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Anesthesia

Effects of repeated use of general anesthesia

04/09/2007

Question:

My sister has has nearly 100 surgeries over last 25 years. In the past several years it is probably very close to one surgery a month. She seems to choose surgery before any other alternatives. What are the possible repercussions of so much surgery under general anesthesia? She`s having another surgery tomorrow and had one two weeks ago. Mostly feet, but now she wants back surgery. She also takes an abundance of medications.. pain, arthritis, restless leg, etc.

Answer:

One hundred surgeries must be close to a record of some sort! You have not stated what the surgeries were, or what they were for, but you seem to imply that not all of them were really necessary. You may have heard of an illness called Munchausen Syndrome, in which affected persons very deliberately seek medical treatment, including surgeries, without having the need for those treatments or surgeries. They may even fake the symptoms of various diseases and conditions. I do wonder whether your sister is suffering from something of this kind but that is of course just a wild speculation.

Until very recently there was very little clinical or laboratory evidence to suggest that anesthetics have any long term effects. It is now shown, at least in the laboratory, that anesthetics can have more than transient effects on brain cells and on the immune system. Nobody can yet say whether the effects on people who have had many anesthetics are significant. And this is a hard question to answer because nobody is volunteering to have surgery without anesthesia!

There certainly is now an increased degree of concern about the possible effects of anesthetics on the elderly. This is supported by studies in older rats and other animal models in which some cells undergo apoptosis, or "programmed cell death". It would be nice if we could say, just avoid general anesthesia. Unfortunately we don't have any evidence that the incidence of one manifestation of possible anesthetic-induced damage - postoperative cognitive dysfunction (POCD) - is any different when general anesthesia is substituted by regional anesthesia (nerve block).

Finally, let's not forget that every surgery (and especially repeat surgeries) has potential surgical complications which are likely to far outweigh the risk of anesthetic effects or accidents.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University