Expert: Ronald Levy, M.D. - 8/16/2010

Question
Hello, I am a  49yo doc(NICU--no adults!) recently diagnosed with breast
cancer. Egg allergy since birth, I remember reacting mostly to egg white, but
not sure. So for mastectomy, they used etomidate instead of propofol, no
reaction except remember severe pain on injection (not for long). When I
needed to have my expander removed, same thing; severe pain is what I
remember, but the anesthesiologist afterward told me that I then had the
worst  myoclonus he had seen, to the point where they intubated me instead
of using the planned LMA. The morning after surgery, I felt like I had been hit
by a truck after running a marathon. After talking to the same
anesthesiologist, he said it was most likely due to the succinylcholine they had
to use because of the myoclonus from the etomidate! Yikes, that muscle pain
was way worse than the surgical pain.
I will eventually need reconstruction after the rest of my rx. Can I get "tested"
for propofol tolerance?? Inject a little and watch? I would imagine an
anesthesiologist would have to do it, or maybe an allergist? If not , what do
you think are my best options?
Thanks so much for your help, I stumbled upon this and its a great thing.


Answer
Before I would try that, there are other anesthetic options. Before Propofol, Thiopental was the standard anesthetic and it is still an excellent drug. While you may be a little more groggy after receiving it, considering that you will have a reconstruction (Which is already a long surgery), it probably won't matter much. I don't know many anesthesiologists (or allergists for that matter) who would be willing to take the risk while there are still alternatives to try.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston