Expert: Ronald Levy, M.D. - 4/22/2008

Question
QUESTION: I am a 55 year old woman. I had a c-section but I was awake and also a huge lipuma tumor taken off my abdomin and only needed twilight and local. That was done by a plastic surgeon and it only left a 1" scar.
I was told a year ago that I needed my gulbladder out. The doctor at the emergencyroom was amaze he was not wheeling me into surgery right then. I keep putting it off because I am afraid of aneshetics. First, I keep hear it is rare, but the stastics I hear is 1,000 people a day in this country are paralize but can feel every single moment of pain. The other is I am afraid I won't wake up. I hear there is a test for this but they don't use it. Since I have never had surgury before I am scared. My questions is why do they have to paralize you? I don't want that. I just want to be put under but not paralize. That way if I did feel pain, I would be able to let someone know.
I know I need this surgery because I am so swollen now under my right rib and I do not feel well anymore. But I am soo terrified. Please tell me if there is an alternative way to do this and not have to be paralize.

ANSWER: First of all that statistic about 1000 people being awake but paralyzed is completely incorrect. It is more likely 1 out of every 1,000,000 patients (or more). It is extremely rare. Aas for not waking up, also extremely rare. This is the job we are paid for. Remember that millions of operations are performed every year and 99.9% of them wake up (the rest were too sick to wake up in the first place). As for the test for that (BIS monitor) it is used but it doesn't guarantee that you are asleep. Our job is to look at your vital signs to make sure you are asleep. Even if they didn't paralyze you, you could tell anyone because you are intubated. The reason you are paralyzed is so that the abodminal muscles are relaxed which makes it easier to do the surgery. Don't worry and have the surgery. You might be surprised how plesant the anesthetic experience is!

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

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

QUESTION: Recently there was a young woman in the news who died. They said it's rare but if it does happen it's usually to first timers under anesthesia. Called thermo something. They said there is a test for that but they never use it. Since hearing about this I know I will be asking for that. Is there anyway I can get this galbladder out under a spinal and twilight or other way? I also seen that accupunture works great. We have many of those here and I did called one yesterday. They said yes, they could do it and it would work, but would be up to surgeon and hospital. Why if accuputure works, is this not being offered in hospitals? It seems much safer and I am less afraid of that. I also have a systemic candida problem that gets ignored by mainstream medicine. I do go to an MD and last couple times my blood cells are now swollen, as well as cells all over. She said my blood doesn't even move it just sits there. Well that also adds to my concern. Would I even be considered healthy enough to have anesthesia? I know I am asking alot and I am paranoid. I do thank you.

Answer
As with all things, nothing is perfect and no one will tell you that there is a 100% chance that nothing will happen but it is more likely 99.999%. The problem is that the only cases that get reported are those that have a bad outcome, so that is what people remember. It is like air travel. People are afraid because they read about a crash but it is safer to fly than any other form of transportation. As for the person you read about, she likely had malignant hyperthermia (MH) which is an extremely rare complication caused by a genetic mutation. The test you are talking about is a muscle biopsy which is painful, expensive and difficult to perform. The reason it is not done on everyone is that the disease is so rare. If you had a family history of MH, then they would do the test. As for a spinal, you would not get a level high enough to be pain free because retraction on the diaphragm causes pain in the shoulder so you would need to cover pain that high. To do that would make it difficult for you to breathe. As for acupuncture, they say in China it works but I am not so sure about how well. Oriental people tend to be more stoic about pain and I can't believe they are completely pain-free. Regardless, there is not much experience with that here because most anesthesiologists don't know acupuncture and most acupuncturists can't work in an OR. As for being safer, I think the opposite is true. If the acupuncture doesn't work, now you have to emergently put the patient to sleep.

With respect to your candida problem, that will be an issue for the surgeon so it should be treated ASAP but as for being healthy enough for surgery, we routinely perform surgery on people who are extremely sick and they do well. That is our one and only job.

I hope this allays your fears,

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston