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Sunday, October 26, 2014
When anesthesia doesn`t work?
My my son was born, via a c-section, I was given 4 epidurals/spinals and they did not work. When the cheif of anesthesiolgy was called in he said this was very rare, that everywhere around the incision was numb, but the exact area. He even tried once more before putting me to sleep. When the mask was placed on my face, i counted backwards to 82. I found this out while being cut and felt it all. do you know if there is a name for this? Also when I go to the dentist I have to have multiple applications of local just for a filling. I also woke up during my tonsils being taken out at age 8, and no oe believed me. I have been trying to find an answer for this for 6 years, PLEASE help! I was also told it is genetic, I want to know so if it happens to my son or for future deliveries. Thanks I hope you can help or lead me to a place that I can find out answers.
Thanks for your question. There are genetic explanations for a lot of what we now consider puzzling in medicine. This is most likely in your case, unless there is a more mundane explanation for what you've experienced, such as inadequate dosing, drug errors, or other "technical" failures of one sort or another. Epidurals sometimes don't work, and the most common explanation is that the catheter tip isn't where it should be. In your case, the fact that "everywhere" was numb suggests it's not that local anesthetics don't work on you, but that the epidural catheter just didn't get to where it needed to be. Please keep in mind that during a cesarean section under epidural or spinal anesthesia, sensation is not completely eliminated. The nerves that carry pain sensations are supposed to be blocked, but you will still experience other forms of sensation, such as pulling, tugging and pressure on the various tissues that are being handled during the operation.
Your problems at the dentist are a bit harder to explain. My colleague Professor Phil Morgan at the University of Washington says that "resistance" to propofol and other intravenous anesthetics probably exists, but that it is hard to imagine resistance to those kinds of drugs AND local anesthetics, AND gases (inhalational anesthetics). These drugs all work in different ways, so you would have to have unusual genetic changes of more than one type. Drugs like propofol and the barbiturates work on so-called GABA receptors and there are specific receptor mutations that cause resistance in animals.
I don't know where you could go to have this problem evaluated. I think it would have to be an academic medical center in which research on the molecular mechanisms of anesthesia is being done. As part of the evaluation they would want to know whether you have any other symptoms or findings, whether you have seizures or any other neurological disorder, and what medications you are taking. To properly verify and evaluate what you are describing it might be necessary to actually give you an anesthetic, and I'm not sure you would want that. Even if you did, it might be hard to find someone willing to do this outside of a research setting.
I would advise you to keep records of all the anesthetics you've had. You are entitled to be given copies of these from the hospitals. Take them with you whenever you need anesthesia as they will be of great value to the any anesthesiologist who must come up with a plan to keep you comfortable during any future dental or surgical procedure.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University