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The dangers of anesthesia

Are You
At Risk?
Sarah Wassner Flynn

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General anesthesia works to knock you out and escape pain during oral surgery, elective surgery and other complicated surgical procedures. But in rare cases, it can also bring about serious, even fatal complications. Are you at risk for complications related to anesthesia?

Female Patient
By most accounts, 18-year-old Stephanie Kuleba, a sunny blonde with a beaming smile and bubbly personality, was perfect. But it was physical imperfections – symmetrical breasts and an inverted nipple – that brought her to a Florida plastic surgeon’s office for a routine augmentation procedure and ultimately cost her her young, promising life. A standard pre-surgery dose of general anesthesia reportedly triggered malignant hyperthermia in Kuleba’s body, sending her heart racing and body temperature rising so rapidly she died about 24 hours after the procedure.

Serious complications from general anesthesia are extremely rare: Malignant hyperthermia effects about one in 10,000 to one in 30,000 patients and far fewer – about five in one million – will die. But even one is too many.

More common are side effects like nausea, dizziness and muscle aches, which are much less dangerous and easily managed. Still, they do happen. If you have surgery coming up and are worried about going under, take these steps to avoid an adverse reaction to anesthesia. anesthesiologist

BE HONEST WITH YOUR ANESTHESIOLOGIST

Prior to your surgery, an anesthesiologist will go over your medical and personal history with you. You will be asked about everything from your allergies to any loose teeth you may have. Though the questions may seem invasive and unrelated to your procedure, they are being asked to get an in-depth health history to make sure your dose of anesthesia is appropriate and, more important, safe. If you leave out details, such as certain medications you are taking or that you are a heavy drinker, you could receive the wrong amount of anesthesia, putting yourself in danger.

CHECK YOUR FAMILY HISTORY

Do you have a mom, dad, uncle or aunt who is allergic to anesthesia? Let your surgeon, nurse and anesthesiologist know right away. Any family history of unexpected complications related to anesthesia may point to potential problems you can avoid if your family’s medical history is known. If you are not sure about your history, make it a point to ask your family members and find out if any relatives have experienced problems in the past – it could save your life. And, at the very least, it can better ensure your surgical procedure is as comfortable as possible.

FOLLOW YOUR DOCTOR’S ORDERS

When it comes to what to do prior to your procedure, follow your doctor’s orders carefully. Especially if you are told to stop eating at a certain time the day before surgery. Going under anesthesia with any food in your stomach can cause complications like aspiration pneumonia, a condition in which you vomit up food and then breathe it into your lungs. If you happen to not follow your doctor’s recomendations, inform the surgical staff immediately – your surgery may need to be postponed or cancelled.

Still worried? While general anesthesia is usually necessary, there may be other ways to approach your surgery. Talk to your anesthesiologist or surgeon about potential alternatives to anesthesia.

For more information on the safety of anesthesia, visit these links:

Anesthesia Patient Safety Foundation

Cosmetic surgery pros, cons and risk factors

Sarah Wassner Flynn is a New York City-based writer. She's contributed to magazines such as CosmoGIRL!, National Geographic Kids, Runner's World, Women's Health, Prevention, and MetroSports New York. Her book, The Book of Happy Things, is slated for a June 2008 release.
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Comments
By martina Jan 12, 2010

im about to get all 4 wisdom teeth taken out and im going under. im really nervous and scared about it. can it cause my heart to stop and if so do dental personel have the equipment to bring me back just in case?? im nervous and scared.

By barry l friedberg md Jun 30, 2008

She wasn’t as famous as Olivia Goldsmith, author of The First Wives Club, but Stephanie Kubela’s death was just as avoidable, says Dr. Barry Friedberg, a globally recognized leader in cosmetic surgery anesthesia. Complications from rare genetic disorder, malignant hyperthermia (MH), appear to be the cause of the Florida teenager’s needless death. Triggering agents for MH are inhaled general anesthetic (GA) agents (i.e. halothane, desflurane and sevoflurane) and the muscle relaxant, succinycholine (SCH), used to intubate the airway. GA is the predominant choice of anesthesia cosmetic surgery, so her surgeon was within the ‘standard of practice’ in that choice â€" expedience over outcomes. Unfortunately, GA or the ‘standard of practice’ includes many unnecessary, avoidable and potentially fatal risks to patients choosing to have surgery that has no medical reason or indication. Among those avoidable risks are MH, blood clots to the lungs, airway mishaps leading to lack of oxygen to the patient’s brain, postoperative nausea and vomiting (PONV), and postoperative cognitive disorder (POCD). All of these risks can and should be avoided by having surgeons and patients choose a kinder, gentler anesthetic technique â€" propofol ketamine or minimally invasive anesthesia (MIA)® pioneered by Friedberg. Neither propofol nor ketamine are triggering agents for MH. Had Ms. Kubela received MIA, she would likely be alive today. BIS monitoring of the patient’s brain gives a numerical value of propofol sedation at which ketamine can be given without negative side effects. In 2005, The Doctors’ Company (TDC) Newsletter extolled the safety of propofol ketamine over general anesthesia for prevention of blood clots to the lungs. TDC is a medical malpractice carrier with a high percentage of plastic surgeons as insured. No airway mishaps have been reported with MIA. With minimal trespass, patients tend to breathe normally and require little assistance or intervention to keep their airways open. No lack-of-oxygen accidents have been reported with MIA. MIA has the lowest published rate of PONV, highly desirable, especially for facelift and tummy tuck patients. Sometimes MIA is called ‘Goldilocks’ anesthesia. BIS monitoring eliminates the common anesthesia practice of giving too much for fear of giving too little. The opportunity for POCD is thereby greatly minimized. More anesthesia providers are recognizing the advantages of MIA. Both surgeons and anesthesia providers need to be asked to provide it to optimize patient safety for cosmetic surgery. Barry L. Friedberg, M.D. has been in active practice exclusively in office-based anesthesia for cosmetic surgery since 1992. He has published 30 letters to the editor, 14 articles and 6 book chapters including 3 in Anesthesia in Cosmetic Surgery recently published by Cambridge University Press. More information can be found @ www.cosmeticsurgeryanesthesia, a patient oriented, non-commercial web site. Disclaimer: Dr. Friedberg is not employed by Aspect Medical Systems, makers of the BIS monitor. He is not a stockholder or a paid consultant. The opinions expressed herein are his professional opinion based on 11 years experience with BIS monitoring.

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