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Tuesday, July 29, 2014
Anesthesia for 35 to 40 surgeries in one year
My nephew was burned 70% of his body (third degree) two years ago this Christmas. He was kept in a medically induced coma for 7 weeks. He underwent approximately 35 surgeries in two years for skin grafting and muscle flaps. At the time of the accident he was 28 years old. His last surgery was May 2006. He needs to have another surgery in February 2007. Most of his surgeries were for between 6 and 8 hours at a time and at least one was for 14 hours (the muscle flap). He is still on pain medication and will probably remain so for at least 6 more months. We have noticed huge changes in his personality. I realize that such a severe accident would cause personality changes and mood swings but am concerned about the amount of anesthesia that has been used to sedate him for the many surgeries. He has huge memory gaps and his short term memory is almost non-existent. He gets very tired and he falls asleep even while eating. I am wondering if there could be any neurological problems associated with all of the anesthesia he was given and for the length of time he was kept sedated. Since he must have more surgery in the future should he first be checked by a neurologist to see if there is any brain damage and would a neurologist be able to check for effects of long use anesthesia?
Wow. Your nephew has been through an incredibly traumatic time. There are very few people who have survived 70% full thickness burns. It is not at all surprising that he has problems with fatigue, memory gaps, and changes in personality. To focus on the anesthesia as a cause of his problems is I think a mistake. Without skilled anesthesiologists your nephew would probably not be around.
Does repeated general anesthesia (for surgical procedures) have direct effects on the brain? Well, it is not possible to rule that out entirely. We are learning more and more about the subtle effects of anesthetic agents on brain cells, immunity and various molecular pathways. There may in fact be some effects that persist beyond the time that the drugs themselves are gone from the body. Whatever effects do occur seem more likely to happen in the elderly patient.
As far as the prolonged sedation in the ICU is concerned, the effects of this approach are also increasingly recognized as having some potential harm. When heavy sedation is used, current guidelines recommend turning off the sedation periodically - at least once per day. This may not always be possible - there are good reasons for using the sedation - and a patient as severely, critically ill, as your nephew may be just such a case.
A neurologist would certainly be able to assess your nephew for brain damage through various means, including a simple physical examination, and to what degree he is impaired. However, this will probably not have any impact on the need for, or type of, anesthesia selected for any future surgical procedures. Such an assessment may be useful for other reasons such as helping your nephew regain abilities to function in normal life.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University