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Wednesday, June 19, 2013
Effects of anesthesia on the CNS
My husband (age 48) recently underwent an emergency Laparoscopic Cholecystectomy (gallbladder removal). Up unitl now, he has never had to undergo any type of surgery requiring the administration of general anesthesia. He did not bounce back from the surgery, and had a lengthy hospital stay (11 days) due to respiratory problems of shortness of breath and oxygen saturation levels of 76% on room air, fluid in the lungs, atelectasis and a collasped diaphragm. Since his discharge, he has had further difficultly with muscle weakness, dizziness, orthostatic hypertension when lying down on his back in bed, coupled with shortness of breath. His current respiratory status reveals O2 saturations of 98%to 99% on room air, however he is not perfusing well (using approx 49% of what he takes in). He had a pulmonary function test which revealed moderate obstruction, and a sleep study which revealed insomnia and apnea. He was prescribed Lunesta 3mg q.h.s. to help him get to sleep at night. This has proven to be not effective, and he continues to suffer from chronic insomnia, a condition that did not exsist prior to the surgery. He is also taking prescriptions of Wellbutrin and Provigil, as well as meclazine, all of which are supposed to help him have increased energy, help with the dizziness and muscle weakness; these appear to be not effective as well. He has further been placed on a C-PAP to aide in the resolution of the apnea. However, getting to sleep is still a huge problem. The treating physician states that he wants to further explore the possibility that he had a mild cerebellar stroke and may request an MRI. I suspect that the effects of anesthesia are the true nemesis here. Finally, to my question. Do the symptoms that my husband is exhibiting coincide with any of the long or short-term effects of anethesia and, if so, can they be resolved, and how can they be resolved? Can anesthesia cause a cerebellar stroke? I want to be very certain that we are moving in the right direction with his care and recovery. He has already been out of work for 2-months. Thank you for your time.
It sounds like you and your husband have had a very tough time. NetWellness is not a diagnostic service, so unfortunately I cannot comment specifically on your husband's complex and difficult problems. On this site you will find several references to recent findings and concerns about the long term effects of anesthesia, in certain populations, on cognitive (thinking) and psychomotor problems. (Psychomotor = the psychological processes associated with muscular movement and to the production of voluntary movements). There are no references in these studies to anesthesia causing a cerebellar stroke.
It is assumed that no anesthetic "mishap" occurred during the surgery. By mishap (not a medical term) I mean a significant problem with blood pressure, heart function, oxygenation or other critical life function. These kinds of events could lead to enough of a drop in blood supply to the brain to cause a stroke. However the kind of stroke seen in these circumstances is not usually a cerebellar stroke, which produces primarily problems with balance.
The other ongoing symptoms you describe, like blood pressure problems, muscle weakness, and dizziness can't easily be ascribed to anesthesia. Obstructive sleep apnea is a problem associated with heart disease, obesity and sometimes diabetes. If your husband has had sleep apnea it is possible that he has had underlying health issues that would have complicated his recovery from a major illness like the one you describe.
Emergency surgery suggests that the gall bladder was infected, and patients with this condition can become extremely ill, especially if they have diabetes. It takes time for a middle-aged person who has had a critical illness to recover. I hope that in time your husband will recover his health.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University