Expert: Ronald Levy, M.D. - 4/16/2008

Question
QUESTION: I am a 59 Y O female and have a UPPP scheduled for 5-21-08, due to sleep apnea and other obstructive issues.  I have several risk factors HTN, Obesity, Gastric Reflux, Severe Anxiety, High Cholesterol.  I have taken meds for years to control my HTN and Cholesterol.  I am currently on Lotrel 5/10mg, Zocor, and Xanax for the anxiety. Most of my serious problems are controlled, and after taking a nuclear stress test, holter monitor, carotid study...I have been "cleared for surgery" by my cardiologist. My concern is me and general anestheasia.  I am scared OUT OF MY WITTS, because everything I read seems very negative.  I know very well that when I go into the hospital that day to get ready for surgery my pressure will be THROUGH THE ROOF  probably around 180/100, this caused from the severe anxiety.  I dont want the surgeon and anesthesiologist to send me home because of my BP.  I had a spinal for a knee arthroscopy several years back, and my pressure was 180/100 then also, however the anesthesiologist gave me VERSED and my pressure throughout surgery was 130/70.( of course I asked..it seemed the more I talked the more VERSED I got..he probably did it to keep me quiet...lol)  Will they give me something this time also even for GENERAL ANESTHESIA?  I dont want them to send me home once I am there.  Also please shed some light on anesthesia, its affects, and if possible some general reassurance for my fear.   

P.S. the surgeon states the surgery should take 1-1/2 hours.

Thank you Please Help.

Nervous 15

Aka Carole

ANSWER: The problem is that people read about the bad things that happen because thats what sells. Anesthesia is very safe and probably has one of the lowest mortality rates of all medical specialties. As for your anxiety, you're not alone. When you see the anesthesiologist for your preop visit, tell him about your anxiety and he will likely prescribe a sedative for you to take before you come in. Even if you come in with high BP, they will realize it is from anxiety and give you some sedation there. As long as your pressure comes down to normal, they will proceed with the surgery. As for allaying your fears about anesthesia, remember that throughout the case there will be a trained person there whose only job it is, is to make sure your vital signs are stable and you will wake up as good as you went to sleep.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

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

QUESTION: Dr Levy thank you, but I do have one additional comcern.  When I asked the surgeon Steven F. Soltes if I would be able to speak to the anesthesiologist, he stated they dont do that...dies that make an ounce of sense?  I will tell you if I cant speak to him I will have to cancel the operation.

Additional fears....

Nervous15

Carole

ANSWER: No that doesn't make sense. Often in surgicenters you see the anesthesiologist on the day of surgery (assuming you are otherwise healthy) but if you have concerns, they should let you see the anesthesiologist prior to surgery. Call the anesthesia department directly and ask to speak to someone.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston


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

QUESTION: Dr. Levy, I have spoken with the surgeon and he stated that before surgery I could voice my concerns to the anesthesiologist.  I have given him some of my fears and he doesnt seem to be alarmed by any of it...so  surgery is on for May 21st.  I do have a question for you......I  understand that some of the drugs that are used in anesthesia interferre with the serotonin of the brain, am I correct?  If so my concern is that My Dr tried to put me on a regime of anti depressants like Paxil., Prozac, and Zoloft a few years ago.  Although on the most minimal dose, after 3 days I got the same response from ALL of those meds.  It felt like an elevator went from my feet through the top of my head...my blood pressure shot up to 220/120....Can you offer some advise regarding not having this happen during surgery.  This is one concern my surgeon told me to make the anesthesiologist aware of so they could watch me closely.

Could they revent this..please enlighten me.

Thank you so much, I dont know what I would do without your help.

Carole an still Nervous15

Answer
Serotonin is the suspected neurotransmitter responsible for sleep. It is a breakdown product of Tryptophan. That is why your mother probably drank warm milk to go to bed because warming milk released tryptophan). So any anethetic is going to work on the serotonin receptors. All three drugs your mention are serotonin reuptake inhibitors and have several potential bad side effects. They should not be discontinued abruptly and should not be used with MAO inhibitor medications. You should definitely let your anesthesiologist know that you are on these medicines as well as the physician who prescribed these medications to see if he wants to taper them or change you over to other medications. We can still do the anesthesia and will will work fine (so long as we know what medications you are on).

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston