Treatment of post-anesthesia dementia with perispinal etanercept injection and hyperbaric oxygen therapy: a case report

Steve Best, Dan G. Pavel

We report on the first case of successful treatment for post-anesthesia dementia with perispinal etanercept injection combined with hyperbaric oxygen therapy. Our patient was a 77-year-old Caucasian man of Mexican ethnicity who presented to our clinic 4.5 years after a knee replacement surgery. Immediately post-surgery, the patient began to show dramatic cognitive, physical, and emotional impairment compared with his presurgical state; these symptoms were still present when he arrived at our clinic. A clinical assessment and brain single-photon emission computer tomography were performed. Diagnoses of dementia with major cognitive deficits and aphasia were established. A 40-session course of hyperbaric oxygen therapy was initiated to address our patient's impairments. After the first ten hyperbaric oxygen therapy treatments, our patient was administered 25 mg perispinal etanercept injections approximately once weekly for 5 months. Starting after the first perispinal etanercept injection, our patient began showing progressive improvements. By the 5-month follow-up, his cognitive and physical function were substantially restored. A follow-up single-photon emission computer tomography scan showed increased perfusion in several small, localized areas. In this case of dementia and major cognitive disorder post major surgery and anesthesia, the very beneficial effect of combining hyperbaric oxygen therapy with perispinal etanercept is outlined.