Anesthetic Information: 7 things doctors don't tell you about anesthetics (but should)


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Mar 24, 2008
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This is an excellent article from the August 15, 2010 issue of Bottom Line Personal:

7 Things Doctors Don't Tell You About Anesthesia (But Should)

All forms of anesthesia can cause side effects or complications, yet doctors don't always take the time to address these issues with patients. What you must know...

Your supplements can inrease your risk. Some herbs and nutritional supplements can be lethal when they're combined with anesthesia. Ginkgo, for example, can elevate blood pressure. Because some anesthetic drugs have the same effect, patients taking both can experience sharp rises in blood pressure. This increases the risk for stroke and heart attack.

Risks from supplements are greatest with general anesthesia, but even with regional anesthesia (such as spinal or epidural), there are dangers. Example: Garlic supplements thin the blood, which can cause additional bleeding with regional anesthesia.

During the presurgery interview with your anesthesiologist, mention everything that you're taking. Also, talk with the doctor or naturopath who prescribed the supplements about any possible interactions.

Nausea can be controlled. Many forms of anesthesia stimulate the chemoreceptor trigger zone, a part of the brain involved in nausea. Older anesthetic drugs, such as nitrous oxide (laughing gas), are far more likely to cause nausea than newer agents. But postoperative nausea and vomiting still are among the most common side effects of anesthesia.

Better control: A relatively new class of drugs, known as 5-HT3 antagonists (such as Kytril and Zofran), may reduce postsurgical nausea more effectively than their predecessors. Scopolamine patches, which are commonly used to prevent motion sickness, also can be helpful.

IMPORTANT: If you have had surgery and experienced nausea in the past, tell the anesthesiologist during the presurgery interview. He/she will make sure that you get the appropriate kinds ond doses of medication.

Constipation and urinary retention are likely. Analgesic narcotics, such as codeine, Demerol and Percodan, have a tendency to make it difficult for patients to urinate or have a bowel movement - problems that can persist for days or even weeks after the surgical procedure.

HELPFUL: Ask the anesthesiologist if your procedure can be done with an ultrasound-guided nerve block instead of general anesthesai. Patients given this type of anesthesia typically require lower doses of narcotics, which can reduce the side effects.

Snoring is a danger sign. Patients who snore or make snoring sounds during sleep may suffer from sleep apnea, a condition which breathing may stop and start, leading to the lowering of oxygen levels.

THE DANGER: Patients with sleep apnea tend to have more complications during intubation, the insertion of an endotracheal tube into the patient's windpipe (trachea) that delivers oxygen and many inhaled anesthetics. Problems with intubation can be the riskiest part of anesthesia - diminishing airflow can cause brain damage or death.

Dantrolene should be on hand. It's the only drug that can reverse malignant hyperthermia, an anesthesia-related complication that can lead to increases in body temperature and a breakdown of multiple organ systems. This occurs in perhaps one in every 65,000 patients. Without treatment, it is fatal in more than 80% of cases. When dantrolene (Dantrium) is administered, the death rate is less than 10%.

Hospitals are required to stock dantrolene, but some outpatient facilities might not have it. Don't undergo any procedure involving general anesthesia unless this lifesaving drug is available and can be administered if necessary.

A "local" prior to an IV reduces pain. Most procedures start with the insertion of an intravenenous (IV) needle into a vein. The IV is used to deliver some forms of anesthesia and/or other drugs during surgery and afterwards while you're in the hospital.

Because these needles are larger than the needles used for regular injections, they can cause pain when inserted. An injection of lidocaine works to numb the skin before an IV is inserted. Many hospitals don't do this, so be sure to ask for it if you are a "tough stick" for IVs or if you want to minimize any potential for pain during this process.

The anesthesiologist should be board-certified (applicable in the USA only). Anesthesia can be legally administered (in the USA) by a medical doctor (anesthesiologist), an anesthesia assistant or a certified registered nurse-anesthetist. Except for the simplest procedures, it's always best to have a board-certified anesthesiologist administer the anesthetic. He/she has the most experience and training. He can administer the anesthesia alone or in conjunction with other professionals. You can find out if the doctor is board-certified by contacting your state board of medicine or the American Board of Anesthesiology (

Bottom Line Personal interviewed David Sherer, MD, an anesthesiologist in the suburbs of Washington, DC, and former physician-director of risk management for a major HMO. His interests include medical malpractice reforms and testimony, the use of anesthesia in starting intravenous lines and the importance of patient advocacy. He is author of Dr. David Sherer's Hospital Survival Guide (Claren).

Reprinted with the permission of:
Bottom Line/Personal
Boardroom Inc.
281 Tresser Blvd., 8th Floor
Stamford, CT 06901
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