Expert: Ronald Levy, M.D. - 7/17/2008

Question
How do you handle a patient that is known to have bouts of autonomic dysfunction, cause not yet dx.  I have suffered from bouts of sinus tachycardia and dramatic fluctuations in blood pressure anywhere from 80/40 to 139/95.  They have been unable to determine the cause of this.  Complete cardiology workup normal other than rare PACs and sinus tach.  I need surgery for possible ovarian cancer and am terrified of being put under.  What is the safest way to go in your opinion and what questions should I have answered before being put under.

Would a block be a better option?

Thank you!
Melissa

Answer
Regional might be possible but that would be up to the surgeons and the anesthesiologist. Clearly, if you have this problem, I would suspect that they will use invasive monitors during the case the keep a closer eye on your vital signs (I assume they will use an arterial line and perhaps a central venous catheter). They may also elect to admit you to the ICU post-op for observation. On the bright side, having one of these attacks during surgery is better than having it any other time because we are constantly monitoring you and have medications at the ready to treat any spikes in blood pressure. So don't be terrified.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston