Expert: Mike MacKinnon MSN CRNA - 12/16/2011

Question
Hello Mike, I am scheduled to have a Total Knee Replacement on the 27th of Dec. I'm 31 yrs old with a hx of having seizures ONLY when I have General Anesthesia. I had a MVA in 05' damaging the cartilage in my Rt knee so I have had a total of 9 surgeries to repair it 7 were spinal while 2 were under GA. When I have a spinal done I have no complications, when I have the GA I have the seizures. The plan for my upcoming surgery is spinal, however the Anesthesiologist fear is that if it does not take they do not have a back up plan, my Neurologist suggest that I receive IV Dilantin at the time of surgery (the present one on the 27th), however the Joint hospital is not comfortable with that. I am having a hard time persuading them that following my Neurologist orders I will be fine, as I have never had complications esp. if it is done under a Spinal. I work as an RN in the ICU, I do not want to hurt myself, but I do understand the risk associated with this surgery and my hx, but I have waited 5 yrs to have a total knee which should have been performed from the start, how can I convince this team?

Answer
Hi Leah and thanks for the question!

What alot to go through! I can understand the concern of the Anesthesiologist when it comes to a spinal not working or wearing off too early. However there are are many local anesthetic choices for spinal injection which are long acting such as tetracaine and additives like epinephrine which can prolong it and duramorph which add further pain relief. I am sure he/she would know this. Also spinals are generally not a difficult skill so placing the spinal, which has been done many times for you, should not be a concern.

I am not sure why they do not want you to have dilantin preoperatively. It sounds to me like the backup plan is general and preemptive dilantin. It may be that the hospital you are going to is a specialty one which does not utilize dilantin? Either way, for you this would be a reasonable plan.

So at this point It lies with you (and your neurologist) to decide if it is worth the risk to do with surgery without preloading dilantin.

Sorry I could not help more.

Mike