Expert: Ronald Levy, M.D. - 7/12/2010

Question
QUESTION: I am contemplating having outpatient surgery to repair a blocked tear duct.  This procedure requires general anesthesia, which I have never experienced.  My surgeon would be an oculo-plastic specialist with impeccable credentials.  My question involves how much input I would have regarding the anesthesiologist.  Is it appropriate (and within my rights) to demand a doctor who is experienced and board-certified (and hopefully without an addiction problem)?  Is it appropriate for me to inquire in advance about the drugs/methods to be used (or do I have to wait until after the procedure to get this information)?  Will my only option be to cancel the surgery if I learn that day that my anesthesiologist is neither board-certified nor experienced?  Obviously, I am very anxious about this aspect of my surgery.  I am a 63-year-old female with no major health problems.

ANSWER: It is certainly within your rights to request an anesthesiologist. Depending on the type of practice, you may or may not be successful getiing that anesthesiologist but remember that most anesthesiologists are qualified and more than capable of doing your anesthetic (particularly since you are otherwise healthy and the procedure is relatively minor). You merntion addiction problem. While addiction in anesthesiologists is higher than other specialties, it is still extremely rare, so it is not something you should worry about. As for board certification, this does not guarantee a better anesthesiologist. As for drugs and anesthesia type, you are certainly welcome to ask the anesthesiologist when you see him preoperatively. They will be happy to explain to you. I would not consider cancelling your case as this will not help your situation. Most people are more afraid of the anesthesia than the surgery but in fact, anesthesia has one of the lowest morbidity and mortality rates in medicine. So don't worry.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston


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

QUESTION: Thank you very much, Dr. Levy, for your prompt response.  You're right, I'm much more worried about the anesthesia than about the surgery.  I had a bad experience with MAC anesthesia years ago.  I didn't meet the anesthesia provider until the day of my surgery, and our conversation consisted of only one question ("You healthy?")  I'm under 100 pounds, and I don't think that this was taken into account when calculating the quantity of drug(s) to be used.  I awakened to a state of extreme euphoria, as though I had just won the lottery.  This wasn't unpleasant, but I ended up tossing my post-surgery instructions into the trash before leaving the surgery center.  I dread a general anesthesia experience with someone like this.  What would you do personally to ensure the safest anesthesia experience for a family member?

Answer
As a non medical provider, the best thing you can do is talk with your surgeon and see who he recommends to do your anesthetic. If he says the whole group is competent, then be at ease. Remember, it is as important for him that you get a good anesthetic so he has a vested interest. Beyond that, I would talk with the anesthesiologist (even on the day of surgery) and make sure all my questions were answered before he left. I recently had to do that for a family member and the anesthesiologist appreciated the fact that I showed some interest. I believe most anesthesiologists will be happy to answer your questions (as long as you don't abuse the privilege).

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston