Expert: Ronald Levy, M.D. - 8/21/2008

Question
Dear Doctor,

There's a lot of literature out there about PTSD occurring after awareness during general anesthesia, but I am searching for some different info on the same topic. I have PTSD due to some very traumatic experiences in my life involving my medical care. Those experiences have included the forced use of sedating or general anesthetic agents on me against my will (too long to explain here, but very real). Since that time, I have vowed I would never let that happen again. I have had a number of surgeries using local or regional anesthesia (no sedation) but now face more serious surgical needs--which appear to need general anesthesia.

As much as I'd like to feel better physically, there's no way I will permit general anesthesia unless it's a dire emergency. The thought of even trying to schedule a surgery with this anesthesia sends me into a continuous freak-out (I mean continous--it goes practically nonstop). No counseling or calming med has helped me so far. My medical history is very complicated and my surgery on indefinite hold.

What do anesthesiologists do for patients like myself with PTSD of this kind? Is there literature on this topic I can read about? I would like to understand my situation a little more. I also wonder, is there such thing as being psychologically unfit for any surgery? I feel I cannot even discuss this matter with anesthesiologists because I'd be turned away. Your feedback is appreciated. Thank you!

Answer
I think the key here is that your previous encounter with anesthesia was FORCED. In this case, it is voluntary. The job of the anesthesiologist is to make your surgery as PLEASANT as possible, without pain and (sometimes more important) without memory of the time in the OR. You should not neglect your surgical needs because of this fear because it may eventually lead to the need for surgery emergently (which is more liked forced anesthesia although no one will actually force you). There is no such thing as pshologically unfit for surgery but we certainly do deal with patients who are afraid of anesthesia. Having had anesthesia for what would have otherwise been a very painful dental procedure, I can tell you that I remember nothing and woke up from a very peaceful sleep. If you think of it in those terms, it may help you. I don't know of any specific articles on PTSD as relates to anesthesia so I can't help you there.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston