Expert: Dr Ian Jackson - please note UK based - 1/1/2011

Question
Hello,  I had a simple outpatient surgery in 2010 in the UK to remove ovarian polyps/fibroids.  Within 5hrs after the surgery i noticed all of my muscles/joints becoming increasingly stiff and sore and an intense feeling of nausea.  The day after surgery I was repeatedly vomiting (inc some blood) and was so weak, stiff and sore that I was confined to bed - unable to walk up/down the stairs or grip anything with my hands.  On the 2nd day after surgery I was able to keep down some dry toast but was still weak and stiff, and only able to get around v. slowly.  Later on the 3rd day I noticed the muscle soreness/stiffness appeared to be easing off and the nausea had passed.  This is my 5th stint of general anaesthetic since 2006 and this has happened on 4 occasions.  On the 1st two occasions I was heavily sedated in the 1st 24hrs and assumed my condition was linked to the procedure.  My concern is that if I have to have general anaesthetic again these reactive symptoms may become permanent?  Is this normal or should I challenge/be more enquiring around the type of general anaesthetic being used?

Answer
Hi Patricia
Many thanks for your email and the especially the background detail provided.
The description you provide is extremely interesting and my initial thought was that this was likely to be a side effect of the anaesthetist using a drug called suxamethonium. This does cause tremendous muscular aches and pains afterwards. However given the history of this having happened on 4 occasions this seems unlikely - as suxamethonium is seldom used these days. However this could be checked against your previous anaesthetic records.
Given the degree of muscular pain and stiffness you report I do believe that you should be more proactive about this. My feeling is that if you were one of my patients I would want to know about this issue and would wish to see you to take a history and then discuss future management of any further anaesthetics with you.
It is possible (just possible remember) that you may be experiencing a subacute muscular reaction called Malignant Hyperpyrexia (MH for short). Now some people are born with an inherited gene that makes them susceptible to this condition and when they are exposed to a 'trigger agent' (one of several anaesthetic drugs) they may develop the full blown MH. This is characterised by tremendous muscular activity at the cellular level which can be difficult to stop leading to increased body temperature, acidosis etc and is bad news. We now have a drug to treat it and so it isn't as bad as it used to be.
However we manage these people by testing them by taking a muscle biopsy to see if they have this condition. If they do then it is easy to anaesthetise them without using any of the trigger agents.
Sorry this is a long explanation!
So it is just possible you might be experiencing a subacute version of this and so if I were seeing you I would consider discussing your case with our regional MH centre to see if they advise testing. They may not think this is worthwhile but they may suggest future anaesthetics should avoid any trigger agents.
So I think it would be worthwhile being referred to your local anaesthetic department to discuss this.
I hope this helps
Kind regards
Dr Ian Jackson
ps I am happy for you to print this off to show to GP and Anaesthetist if you wish!