Anaesthetics for local or general surgery

Following surgery many become confused. ICU psychosis is a term commonly used by Healthcare Professionals. Several papers can be found discussing this. However we need to make family members aware a sudden onset of psychosis can emerge some days after the surgery, following discharge from hospital.

For some personal stories click here: Adverse reactions following surgery due to a combination of drugs administered  pre and post surgery and anaesthetic agents

Intrusive memories of hallucinations and delusions in traumatized intensive care patients - interview study.

CONFUSION AFTER ANAESTHESIA

The Royal College of Anaesthetists produced a pamplet  'Becoming confused after an operation' 

The above leaflet was one of a series of booklets for patients 'Risks associated with your anaesthetic' which has now been removed it seems.

The web site of the RCOA needs to be more straightforward and not so confusing.

More information about confusion

https://www.verywellhealth.com/confusion-after-surgery-3156861

 

An Inquiry ' A Concscious Decision 'ihe Chief Medical and Dental Officers in 2000 tnto the use of general anesthesia relating to dental treatment produced startling comments which are still relevant today. I contributed my concerns, which I was assured by a Senior Dental Officer, was read as he personally kindly handed my letter to the two Chiefs. This was in the year 2000 and little has been done to rectify some issues :

Page 37 in the Report by a group chaired by the Chief Medical Officer and the Chief Dental Officer stated: .

"...it is generally accepted that adverse incidents are under-reported. Also, reports received directly from patients without validation by a doctor or dentis are not entered on the MCA's (Medicine Control Agency) Adverse Drug Reactions On-line Information Tracking (ADROIT) database.

it goes on to state " The extent of morbidity for general anaesthesia and conscious sedation for dentistry in England is unknown. Without this information it is not possible to assess fully the riss inherent in a course of treatment or to provide patients and practitioners with the complete information regarding those risks."

It is recommended that the extent of morbidity associated with general anaesthesia and conscious sedation is recorded and analysed by the Royal College of Anaesthetists and the Society for the Advancement of Anaesthesia in Dentistry respectively.

There is more in the rcommendations and this leads me to explain what I did following  reading this publication.

I personally called a Professor of Anaesthesiology and asked him if he has informed his members in the RCOA to be sure to report all know cases of ADRs following surgery to the Medicines regulatory authority, then called the MCA and today called the MHRA. He responsed he did not have the means to do this. "AND ANYWAY IT WAS ONLY A RECOMMENDATION".

Over the past 22 years I have made several attempts to encourage the RCOA in their duty to not only educate the doctors to understand people with no history of mental illness can be psycologically affected by the drugs used in anaesthesia. The importance of taking a medical history of such possible Adverse reactions and asking the right questions.  Have you any allegies? will not get to the  right answer in order to measure risk.  The subject is not included in edcuation either or wasn't when I made enquiries.

Is there anywhere on the RCOA web site to encourage patients to report ADRs? let us check.

Please write to the https://rcoa.ac.uk/patient-information/leave-your-feedback/patient-information-group and tell them your concerns and suggest they include the link on the RCOA web site for patients to report adverse reactions following surgery, there is no other way to get the record straight. 

SHOCK HORROR !

It seems the new MHRA Yellow Card reporting site has no way to reports ADRs following surgery.  The RCOA dont have a system either.

 

CHILDREN

A UK study of Adverse Drug Reactions in Children (ADRIC) found the following in regard to anaesthesia and drugs used around surgery:

The most surprising findings were from the study of ADRs in hospital. First, we found that the incidence of ADRs in children is much greater than in adults.

We also observed that the risk of experiencing an ADR was increased over six times in children who had a general anaesthetic during their admission and over half of the drugs implicated in all ADRs were used either perianaesthetic or post anaesthetic.

These drug groups have been under-represented in previous studies and our findings have important implications for all clinicians concerned with the perioperative and postoperative management of children, in particular in view of the recent moves to ambulatory surgery in the UK and elsewhere.

 

  • IMPORTANT -  Check the Liver and kidney function of patients suffering psychiatric disturbance following surgery.

Anaesthetics
An anaesthetic drug that brings about a reversible loss of consciousness. These drugs are generally administered by an anesthesia provider in order to induce or maintain general anaesthesia to facilitate surgery 

Drugs given to induce or maintain general anaesthesia are either given as:

  • Gases or vapors (inhalational anaesthetics)
  • Injections (intravenous anaesthetics)

Inhalation
Inhalational anaesthetic substances are either volatile liquids or gases and are usually delivered using an anaesthesia machine. An anaesthesia machine allows composing a mixture of oxygen, anaesthetics and ambient air, delivering it to the patient and monitoring patient and machine parameters. Liquid anaesthetics are vaporized in the machine.

Many compounds have been used for inhalation anaesthesia, but only a few are still in widespread use. Desflurane, isoflurane and sevoflurane are the most widely used volatile anaesthetics today. They are often combined with nitrous oxide. Older, less popular, volatile anesthetics, include halothane, enflurane, and methoxyflurane. Researchers are also actively exploring the use of xenon as an anaesthetic.

Injection
Injection anaesthetics are used for induction and maintenance of a state of unconsciousness. Anaesthetists prefer to use intravenous injections as they are faster, generally less painful and more reliable than intramuscular or subcutaneous injections. Among the most widely used drugs are:

  • Propofol
  • Etomidate
  • Barbiturates such as methohexital and thiopentone/thiopental
  • Benzodiazepines such as midazolam and diazepam
  • Ketamine is used in the UK as "field anaesthesia", for instance at a road traffic incident, and is more frequently used in the operative setting in the US.

 

Where can we find the required information to enable us to make informed choices?

Decisions by patients to go ahead with, as in this case, unnecessary surgery, or where a local anaesthetic would be an alternative, should be made on the basis of informed choice.

Research is needed to ascertain which drugs are less likely to cause problems for mentally vulnerable patients of all ages.

This is a matter of utmost urgency. There is too little attention paid to this problem, by the colleges, conferences and professionals involved in anaesthesia.

Warning to patients taking trycyclic antidepressants:

There is a higher risk of side effects from the drugs used during surgery or dental or emergency treatments, so the doctors must be informed that you are taking this medicine.

Related links and information
Anaesthetic's effect on women

Adverse effects of anaesthetics
http://www.general-anaesthesia.com/adverse-effects.html

Reporting Adverse Drug Reactions (ADRs)

It is well known that serious side effects of medicines are under reported and the UK regulatory body the Medicines and Healthcare Regulatory Agency (MHRA) estimate less than 10% of serious ADRs are reported.

If you are, for no apparent reason, feeling mentally distressed, it may be caused by starting or stopping medication, due to a changed dose, withdrawal effects, interactions with other drugs, or following surgery. You can request a list of drugs used pre surgery and during surgery and those for pain or infection to be taken later.

Some drugs must not be stopped suddenly

If you have suffered psychiatric, neurological or physical adverse drug reactions (ADRs) please report them. There may be adverse effects not mentioned on the patient leaflets (PILs) or data sheets. (SPCs)

You should be given a patient information leaflet (PIL) for all drugs prescribed, either as you are discharged from hospital, or if the pharmacy supplies you from a bulk supply of pills. (EU Directive 1997)

Please report Adverse Drug Reactions (ADRs) to:

UK - Yellow Card Reporting for Patient and Health Professional reports of Adverse Drug Reactions you can report to the MHRA using the link above or call them 0808 100 3352 10am - 2pm Monday to Friday

USA and worldwide - to the Food and Drug Administration for Patients and Healthcare Professionals

Universal free, independent drug safety website - Rxisk

 

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