Expert: Ronald Levy, M.D. - 5/14/2009

Question
QUESTION: Hello Dr. Levy.  I may be having gall bladder surgery in the next few weeks and I have a serious question.  I have been in withdrawal from Valium for the past 15 months and still have many withdrawal symptoms, especially anxiety.
I know that I can't have any benzo drugs along with whatever anesthesia is used and I am wondering if you could ease my mind and give me any information as to what anesthesia you would recommend be used so that I don't suffer any more than I am on withdrawal.  Part of my withdrawal causes rapid heart rate along with the anxiety.
In your medical opinion as an anesthesioligist, what would you suggest I ask for when I meet with the one in my local hosptal. Though I realize that person might tell me what's best for me, sitting home tonight I am terribly worried so your answer could possiblly assuage my fears.  Is there anything that could be used that wouldn't upset my sensitive CNS and Gaba situation and not cause me to fall back into deep withdrawal dispair.  I thank you so much for your reply.  Oh, as an aside, I in the past have asked for a chemotherapy drug to be used in my anesthesia that had helped me not to be nauseous after surgery.  Would that drug affect my withdrawal issues. Again Thanks for providing a service to those of us in need.

ANSWER: Your anesthesiologist will discuss with you the options but benzos are not REQUIRED for anesthesia. There are several other drugs that have sedative properties that could be used for your anxiety (Propofol comes to mind) but I am sure your anesthesiologist will be able to assuage your fears. As for the nausea, there are several drug options including Ondansatron, Droperidol. Ondansatron is probably the drug you are referring to. It should have nothing to do with your withdrawl symptoms.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

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

QUESTION: Hi, thanks for your reply.  Is Propofol any more dangerous than use of benzo's in anesthesia? I'm 61, have high cholesterol and am diabetic. I also am currently in withdrawal from taking valium at night for sleep, and have been having side effects such as racing heart at times and elevated blood pressure along with extreme anxiety like burning skin, etc. I Thank you so mucg for your reply.

ANSWER: They are two different things. Benzos are used for anxiety and sedation prior to anesthesia. They are very rarely used as the anesthetic. Propofol is used for general anesthesia but can occasionally be used as an anxiolytic and sedative. Propfol is not dangerous if used by a qualified anesthesia provider and is one of the most commonly used anesthetics today.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston


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

QUESTION: Again thanks for your reply. I looked up Propofol and the information I read is that increases or enhances GABA which is something that would be detrimental to me given that I have withdrawn from Valium.  Anything that enhances GABA would cause a problem.  I know you must hate us internet patients who look up every detail.  Anyway, curious if I am reading this correctly and if so, what other choices would be available. Reason I'm asking is I'm not due to see anesthesiologist until Monday and I'm sort of getting really upset. Is there one inhalation gas that would cause more nausea than another because that is another huge fear of mine.  Again, much thanks.  Sorry to be a nuisance.  

Answer
All anesthetics work on GABA as these are the receptors to work on sleep. There are other choices the anesthesiologist could use including Pentothal, Brevital, Etomidate, etc but they will all work on the same area. As for inhalational agents, the one most associated with nausea is Nitrous Oxide. Most anesthesiologists don't use it that much especially if you tell them you get nauseated. All inhalational agents can cause nausea but we have other drugs that prevent it. The anesthesiologist will explain all of this to you. If they only have you meet the nurse, ask to speak to an anesthesiologist.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston