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Thursday, August 21, 2014
Longterm effects of general anesthesia?
I have been under general anesthesia 3 times in my forty years: once for tonsils, as a child (8 years old); once for a tooth extraction at 9 years old; and at the age of 29 for wisdom teeth extraction. I never worried about it: it was no big deal and, fortunately, everything went fine. I seem to become a "chicken" the older I get! A friend, quite a smart person, told me that general anesthesia is a.) cumulative in one`s body/brain, and b.) can cause all kinds of problems, such as memory loss and mental impairment!!! I know that this sounds silly. It sounds ridiculous. But I am supposed to have an elective procedure (uterine polyp removal...not medically necessary at all) that I would really like to have done. If it were necessary, I`d say, "Go ahead," and not care. Since it`s a bit elective, her words scared me a bit. Not a lot, just a bit. I guess I just would rather limit the times I have to use gen. anesth. Is there any truth to this? I know it sounds ridiculous, but I`m glad to have this anonymous forum on which to ask! Thank you.
Great question! And not ridiculous at all. I think that fears of this sort, though not uncommon, arise in societies where so many other, more critical threats to existence, have been neutralized! You are perhaps one of the fortunate ones living in a place where such fears take the place of concerns about war, famine or pestilence!
To answer your question most directly and honestly, we don't have all the data we need to say conclusively that there are no long term effects of general anesthesia in young (that includes you!) healthy individuals. We do have the experience of many hundreds of millions of anesthetics conducted around the world over more than 150 years that do not seem to have caused obvious brain damage in those individuals. Doesn't that reassure you just a little bit?!
Anesthesia really is one of the greatest scientific advances of mankind. Anesthetic drugs, with a few exceptions, (the drug pentothal is one) are not chemically detectable in the body more than a few hours or days after administration. So to say they accumulate, in the traditional sense of being measurable, is not correct. On the other hand, to state that general anesthetics are cumulative invites a deeper analysis. In a sense everything we take into our body, whether it is food, air or drugs is cumulative. The body takes these substances and alters them through digestion, metabolism and other chemical processes. Certain constituents of those substances then become part of us! And what about the effects of the multitude of chemicals in our environment that we are breathing in or ingesting or even absorbing through our skins each day? Your exposure over a lifetime to these mostly poorly studied chemicals seems to be much more likely to result in some sort of long term effect than general anesthesia for less than an hour!
There is a little bit of evidence, although controversial, that some elderly patients have memory and thinking deficits that last more than a few days after anesthesia, up to several months. There is even one study suggesting that patients who had a low measurement on a brain monitor during general anesthesia, indicating they were deeply asleep, had a higher mortality than patients with a higher number. But this is difficult data to interpret. The problem sorting all of this out is that anesthesia is accompanied by the stress of surgery and it's not easy to separate the effects of the two. Is is the stress of surgery and the body's response to tissue injury that causes its own problems, or is it the anesthesia, of one sort or another, that causes difficulties? If its anesthesia then is it an all or none effect or is it dose-related?
If you are really concerned about the general anesthetic then keep in mind there are alternatives. Firstly, you can have deep sedation rather than general anesthesia, thus limiting the amount of medicine you are given. The sedation can be accompanied by a paracervical block given by your surgeon - ask him/her about this. Secondly, unless you really are a "chicken" you could opt for a regional anesthetic - that is a spinal or epidural anesthetic - without being given any sedative or anesthetic drugs at all. You would need to discuss these options with your anesthesiologist and surgeon. Finally, I wonder whether you have understood your surgeon correctly. "Elective" does not usually mean that you could have the surgery or not have it. It means that the surgery is not urgent. If there is a uterine polyp it probably needs to come out. Again, check with your surgeon!
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University