Expert: Ronald Levy, M.D. - 12/15/2007

Question
QUESTION: Hello,

I am due to have surgery in the next week and I have a few questions.  I met with the anesthesia clinic and went over my medical history and to discuss my concerns, and they were great, however, I am still apprehensive about the surgery.  I will be undergoing a repair of my scaphoid ligament which is torn and a scaphoid bone fracture with pins.  I am hesitant because of previous reactions following surgery in which I had seizures and/or became extremely combative with the staff, the exact opposite of how I am normally !  I know I am combative post seizure, but even when I have not had this complication, I've fought with them pretty hard.  I do know the procedure is scheduled for a block with general anesthetic.  The anesthesia people made light of my seizure history and didn't seem too concerned.  Said they would just deal with it if it happened which I know is true, but I want to know what preventions can be taken to reduce this risk.  Also, is there anything I can do to keep me from fighting the staff so badly?  It is scheduled outpatient (which I prefer when possible) and I have been through multiple surgeries, so anxiety is not a huge issue (though anyone would be nervous about undergoing surgery).  Any advice regarding prevention would be appreciated as well as if there is a good reason to prefer general over regional anesthetic.  Also, how long does it take for a regional block to wear off?  Thank you for your answers.

ANSWER: First of all, it might be possible to do the whole procedure under regional (which would eliminate the combativeness from waking up). I would also doubt you had "seizures" unless you normally have seizures (e.g. from epilepsy). If that were the case, you should be on meds for that. The length of time a regional lasts is dependent on what they use for the block, but in general it should wear of between 1 and 3 hours after surgery.

Ronald Levy, MD
Associate Professor of Anesthesiology
ITMB-Galveston

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

QUESTION: I do have a significant true seizure history (left frontotemporal lobe epilepsy), with a frequency of about once a month despite being on meds.  The post surgery seizures I have experienced were verified with EEG, so no question as to their validity.  I have been told that many anesthestic agents provide a good amount of protection especially propofol(diprivan).  Is there any other steps I can take to reduce my risk besides a regional as I really do not care to be aware of things in the OR.

Answer
Many of the agent we use have anti-seizure properties so I am sure your anesthesiologist will use some of these meds (assuming there are no other contraindications). There is nothing you can do other than take the meds your doctors have prescribed.

Good Luck,

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston