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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by colin wallace on July 31, 2003, at 15:59:11
Guys, do any of you have any experience of how a general anaesthetic affects your meds/depression?
I have a nasty feeling that, if alcohol messes me up for nearly a week, anaesthetic will really ruin my day!
Also, I don't relish the thought of being comatose and hacked to bits at all.
Actually, it's only an arthroscopy, but I'm thinking of insisting on a local anaesthetic anyway( they tell me that's out of the question
but I really can't see why).
Any thoughts,Col.
Posted by stjames on July 31, 2003, at 16:27:28
In reply to Anaesthetic and antidepressants, posted by colin wallace on July 31, 2003, at 15:59:11
> Guys, do any of you have any experience of how a general anaesthetic affects your meds/depression?
MAOI's and Anaesthetic have a contraindication.
If at all possible, go for the local with IV sedation. Recovery is quicker and you avoid
intubation.
Posted by mattdds on July 31, 2003, at 21:52:28
In reply to Anaesthetic and antidepressants, posted by colin wallace on July 31, 2003, at 15:59:11
Hi,
I'm a fourth year dental student. During my training, they told us that the main concern with local anesthetics is the epinephrine contained in lidocaine 2% solution. The epinephrine is only in 1:100,000. This is an extremely tiny dose of epinephrine!
It is my opinion that the only reason clinicians avoid vasopressors in local anesthetics for folks taking MAOI's is for medicolegal reasons (i.e. they want to save their butt from being sued!).
Stanley Malamed, an authority on local anesthetics at UCLA, has done some research on this. He showed that the amount of epinephrine entering the bloodstream from lidocaine with epinephrine is negligible, and there is no evidence that they should be avoided with MAOI's. I also believe that local anesthetics WITHOUT vasopressors are markedly inferior (at least in my experience). For example, the other night, I did an extraction with mepivacaine without epinephrine, and the patient was squirming in the chair the whole time, even though I gave a high dose of it! I never have this problem with LA's with epinephrine, and imagine the amount of epinephrine released naturally by this patient well exceeded the amount I would have given her had I used lidocaine with epinephrine! I felt terrible about this.
My thinking is, get good anesthesia, and that will reduce anxiety about the procedure. As we know, anxiety releases loads of epinephrine into the bloodstream (the exact same epinephrine in lidocaine 2%, just LOTS more of it!). So if you go for good anesthesia, you are actually less likely to experience a hypertensive crisis.
That being said, local anesthetics containing *levonordefrin* ARE contraindicated with MAOI's and TCA's!
This is not medical advice, just general information. I'm just a dental student, not a physician, but hopefully some of this may help.
Best,
Matt
Posted by Larry Hoover on August 1, 2003, at 8:14:09
In reply to Anaesthetic and antidepressants, posted by colin wallace on July 31, 2003, at 15:59:11
> Guys, do any of you have any experience of how a general anaesthetic affects your meds/depression?
> I have a nasty feeling that, if alcohol messes me up for nearly a week, anaesthetic will really ruin my day!
> Also, I don't relish the thought of being comatose and hacked to bits at all.
> Actually, it's only an arthroscopy, but I'm thinking of insisting on a local anaesthetic anyway( they tell me that's out of the question
> but I really can't see why).
> Any thoughts,
>
> Col.As a "recipient" of two arthroscopic procedures, there is likely to be good reason why they don't want you to be conscious. "Only...arthroscopy", as you say above, is a trivializing statement. Orthopedic surgery is probably the most primitive surgery there is. Hammers. Saws. Drills. Grinders. Staplers. More like carpentry than surgery.
I don't respond well to general anaesthetic, but having read up on what transpired during my procedures, I'm quite glad I was "elsewhere" during the events themselves.
I'd be more concerned about the psychoactive effects of the opiates you're likely to encounter, rather than the general.
What procedure are you having done?
Lar
Posted by noa on August 1, 2003, at 10:09:25
In reply to Anaesthetic and antidepressants, posted by colin wallace on July 31, 2003, at 15:59:11
I had arthroscopic surgery a few years ago. I think that the anasthesiologist might have selected anasthesia and pain meds that are less likely to have dangerous interactions with my meds.
I have always had bad reactions to general anasthesia, although the previous operations I had had were so long ago that I know the anasthesia has changed so much.
I did have difficulty coming out of anasthesia, but this apparently was not the case for all the other patients in the recovery area of the day surgery at the hospital! They were up and out of bed, seemed to get dressed without any help (I can't be certain because they were dressing behind a curtain, but I don't think anyone was helping any of them). Me? I could barely even open my eyes when people who came out of surgery after me were looking pretty darn chipper and walking out of the hospital on their own two feet.
That being said, I do NOT think it was the all the fault of the anasthesia per se. I think it was the morphine they gave me before I awoke and once more in the recovery room. Because of my meds, they did not give me the pain killer that is usually given, although knowing my typcial reaction to painkillers, I am pretty sure I would have had a similar reaction to those as well.
When I was in recovery, I was not fully conscious, but even with me being unable to open my eyes, I was able to hear the nurses and answer them--it is just that I wasn't fully there to understand what was going on or explain what I wanted. So, a nurse asked me if I feel any pain and I said yes. But I was not alert enough know why she was asking me, and if I had been able to explain, I would have said, yes, I feel pain but it doesn't bother me that much, or yes, I feel some pain, but I don't want any more morphine. Well, she asked me in order to know whether to give me more morphine, so she did, and I was so doped up.
The nurses kept trying to push me to get up and get out, but I was really not able to open my eyes and move. When they moved me to the 2nd stage of recovery, where my friend was able to come in and help me get ready and take me home, that is where I saw the other patients looking alert and active. I wish I could have complied as the nurses were pushing me to do, but I was totally sedated. And nauseous. I have always had nausea from anasthesia, and it could have been from the morphine as well.
Eventually, they got me dressed and wheeled me out to my friend's car. She took me home and put me in bed and I slept a long time.
In the days following, I did not need to use the painkiller the doctor gave me--and was reluctant to do so because of how I react to sedatives. I just used ibuprofren instead.
I had asked the doctor about local anasthesia but he had told me that the problem is that although I might not feel pain, I might stiffen my muscles during the procedure, and that would throw the procedure off.
Talk to the doctor about your medications. Ask to speak with the anasthesiologist ahead of time about your meds and interactions with the anasthesia and pain meds. I wish I had spoken with the anasthesiologist before hand. I had only a brief conversation with him right before the surgery, when he told me they were going to use morphine instead of the standard painkiller. But I wish I could have asked more questions and talked more aobut my concerns.
Good luck.
Posted by noa on August 1, 2003, at 10:12:27
In reply to Re: Anaesthetic and antidepressants, posted by Larry Hoover on August 1, 2003, at 8:14:09
>I'd be more concerned about the psychoactive effects of the opiates you're likely to encounter, rather than the general.
Larry--this validates my own experience, described in my post to Colin above.
Posted by colin wallace on August 2, 2003, at 9:41:06
In reply to Re: Anaesthetic and antidepressants » Larry Hoover, posted by noa on August 1, 2003, at 10:12:27
Thanks for you input here guys.Not exactly thrilled at the prospect of undergoing even minor surgery, but at least now I'll have some idea of the 'pitfalls'!!
Col.
This is the end of the thread.
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