9 replies to this topic

[lizziegoatgirl]

Hey everyone,
I have to get surgery tomorrow and I was wondering if anyone has any insight on how anesthesia will interact with my meds, if at all. I don't necessarily trust the anesthesiologist to know much about psych meds to be honest. I am a nurse and have worked with anesthesiologists before and know where their scope of understanding ends.

Wellbutrin
Lamictal
Buspar

That's my drug cocktail. Any input? Any experiences?
Thanks,
LGG

[lavender]

I had a procedure a couple weeks ago, and was given demerol with no problems.

[korey1015]

Just be sure to tell the nurses and doctors what medicines you're taking. I think they ask that question regarding all medicines and supplements, not just psych meds. I only know of MAOIs and sedatives having bad reactions with anesthesia, so your cocktal looks safe to me. But I'm not a nurse or a doctor, so make a point to tell the nurses and doctors what you're taking. Bring a list of your meds and such. They should understand that you're just being precautious.

[Mr_West]

Just be honest with the anesthesia people. If they are unfamiliar with things, the will probably look them up. Make sure you let them know about any bad anesthesia experiences and don't lie about past alcohol use patterns in the window of time they care about (it can differ).

An example of a bad anesthesia experience to note would be when I was 14 under general getting my wisdom teeth cut out and woke up taking swings at the dentist. The left side of my mouth can't salivate anymore and a big wad of scar tissue in my cheek may be contributing to that. Abnormal reactions to anesthesia go with MI though. Less sudden death, but more waking up incredibly pissed. My medical peculiarities card I carry request's restraints if I am anesthetized now. This happened in the summer when I was too young to know what was what so I may have been running as manic as hell. My memories of that summer are seeing a lot of people with nice but and then eating only chocolate ice cream and pain as I tried to return to playing the Tuba.

[VisualSnow]

Definitely let them know exactly what you're taking, regardless of whether or not you think they'll know what to do. I'm surprised they didn't go over any of that with you in the pre-op. When I had my surgery last year, they told me in pre-op that amitriptyline and anesthesia was a really bad mix and I had to be off of it for the surgery. Still, the meds you're on aren't unusual or anything, so odds are they have encountered them before.

I'm sure people have been under anesthesia with practically every med at some point (after all, not all procedures come with a convenient advance warning), but it may warrant a change in the agents they use and the dosages. The time I had emergency surgery, I was taking Topamax and Benadryl at the time, and I'm still alive to tell the tale, but of course a single piece of anecdotal evidence regarding completely different medications doesn't mean much.

If you're worried about it, I would call and ask to speak with someone to put your mind at ease.

Edit: You can even look up the interactions yourself if you know what agents they will be using, but that's probably not a great idea if you're the type to worry or obsess over the information (not that I would know anything about that...), and of course don't replace that info with any instructions your surgical team has given you.

Edited by VisualSnow, 12 March 2012 - 04:38 AM.

[metatrix]

It's impossible to say what the interactions will be, if any, because each anesthesiologist uses a different cocktail of meds to put you under and keep you under. MOST LIKELY it will be something like:
1. midazolam
2. fentanyl
3. lidocaine
4. propofol
5. some muscle relaxant
6. volatile anesthetic mixture

In that order.

It is super important that you let your anesthesiologist know what meds you are on. He/she will likely look them up, and it may influence what cocktail he/she decides to use.

In REALITY though, the process is a dynamic one, and anesthesiologists are trained to sort of 'go with the flow'. They know that many patients will lie about what they are taking (or in trauma situations, the patient is not awake to say what they are on). So putting and keeping a patient under is a dynamic process, and they will monitor your vitals, and adjust the drugs they give you based on how you respond. So, I wouldn't worry too much. Except if you get one of those anesthesiologists who decides to fall asleep or leave the room while you are under....which I have seen happen more often than not, unfortunately.

[VAL]

Two weeks ago, I had a short procedure using propofol and had no ill effects or mood effects whatsoever. Just felt like I had a nice sleep and woke up feeling refreshed. I've had the same results with propofol with fentanyl but with the exception that I had a slight, good elevation in mood from the fentaynl. It didn't last long. I've had surgery while on lamictal, wellbutrin and abilify with no ill effects and had dilaudin afterwards with nothing but what I imagine was a normal dilaudin reaction...bit whoozy. I didn't have any nausea but again experienced a slight elevation in mood in a good way....helped along by the fact that I had no pain for the first time in decades. I don't think this is particularly unique to being bipolar II though as I've seen friends with no MI have similiar reactions. The anesthesiologist on my recent procedure, called me the night before to insure I would be taking all my medications in the morning, particularly my blood pressure medicine, using a small sip of water. As a nurse, you've seen the worst but I'm sure you've seen the best as well. In all my million times of dealing with anesthesiologists for family members, they've always done an excellent job working with people who were hard to keep alive to begin with.

[VAL]

oops...just realized you must have already had the procedure.

[lizziegoatgirl]

Thanks everyone! I'm home now, did fine w anesthesia. The even let me take the lamictal at my usual time before the surgery. Appreciate the feedback
LGG

[forgetmenot]

glad it went well!