Anesthesia and CFS

Marilyn Seskin, MD

(Reprinted from the Carousel Network, June 2000.)

The following is an answer to a question about anesthesia for shoulder surgery, but can be applied to any anesthetic:

I am an Anesthesiologist with CFIDS/FMS.

Anesthesia is not a big worry. Anesthesiologists are highly trained specialists and able to deal with all situations. They are trained to deal with emergencies. Most people with CFIDS/FMS have no more problems with anesthetics than the healthy population.

Just follow some simple suggestions.

Talk to your Anesthesiologist, tell her/him that you have your illness and it involves the nervous system, particularly the autonomic; and the immune system. Be sure to bring a list of your medications and herbal supplements. Tell him/her all your allergies to medications or latex and any unusual problems you've had with medications in the past. Stop your vitamin E at least 3 days prior as it may increase bleeding.

If they only want you to see the Anesthesiologist just prior to the surgery and you have a lot problems you want to call ahead and ask to speak with an Anesthesiologist the day before if the system makes this possible. Sometimes it doesn't due to cost saving.

I am assuming you are having general anesthesia. Modem anesthetic gas presents very little toxicity to the liver. Halothane (which can rarely cause liver problems) is used only for children.

Everyone's manifestation of the syndrome is different and you want to discuss your own particular problems individually, e.g. asthma, NMH, thyroid disease, other autoimmune diseases. If you are prone to rapid heart beats this should be discussed. Most of these issues would come up in the usual interview an Anesthesiologist would have with a patient.

If you have been supplementing as most of us have., magnesium is important as we are thought to be relatively low (this will not show up in the basic serum magnesium test) so be sure to take your magnesium regularly.

If you have Neurally Mediated Hypotension, tell her, as anesthetics vasodilate you and for shoulder surgery they sit you up so you may have a drop in blood pressure, therefore you need to be properly hydrated. Vasodilation is relevant to all anesthetics as this is a side effect.

If you have TMJ, tell her, so they will be extra gentle for the intubation.

It would be wise to avoid muscle relaxants that release histamine such as curare, atracurium, and probably wise to avoid succinylcholine.

If you are very sensitive to all medications, i.e. you just look at the bottle and it effects you, then mention that. Your Anesthesiologist will keep that in mind, but the decision on how much to give is based on the situation and hers/his evaluation of your needs. It's a moment to moment decision.

Avoidance of epinephrine is wise especially if you have mitral valve prolapse and get palpitations. Epinephrine is used in regional or local anesthesia. It is also used in the irrigation if you are having arthroscopic shoulder surgery. Otherwise epinephrine would only be used in life threatening situations.

Another thought that is only recent knowledge is that nightshade vegetables (tomatoes, white potatoes, peppers, eggplants, zucchini and tobacco) contain chemicals called solaneous alkaloids which the plant produces as a natural insecticide. These chemicals have the ability to prolong the action of muscle relaxants used in anesthesia (this is not to be confused with muscle relaxants like Flexoril, which is used for muscle spasms). So maybe you could avoid these for several days before the surgery. Don't worry too much about this as the effect is very small. What is interesting is that these nightshades are also known to increase pain in chronic pain conditions. It happens to me. I can't touch these vegetables without having serious burning for about four days. All problems can be dealt with. Communication is what is important.