Expert: Ronald Levy, M.D. - 11/9/2009

Question
Greatly appreciate your expertise and advice!

I had reconstructive ligament surgery of my ankle last year..was to be in hospital as out patient--stayed in 4 days--had the WORST HEADACHE OF MY LIFE %26 Terrible nausea. I had no issues or pain at all--it was either the pain pump or the anesthesia--and I was miserable and swore, never again to have surgery.

However, I am scheduled and looking forward to RNY-Laproscopic gastric bypass surgery--my surgery is in a couple of days and I meet with my Anesthesiologist on Thursday--I've researched and heard about asking for Tiva, an intravenous anesthesia vs. gas? I'm not sure what I'm talking about and would love some professional input on your part to help with my peace of mind.

I'm 43 in excellent health, except for obesity (270lbs).
Thanks!
Sherri

Answer
What kind of anesthesia did you have for your ankle? Was it general or regional? If it was regional (e.g. a spinal) you might have had a spinal headache. As for the gastric bypass procedure, It will need to be done under general anesthesia. TIVA is just one of several ways to give anesthesia but it will not necessarily lessen the nausea. If you tell your anesthesiologist that you had bad nausea and vomitting with your last procedure, he can tailor this anesthetic to reduce the liklihood of it happening again. That might include giving you Zofran (an anti-nauseant), not giving you nitrous oxide (but you can still get other gases), giving you Propfol and reducing the amount of narcotics you receive. There are numerous options and combinations that your anesthesiologist can explain to you when he sees you preop.

Good Luck,

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston