Expert: Ronald Levy, M.D. - 10/2/2009

Question
My mother is a 67 year old with post-concussive syndrome from a car wreck several years ago who when she turns her head parallel to her shoulders had a pulling sensation of blacking out, she has not blacked out this way in 2 years and avoids these movements.  She is a diabetic taking lantis and her arterial Doppler, CT scan and mri's are clear.  Could she be at risk of stroke undergoing general anesthesia?  Also they mentioned a type of anesthesia where she would breathe on her own with IV sedation as an alternative, is that twilight? What are the risks with this? She had  this twilight 2 years ago and felt funny but  was ok for an endoscopy.

Answer
I cannot explain the blacking out but it has little to do with how she will respond to general anesthesia. She is likely at increased risk for stroke (in general) but noto related to anesthesia. As far as the alternative anesthetic, there are a variety of possibilities but it depends on what type of procedure. For simple procedures (mass excisions, endoscopies, angiograms) sedation will work fine, but for larger procedures it will be ineffective.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston