Expert: Ronald Levy, M.D. - 5/24/2007

Question
Thanks for taking the time to read my request.

I had my gall bladder removed 2 weeks ago by laproscopic surgery.  In recovery, I remember a little of what happened, but the person that was sitting with me filled me in on the blank spaces in my memory.  Anyway, it seems that my blood pressure was very low...the lowest (when my friend was in the room) being 55/31....and there was some trouble getting it to stabilize.  I was out of surgery at 10:30 am, but I wasn't released until sometime after 6:30 pm----that was when my blood pressure stabilized, the last reading was 102/69.  I know that the nurse had to give me something twice through my IV to try to bring my blood pressure up, and she was also rubbing me with a wet washcloth to try to wake me up....because I just could not wake up.  I have been taking blood pressure medicine (Toprol XL 25 mg) for almost a year (it was slightly high at my last physical--143/87 was the highest reading I got when I was monitoring it last year before being prescribed the Toprol).  

This was not the first time I had a reaction to anesthesia, though.  In 1981, I had a miscarriage and at the hospital a D & C was done.  I woke from surgery to find that although my mind was awake, I could not move any part of my body on my own.  I couldn't open my eyes, couldn't say a word, and couldn't even move a finger.  I know I had to be in that position only a couple of minutes, but it seemed like hours.  That was also blamed on the anesthesia.

Anyway, do you think the anesthesia was responsible for my blood pressure dropping as it did?  Should I keep a log or something about the type of reactions I have in case I have to have further surgeries (I hope not)?  Can you tell me if it could have been something else?

Answer
One case at a time... Why was your friend with you in the OR...This normally not allowed? Was he just relaying a story he was told or was he actually there? As for the blood pressure, the anesthesia was likely the cause but not because you are allergic. Anesthesia is an art, not a science. The combination of your underlying physiology, amount of surgical stimulation and the effects of your Toprol (plus the anesthesia) all contributed to the hypotension. Hypotension is very common in the OR and as long as it doesn't last long, it is not a problem. Yours doesn't seem to have lasted very long so I would not worry about it. With regard to the previous surgery, it sounds like you had residual muscle paralysis from the surgery. Again this is not an allergy but probably inadequate reversal of paralysis. Normally we keep patients asleep until we are sure the paralysis wears off. In you case it sounds like they let you wake up too soon.

You do not need to keep a log but if you should ever need surgery in the future, you should certainly mention these events to the anesthesiologist.

Good Luck,

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston