Expert: Dr Ian Jackson - please note UK based - 11/22/2008

Question
QUESTION: I had out-patient surgery one week ago today.I had told the anesthesiologist that I was very sensitive to anesthesia in that I didn't wake up easily, 'like most people in the recovery unit', per my daughters, had n/v often. I asked her for as "little anesthesia as possible" if that was possible. Last week when I did wake up I was 'more alert' than in the past and actually had some toast, gingerale, and water. I left soon with a dizzy headache I could feel coming on.When I got home the headache worsened and I had 3 episodes of n/v. I couldn't keep anything down. I was lying on the couch and when I opened my eyes I felt like I was getting dizzy. (Was this a migraine? I have never had a migraine before.) I went to bed and after sleeping that night the headache greatly lessened, but with a touch of occassional nausea. Off and on this week I have had this headache with accompanying nausea. I called the doctors and they felt I may be dehydrated. I felt better after drinking lots of liquids but on Friday, one week later, I still have slight nausea at times and at times I can feel that I get very tense with any sign of the headache returning. I don't know if my stress causes the headache or the headache causes the stress which intensifies the headache. I am an RN and work in an ICU setting. I can't figure this out. Anesthesia sicknes? I just had final stage of breast reconstruction. I had the tissue expander inserted in April of this year. After that surgery I was sick as well but without the headache! I thought the abd upset was from the clidamycin I took pre and postop. I did feel better after I stopped the clindamycin per my doctor. I look forward to hearing from you and thank you in advance for your time.  Sue

ANSWER: Hi Sue
As an RN in ICU you must be as puzzled as I am about this. It is difficult to give much idea without a complete breakdown of the drugs and techniques used. From your history it is obvious that you are sensitive to anaesthesia from the point of view of nausea and vomiting. It might be that you have some sort of metabolic issue with anaesthesia or the drugs given to you for pain relief? I assume you were given something to take?
For an issue to last this long is strange as the anaesthetic would have left your system some time ago, hence my question about any other medication given to you.
At the end of it all I would say that anaesthesia is basically not well understood and has very different effects on some people. It could be that you body produces some toxic metabolite that makes you feel this way from the anaesthetic drugs or that your receptors in the brain are effected in some more profound way.
I am sorry I can't give you a definitive answer but suspect you have access to many colleagues with anaesthetic knowledge who are equally puzzled. If you presented to me I would want to have a good history of what drugs had been used in each of your previous anaesthetics, I would review these with you and then choose how we would look after your next anaesthetic. Hopefully by a process of elimination we could come up with a technique that was OK for you.
I wish you all the best.
Dr Ian Jackson

---------- FOLLOW-UP ----------

QUESTION: Dr. Jackson, Again I apreciate your reply. Interesting. I'm not sure what anesthetics were used in the past. I think I remember this anesthesiologist, before she put me to sleep, mention something about propofol. I don't know if she have used anything else or not. The nurses in recovery may have given me fentanyl, I don't remember. In the second stage recovery room, because I was going home later that day,the nurses gave me celebrex and vicodan together that had been ordered by the anesthesiologist. I don't think she wanted to give me anything stronger because I fall asleep and I'm there another couple of hours. Anyway, I'm feeling better today. Definitely perkier. A touch of the headache today but no nausea. As far as pain killers at home, I haven't taken any except naproxen sodium. I don't like to take pain medicine. Thank you for your professionalism! Sue

Answer
Mmm so it can't really be the pain killers then - I certainly wouldn't be suspicious of naproxen normally. I'm glad you are feeling better. So it falls back to some sort of reaction to the agents used. I have to leave it as before the more I think about it the more I just wonder about it being an almost subclinical metabolic issue a bit like Malignant Hyperthermia (don't panic I'm not saying it is MH! just something happening at a similar sort of level)
A puzzle indeed. If you ever need further anaesthesia then my advice from last post holds. However I would add that if you feel bad after it again that it would be worthwhile having some baseline bloods checked within 24hrs to include creatinine and markers of muscle damage - but only as a long shot!
Anyway, all the best and take care as ITU nurses are a rare breed and we need you all!
Kind regards
Dr Ian Jackson