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Anesthesia

Anesthesia and Lupus Flare

04/09/2010

Question:

Can anesthesia cause your lupus to go into a flare? Every time I have surgery my lupus symptoms reappear.

Answer:

I am not aware of any studies that have directly addressed this question. People often want to know whether anesthesia contributes to or causes worsening in the signs and symptoms of various conditions. Its really hard to answer this definitively because patients don't normally get anesthesia without surgery. And surgery itself causes a large range of reactions, depending on the site and intensity of the procedure, as well as the course of recovery, including the potential occurrence of complications.

In general terms, a person with a chronic disease like lupus may be more at risk of problems during and after surgery and anesthesia. The risk of problems depends obviously on the severity of the disease and the body systems that are affected. We are concerned particularly about diseases that affect the function of the heart and lungs, but any major organ dysfunction, including kidney disease, common in lupus, is significant.

So that's the effect of the disease on the surgery and its outcome. But you're asking about the effect of the anesthesia and surgery on the disease. One issue is that major surgery may disrupt your normal medication routine. For example you may be given additional medications which interact with the drugs you take on a regular basis. Second, if heart, kidney or liver function are affected by the anesthesia and surgery then the metabolism and excretion of drugs can be affected too and will require dosage adjustment. Third, lupus is an autoimmune disease and we know that both anesthesia and the surgical stress response have effects on the immune system. Some anesthetic drugs, like propofol, are shown to have immune suppressive effects. Whether this is beneficial or harmful to a person with lupus in the context of surgery has not as far as I know been investigated.

So it's apparent that there isn't a simple answer to your question. As a general rule any person with a severe chronic disease should be circumspect about elective surgery - i.e. recognise that you may be at risk for complications and be cautious about undertaking surgery that you don't absolutely need. Be sure that your doctors have as much information as possible to manage your condition while you are in hospital, and afterwards - e.g. your steroids, anticoagulants, heart and lung function, etc.

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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