July 1, 2026 Salus Health Care Forum

That’s important in critical care too. We try to bring the families along as to what they’re likely experiencing. And we must always make sure we’re talking to the patient as if they’re there. Because there’s circuits in the brain that are still working even when they’re heavily sedated. That’s an important piece. I think that with delirium, it is a whole different level of magnitude of badness to the brain than anesthesia. And I think anesthesia is not always good.

To avoid anesthetics, I think sometimes is the right thing. So I asked ChatGTP, what can I do? So I had just had colonoscopy, TMI. And I got propofol. I have probably used propofol a thousand times with thousands and thousands of hours of people on it. Doing all sorts of procedures and just sedating for ventilation. They gave it to me and I was out. And I don’t remember anything after that until I woke up. And then I was awake. I kind of liked that. And all my memories are there. That’s a pretty good way to go. She came and talked to me and told me what was going on.

And I remember it. But if I’d got benzos or narcotics, I know that’s not the case. I know I’d be in a slow wake up. They wouldn’t talk to me and I wouldn’t remember. And so I think that’s important. One of the things that ChatGTP said is you can nourish yourself. Especially after colonoscopy, you got to replenish your gut flora and everything. And cruciferous vegetables, believe it or not, are a huge source of antidote to metabolizing anesthetics, narcotics and benzos. I thought that was really interesting. There’s relevant literature to that.

Jeremy

I’m just going to summarize a little bit, because we’ve heard about delirium as a very serious consequence and more common than we’d like it to be, although the statistics vary a lot. Depression, anxiety, I think we heard a lot from Jack about the high incidence of depression that goes unrecognized and untreated. And then kind of PTSD. Sort of three buckets of crossover. I am curious about one thing, because this kind of reminds me of perioperative beta blockers or perioperative cardiovascular events. A whole lot of research goes into it, figuring out what to do. What would it look like? Because an operation does feel controlled. Going to the ICU is an unpredictable event, thankfully for most of us. So like Mitch said, you can’t do the pretest for the ICU, but you sure can for the OR. And it just seems like this was a huge missed opportunity. But I wonder, Gary, do you think neuropsych testing is inappropriate? What could you do to test a person before for PTSD, depression, anxiety, and delirium risks ahead of time, and then confirm post-op through some reliable test? Because I’ll tell you, doctors are not hugely reliable in identifying any of the things we just mentioned. These are all kind of under-the-radar difficult things. We’re pretty good as assessing depression and anxiety. I’ll give us credit for that. But PTSD gets missed all the time. Delirium makes you delirious trying to figure out whether it’s there or not. It’s hard. So are there tests that are reliable for delirium and PTSD that could be done pre-op and post-op?