Thursday, November 27, 2014
Anesthesia for prostate sugery
I am scheduled to have laser surgery for an enlarged prostate; it`s a "green-light" PVP laser and my doctor said that it would take about 20 minutes. She said that they normally use a block for this, but I had an epidural once that lead to a spinal infection and I had to have my L1 and L2 vertebrae fused as a result...so I really don`t want any type of spinal or epidural (not even sure if it can be done after the fusion anyway). She said that my other option is a general; which seems scary to me. My question is: can a general be given without the paralytic drugs (I can just see myself being unable to breathe and not able to tell anyone) and via IV without the volatile agents? My doctor doesn`t seem to know and when I called the ambulatory surgery center, they said that I can only talk to anesthesia on the day of surgery. Any help will be appreciated.
It is pretty remarkable that the ambulatory surgery center can't give you the information you need until the day of surgery. I wouldn't be happy about that.
I think your concerns about avoiding a spinal or epidural anesthetic, given your previous spinal surgery, are justified.
General anesthesia is usually a pretty routine affair for those of us trained to administer it. Of course it's hardly ever seen that way by those at the receiving end of the needle or mask, so we should be able to appreciate the anxiety it evokes in many people.
It's hardly ever a good idea for a patient to "prescribe" to an anesthesiologist, or any other trained professional, the exact technique or medication that should be used. It is always a good idea to tell your anesthesiologist about your fears and concerns, so the anesthetic can be tailored to suit both medical necessity and patient preference.
Having said that, I will tell you directly that general anesthesia can be given without paralytic drugs. It can also be given IV without volatile agents. However there is no evidence that volatile agents are less safe overall than intravenous agents. Your anesthesiologist's job is to make sure that you are asleep AND breathing. To that end, it is normal and safe practice to insert a breathing tube to make sure that the airway is kept open and that breathing is adequate.
How you use this information is now up to you!
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University