AboutRonald Levy, M.D. Expertise Associate Professor of Anesthesiology, University of Texas Medical Branch at Galveston. I am a board certified anesthesiologist who can answer all questions related to any type of Anesthesia with the exception of Pain Management.
Expert: Ronald Levy, M.D. Date: 7/4/2008 Subject: anesthesia options for BPH surgery
Question QUESTION: For years I have had BPH; the drugs no longer help and it's now time for surgery. I'm 54 and in good health except fo the BPH which means trips to the bathroom ever 2 hours or so at night...I saw 2 urologists, one recommended the old TURP procedure and the other doc recommended the newer laser PVP procerure (I guess since she's a younger urologist)..The 2 urologists even talked to each othr and the consensus was that I needed the procedure and that they used general or spinal anesthesia (which is a bad idea for me since I have had extensive back surgery)..My question is: lacking the spinal/epidural option, is there anyway that I can avoid a general anesthetic? The urologists didn't know and the hospital anesthesia epartment won't answer questions until the morning of the procedure (seems like a really bad idea). They both said that the procedure would likely take 30-45 minutes; I'm willing to take the pain, but if it's anything like the cystoscopy that I had 10 years ago, I'll probably pass out anyway..It hurt a lot, but if thats what I have to do, I will. Thanks for reading this long message.
ANSWER: There is no way to do this procedure without anesthesia. If spinal is not an option, then general is the way to go. There is nothing wrong with general and for this short procedure, it seems reasonable. Many people are scared of general anesthesia but it is EXTREMELY safe. If you have no other medical problems, go for the general and enjoy the nap.
Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston
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QUESTION: Thanks for the reply; one more question, if I may. My problem with general anesthesia was from the sevoflurane (hours of PONV as well as the nasty smell and feeling of suffocating)...I have had propofol and fentanyl befoer without problems; would it be reasonable to request a general with just these 2 agents? Thanks again, I feel comfortable with the general anesthetic after reading your comment.
ANSWER: While it is possible to do the entire anesthetic with injected agent (called a TIVA or Total IntraVenous Anesthetic) I would not recommend it because it will likely delay your discharge. Again, if Sevoflurane was the problem, there are other inhaled anesthetics (besides, it was probably not the Sevo but rather Nitrous Oxide or the narcotics that gave your the PONV).
Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston
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QUESTION: I have had anesthesia with propofol/fentanyl with no problem and the next time they added sevo and I really got sick...Never had nitrous, did get 4ml fentanyl when I had my dislocated shoulder popped back in last year with no nausea/vomiting....so I'm thinking that the inhalation drug was the culprit. Last question, I promise: other than prolonging my discharge (no problem), is there any other disadvantage to TIVA with just propofol/fentanyl? The surgeon doesn't know or care and says "pick your own poison" and the anesthesia prople won't answer questions other than to say that they will "do it their own way"....The surgeon says to specify on the consent "TIVA with propofol/fentanyl-no other anesthesia drugs" since i was promised this last time , but they addded sevo anyway..and blamed it on "poor communications"...is this a erasonable way to proceed? Thanks for answering; I'm not getting much help on this end; your advice is invaluable.
Answer I would not tie the hands of the anesthesiologists by saying TIVA only. This severely limits what they can do and is not in your best interests. Again, the likely cause of the nausea was probably the Nitrous oxide but even if it was Sevo, they could use Isoflurane or Desflurane instead. There are also drugs they can give you for to reduce the risk of PONV (like Ondansatron). My suggestion to you is to talk to the anesthesiologist on the morning of surgery and tell them your concerns and what happened previously and see what solution they have. Our job is to make you comfortable and I am sure they will do that within the confines of what is best for you medically and hemodynamically.
Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston
