Expert: Ronald Levy, M.D. - 8/28/2007

Question
QUESTION: Dear Dr. Levy,

I've been on Nardil (MAO Inhibitor) for several years, and will need to have some corrective surgery in the near future that could require several hours of anesthesia.  I cannot stop taking the Nardil because of the severe depression that would occur.  Twelve years ago, I had elective surgery which lasted 8 hours while on Nardil with no problems, as a special type of anesthesia was used.  Unfortunately though, this surgery left me with some scar tissue and a pocket of inflammatory fluid in the left hip (as shown in an MRI scan that was done recently).  My doctor believes that this is the cause of the chronic pain I've been having, which has recently become more acute, esp. when walking.  He also believes that it needs to be corrected surgically.  I can't contact the anesthesiologist to ask him for the list of chemicals he used, as the doctor who performed the initial surgery has passed away.  I would appreciate it if you could inform me where I could find this information, or if you would share with me any data that you have on this subject, so that I could present it to the doctor I will be seeing for my corrective surgery.  Thank you in advance.

ANSWER: Any anesthesiologist can give you an anesthetic that will be safe while on Nardil. Also depending on the type of surgery, it may be possible to use a regional technique and avoid general altogether. I don't want to give you a specific anesthetic regimen as there are many equally good approaches so your anesthesiologist will be the best to tell you what s/he plans to do. You should definitely meet your anesthesiologist several days before surgery so they can discuss the options with you.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: Hi Dr. Levy,

My problem though is getting through to the doctor who will be performing the surgery.  It's a kind of a Catch-22 situation.  They fear handling your case because of the risks MAOI's and anesthesia pose, so they tend to refuse to perform the surgery right off the bat.  It's already happened to me once in the past month.  I found a new doctor and fear that the same thing might happen, and since the initial operation was plastic surgery, it costs me $100 for each consultation -- since insurance doesn't cover corrective plastic surgery. So how can I get to the anesthesiologist to discuss a safe method of anesthesia unless I can get the surgeon to take my case in the first place; by showing him/her that there are relatively safe ways to do it? Thanks.

Answer
My first suggestion would be to go to a University hospital setting where the surgeons and anesthesiologists are used to these and other complex cases. No information I give the surgeon will change wheter they will do the procedure but a teaching hospital is more likely to accept your case than a private doc working in a "fashion" plastic surgery center.


Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston