Expert: Ronald Levy, M.D. - 7/10/2008

Question
Maybe I'm making more of this than necessary, but I need to ask an anesthesia doc this question.......I was supposied to have outpatient surgery this morning and i had concerns about the anesthesia; nobody would talk to me before the procedure, so I went in 1 hr ago and tried to ask my question.  I'm just having a vertebre in my neck fused and was told that they would use general anesthesia; when I expressed concern over getting violents sick the last time that they tried to giveme "gas"....got sick at the dentist with nitrous, barfed a lot after sevofluro (sp) and they rescheduled and tried "other" iso/des or something like that...and I really, really got sick...the anesthesia doc said that she had her neck done and would NEVER get a general, just lots of narcotics and prhaps sedation in a vein, but only if she demanded it.  She extolled the advantages of being awake adn in control.   i asked for the same, the called it "complete IV anesthesia" or something like that and said Diprivon and sublimaze...well, when I wrote this on the consent, you would think that I tried to kill someone!  they went nuts and said "you can't tell us what to do"!!  Oh, I guess that I'm supposed to write them a blank check and let them give me what made me sick before?/  they even made fun of the fact that I brought my old rfecords indicating that I can't do the gasses and that the "zofren" made it much, much worse...They basically told me to get lost....it hurts so much to have this neck problem, it would be worse barfing after surgery..any suggestions?  thanks

Answer
First of all, you can't do a neck fusion awake. Whoever told you that doesn't understand what you mean. Yes you can have a TIVA which is a total intravenous anesthetic but that doesn't guarantee that you won't get nauseous and likely you might because a large part of that would be narcotics which tend to cause nausea. While I understand you have gotten nauseous with inhalewd anesthetics, we have other drugs in our arsenal (in addition to Zofran) that might help you. I agree that you should not tie their hands with how they do anesthesia but you can certainly speak with them, explain the problems you have had, and see what options they offer you.

Ronald Levy, MD
Assoicate Professor of Anesthesiology
UTMB-Galveston