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Thursday, December 18, 2014
Anesthesia after Pneumonia
How long after having pneumonia do you need to wait before receiving general anesthesia?
As is often the case in medicine, the answer to your question is "it depends!".
It depends on the urgency of the procedure for which you need general anesthesia. It depends on how well you have recovered from the pneumonia. It depends on your general state of health. It depends on the type of surgery you need to have. It depends on whether you had lung disease before you got pneumonia.
In most circumstances if you have recently had pneumonia, the ideal thing is to wait until complete recovery before having a general anesthetic. The time you need to recover will vary. Signs of recovery would be a normal temperature (no fever), no breathlessness, no cough or wheezing, a return of your white blood cell count to normal, the disappearance of any abnormal findings on your chest x-ray, and the return of a general sense of well-being including a healthy appetite. How long is that? A good rule of thumb is at least 6 weeks. Often, the chest x-ray takes longer to recover than the patient.
Here are some reasons why having a general anesthetic when you have pneumonia, or are recovering from pneumonia, is not such a good idea.
First, general anesthesia causes some of the small airways in the lungs to close, and this effect may be more pronounced, and less easy to reverse, if you've just had pneumonia. The closure of small airways means that the lungs are less efficient in picking up oxygen to supply to your body. In normal lungs the effects disappear within a few hours. If your lungs have been infected (pneumonia) this recovery process may not happen, and in fact you may get quite sick. If you are having surgery on your abdomen, or on the lungs themselves, the risk is much higher.
Second, pneumonia or other types of lung infection may make the airways more irritable and prone to spasm, a bit like an acute asthma attack.
Third, after pneumonia, the cells lining the air passages don't work so well doing their job of protecting the lungs, which involves whisking particles and bacteria out, killing bacteria with white blood cells, and so on.
Pneumonia can sometimes be a very serious, even deadly illness. If you have had a very bad attack of pneumonia and were hospitalized or even on a ventilator, this is a very different situation than someone who had 'walking pneumonia' and had to miss a day or two of work.
If your general state of health is excellent, and the surgery is very important or urgent, for example cancer surgery, it might be okay to have the general anesthetic sooner than 6 weeks after the episode of pneumonia. On the other hand, even if you've waited 6 weeks and all the symptoms and signs of your pneumonia have disappeared there may be some increased risk of lung problems with a general anesthetic.
The most important thing is to consult your regular doctor(s) and your anesthesiologist before the surgery to discuss your specific circumstances and problems, and to be properly examined and appropriately tested (for example a chest x-ray and a measurement of your blood oxygen saturation). There is no easy answer to your question, but good medical judgment and care will help you through, hopefully without complications.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University