Expert: Dr Ian Jackson - please note UK based - 9/17/2010

Question
I'm intrigued by my patient's report that following TKR surgery recently under general anaesthetic, she immediately felt no cravings for cigarettes. She has been a heavy smoker for 60 years, and can easily tolerate being in the company of smokers without any temptation. She has suffered no withdrawal symptoms. She also reports feeling nauseated by the smell of coffee, which she previously enjoyed regularly. The lady is quite delighted, but mystified. I would be interested to hear your comments on this. Regards, Julie. (Physiotherapy Assistant Practitioner)  

Answer
Hi Julie
This is not a common occurrence but it does happen. Unfortunately there is still much that we don't understand about anaesthesia and the bodies stress response to surgery.
Sometimes I feel that issues around general anaesthesia are perhaps not discussed in sufficient detail with more elderly patients. For example we know that around 10% of those over 60 will have a long lasting change in their cognitive function following anaesthesia - latest theory is that there is something in their genetic makeup that makes them susceptible. It appears in your lady this 'alteration in function' has affected the part of her brain that was responsible for her nicotine addiction.
I suspect the mechanism for your lady is as I describe but acknowledge that I cannot be certain.
I hope this helps.
Dr Ian Jackson