Expert: Arjav Shah, M.D. - 12/23/2011

Question
Hello, even though I have been under generalanesthesia some 16 times, it has been over 11 years since my last time.  I am scheduled to have a tumor embolization procedure done and the radiologist doing it insists on using general anesthesia instead of a local and light sedation.

I am obviously upset at this as I do not like the whole anesthesia thing at all.  I do not respond well to Versed or the anesthesia itself, It takes me a very long time to come fully out of anesthesia and am often grogy for some time afterwards.  I also do not want to be on a foley catheter or be intubated, nor do I want to be an inpatient just because of the effects of the drugs.  There is also the problem that the doctor is going to want to go back 3-5 times as he does not want to occlude too many healthy vessels.

As this is for a benign tumor condition I just feel the added risk (and cost) of having to go to the OR instead of the cathlab is too much.  My doctor says though the procedure is very painful and even heavy sedation would not work.

Are my fears unfounded?
Is embolizing a tumor of the jaw painful or does the pain come some hours later as tumor necrosis sets in?

I know the cath procedure itself is extremely safe as I am young, not overweight and have no heart or vascular problems to speak of.

Answer
Your fears are very understandable. Coil embolization procedures can take hours and when it is for tumors--benign or malignant-they can be very uncomfortable.

Likewise, undergoing general anesthesia is also a big deal. But given the nature of and potential duration of your procedure, general is the safer bet. There are couple of reasons I believe that to be the case. 1. Pain-If local anesthesia is not administered, as is probably the case in your embolization, standard intravenous sedation will be inadequate to keep you comfortable. It would require substantial amounts of IV medication, so much that your breathing and blood pressure might become impaired. The recovery time would also be prolonged. 2. Movement-embolization is very precise, and requires minimal patient movement. While a sedated patient may be "asleep" and unaware of the procedure, squirming may be a problem, and a sedated patient may not adequately follow the physicians' instructions to hold still.

General anesthesia will minimize these two problems. Also, you will have a second physician--an anesthesiologist--present, whose only focus will be on your comfort and safety. That allows the interventional radiologist to focus on the embolization. There are a variety of general anesthetic medications that can be tailored to your desire for less of a hangover and a quick recovery.

While I am not qualified to specifically address the differences in cost between an operating room and a radiology suite, I do firmly believe that general anesthesia can be done safely and potentially shorten the duration that you are on the radiology table.

It is so important that you discuss these very valid concerns with your anesthesiologist before you undergo your procedure.