Expert: Ronald Levy, M.D. - 11/11/2009

Question
QUESTION: I am 29 years; I underwent an operation for a breast augmentation which lasted approximately 2 hours.  It took me an hour and a half to become semi-conscious in the recovery area, and while still not fully conscious I was taken in my room until it weared off and I was back to being fully awake.  Until I was fully conscious, I remember experiencing a fast heartbeat like as if I was running about.  In fact I was given back the oxygen while back up in my hospital room.  Why is this?  I also vomited for the rest of the day, even though all they gave me was water.  Even the day after, I was still vomiting, and fainting if I woke up from bed.  The anaesthetist on visiting me the day after, he told me that if he had to put me to sleep again he would administer another type of general anaesthesia. The other type I know of, is the gas type administered by inhaling.  Therefore, am I allergic to the anesthesia administered intravenously?  Would inhaling anaesthetic make it any better for me to not have the same bad side-effects? You see, I was still not very much reactive, and I did not ask him such questions.  Seven years ago I underwent an operation with the same general aneasthetic intravenously; the operation lasted about 2 hours as well, and I did have nothing of those nasty side-effects.  Does this means that a person could develop  an allergy to anaesthesia later on in life?

Thank you Dr. Levy.

ANSWER: You do not have an allergy. It is not uncommon to feel groggy after surgery (even a day later). As for the nausea and vomitting, it is also common but you probably had it worse than most. I think what the anesthetist was referring to was he would change you anesthetic to one that had less liklihood of causing the postoperative nausea and vomitting. I am sure that, as part of your anesthetic this time, that you had inhalational agents. This would not change things. There are other anesthetic choices that reduce the liklihood of vomitting and the best thing for you to do is if you should need surgery in the future, let the anesthesiologist know that you have bad postoperative nausea and vomitting. He will tailor the anesthetic accordingly.


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: Okay.  I thank you for your informative reply.  But how come 7 years ago I had nothing of all those nasty side-effects of post-anesthesia? Seven years ago it lasted about the same time, for 2 hours, and I was out of it very quickly.  Is this part of growing up?  This was meant to be a day sugery and I had to stay over another couple of nights at hospital because of the side-effects.  Another 2 ladies underwent the same procedure with me and they left the same day.  Since vomiting did not cease, the anesthetist also gave orders to the nurses to inject me metoclopramide (Stemetil), which definitly made me worse, as from it I also developed a rare and serious side-effect - retardive dyskinesia, where I had a crisis with upturned eyes, stiff body, and a fast heartbeat.  I really hope that I would never get myself into the same side-effects if another operation should be needed in the future.  Would you roughly mention to me the anesthetic choices that reduce the likelihood of my side-effects?  Thanks.

Answer
Tardive dyskinesia is a rare side effect of Metoclopromide (Reglan). Normally Reglan is used to increase gastric motility and has been shown to be effective in N/V from chemotherapy and postoperatively, but obviously not the best choice for you. As for why it didn't happen the first time you had surgery or the other women didn't get it could be realted to a number of issues, type of anesthesia, drug choices, etc. As for the future, when we have patients who have severe N/V we try not to use nitrous oxide, we use Propofol for the anesthetic and we give several drugs intraoperatively to treat N/V such as Reglan (not in your case), Ondansatron and/or Vistaril or Droperidol (with Ondansatron being the most popular). Your next anesthesiologist will know this but do make sure to point out your reaction to Reglan.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston