Expert: Ronald Levy, M.D. - 12/6/2009

Question
QUESTION: I have had several surgeries in the past from age 27 through age 35. Some with severe headaches and nausea, some not. but most were 1 to 2 hour procedures. i am scheduled for a 10-12 hour procedure in a week  at age 59 and would like to know how anesthesia management differs in that setting, if at all. Also what sort of precautions are taken to prevent toxicity and other side affects like long term memory loss and muscle weekness.The surgery is for cancer and immediate reconstruction. Than you.

ANSWER: First of all, if my math is correct, your last surgery was 24 years ago. We have made many advances in anesthetic management since then. Anesthetic management doesn't change much whether the case is 1 hour or 18 hours. The main problems in these cases are related to body temperature, body position and fluid managment. Toxicity is not a problem. As for memory and muscle weakness, those are more often related to surgical recovery than anesthesia and depends in large part on your preop health, age and whether your recovery is smooth or you have complications.


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston


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

QUESTION:  I had some concerns about the anesthetic medications that are used for short cases versus long cases. Don't they run into too much accumulation over a longer session leading to some sort of over dose. Does it take any longer to wake up after a 12 hour case rather than a 2 hour case? Isn't it the responsibility of the anesthesiologist to manage fluids in this situation?  

Answer
We use the same medications for short and long cases. After we put you to sleep, the remainder of the case is done under gas anesthesia with narcotics for pain management. Assumming you are otherwise healthy, any of the gases would work fine. For certain medical conditions we might choose one gas over another but it is not related to length of case. While anesthetic does accumulate in the fat and muscle over long cases (and therefore takes longer to wear off) it does not reach toxic levels. It is the job of the anesthesiologist to make sure you get the right dose of anesthetic and not an overdose. So yes it does take a little longer to wake up after a long case (most of this time is in recovery or your room). The time from the end of surgery until you wake up enough to extubate is generally about the same (the anesthesiologist times the wake up based on the exhaled concentration of the gases near the end of the case). We are responsible for fluid management thoughout the case but this has nothing to do with the levels of anesthetic in the body.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston