Expert: JM Starkman, MD - 7/3/2009

Question
At the age of 13, I had routine oral surgery after which I was violently ill, and suffered from vertigo and nausea for 48 hours or so.

Later in life I had a gallbladder removal, and an abdominal exploration for a possible intussusception, with the same post-op vertigo and vomiting.

Ten years ago, I had a laparoscopy under general anesthesia, and not only had the usual vertigo and vomiting post-op, but this time it lasted for three days.

Three years ago I had a shoulder arthroscopy under general anesthesia with the same routine.  However, when I awoke, I was informed that the surgery staff had been attempting me to wake up for three hours, when I should have been out of anesthesia 20 minutes post-op.  They explained they had trouble regulating my blood pressure, and so many capillaries in my eyes had blown, the whites of my eyes were blood red.

I have just scheduled a ventral hernia repair the end of next month, and I am terrified.  I know they will need to put me under general anesthesia, and as it seems that my reaction to anesthesia worsens with every surgery, I'm afraid I won't wake up at all this time.

I am a slightly overweight 40-year old woman with historically excellent blood pressure and no other health issues.

I have talked to doctors and anesthesiologists about these issues, but none of them seem to show much interest, or as much concern as I do.

What measures should I take to ensure a minimal reaction to future anesthetic events, especially the one coming up in a month?  I have two children under the age of two, and I don't want to leave them orphans, but I know I can't live forever with a hernia either.

Thanks in advance for any feedback.

Answer
You sound like you are what is known s a "slow acetylator" (google that one!).  

Too bad you have a bunch of doctors who are not willing to look more carefully at your history and adjust the anesthetic to minimize the complications you describe.  A ventral hernia is not an urgent matter unless it is at risk for incarceration/strangulation.  So, my best advice would be to search out an anesthesiologist who IS amenable to working with you to meet your needs...then let him recommend a surgeon he works with who he knows can fix your hernia.

I'd guess that an epidural anesthetic with an absolute minimal amount of sedation would be best given your history.  Another option is P-K about which many anesthesiologists are not even aware (http://drfriedberg.com/about-pk.html).

Anesthesiologists are not used to being approached directly by potential patients, so you might want to be prepared for some strange looks.  Seek us out by calling or visiting hospitals or free standing surgery centers who are willing to make appointments for you with their anesthesiologist to discuss your needs and requests.  It would be helpful to them to bring copies of your previous anesthesia records with you such that they might review the possible causes or risk factors of your complications.