stay well hydrated

One of the primary ways that we clear toxins, including those from medications, is through the urine. That means that when we hydrate well, we more effectively excrete certain toxins. A good way to determine your hydration needs is to divide your weight (in pounds) by 2 and drink that much water in ounces per day. For example if you weigh 150 pounds, you should drink at least 75 ounces of water per day (or 2.2 liters). This is normally adequate to maintain proper hydration, but when recovering from general anesthesia, your needs may be higher. Unless your condition has you under a fluid restriction, aim to drink at least 3-4 liters of water for the two week period of recovery from general anesthesia. 

Practice deep breathing exercises

While not a primary site of toxin metabolism, some medications used for general anesthesia are metabolized in part through the lungs. For this reason, practice some basic deep breathing exercises twice per day. There are many deep breathing exercises and you can choose one that best works for you. If you’ve never done a deep breathing exercise, simple sit or lay down with one or both of your hands on your belly. Breathe in slowly, filling your lungs and feeling your belly rise beneath your hands. Then blow the air out of your lungs completely. Repeat this several times. 

 Take a sauna

Sweating, such as through a sauna, is a great way to excrete toxins. For the two weeks after surgery, take a sauna a few times if permitted by your doctor. Make sure to wash the toxins off of your skin after the sauna by showering and washing your body with a castile soap. 

While there are risks to undergoing general anesthesia, the surgeries for which this type of medication are necessary are often life-saving. If your surgery is planned, have a discussion with your doctor about whether or not general anesthesia is necessary. If it is, take these steps to protect your brain and body.

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References

1. Alzheimer’s Society, (2022). 
2. Jiang, J., & Jiang, J. (2015).https://doi.org/10.3892/mmr.2015.3424
3. Wu, L., Zhao, H., Weng, H., & Ma, D. (2019). https://doi.org/10.1007/s00540-019-02623-7
4. ​​Yang, L., Palliyaguru, D. L., & Kensler, T. W. (2016). https://doi.org/10.1053/j.seminoncol.2015.09.013
5. Abebe W. (2019). https://doi.org/10.1007/s13167-018-0158-2