Expert: Dr Ian Jackson - please note UK based - 10/12/2008

Question
I'm having abdominoplasty and have had severe PONV with inhalation agents and I asked my surgeon to use TIVA with propofol/fentanyl only and she agreed since I have had both agents in the past without problems.  Sevo, notrious etc give me severe PONV.  The anesthesia team agreed to this nd not to use other agents, but flipped out when I wrote this on the consent.  In other words, when I documented what they verbally agree to, they went nuts.  I don't think that I'm a "difficult" patient, I just don't want to sign a blank check and receive anestheisa that had proved problematic in the past. How can I limit my consent to drugs that I know will not make me deathly sick?  I was to have surgery this morning, but my surgeon and anestheia got in to and angry shouting match and I left........thanks

Answer
Hi there
Well I have no problems with your request and see no reason why you shouldn't make this explicit on the consent form. I am not certain why this should cause them such concern when they had already agreed to your request. However it is important to understand that not all anaesthetists are comfortable using total intravenous anaesthesia (TIVA) - so my concern would be were they actually experienced in the technique?
I use it routinely (have done for 20 years now) for the very reasons you outline - however of my 29 senior colleagues at my hospital there are only another 5-6 who would be comfortable using it but don't actually use it all the time.
I think you are doing the right thing.
Dr Ian Jackson