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chicpoena
23-07-2007, 07:27
I figured this was the forum where people would be the most knowledgeable.

Does having a high tolerance to opiates affect anesthesia during surgery? I know they use fentanyl sometimes but I'm not sure what other drugs they can use. Should the anesthesiologist know how many opiates the patient has been taking so that they can make sure they're unconscious?

fastandbulbous
23-07-2007, 10:13
Should the anesthesiologist know how many opiates the patient has been taking so that they can make sure they're unconscious?

Of course they should know - that's the sort of thing that can lead to tragic accidents if it's not disclosed. It shouldn't have any bearing on unconciousness as most anaesthetics don't work through the mu opiate receptor, but the opiates will interact with some of the drugs being used. Also you don't want to wake up and find you've got inadequate post operative analgesia because they didn't know about your tolerance.

Basically, if your life could be threatened by not saying anything, make sure you do tell them

vecktor
23-07-2007, 11:20
you must tell the anaesthetist, modern general anaesthesia relies on opiates for analglesia (Pain relief), a muscle relaxant and a sedative/ and or inhalational anaesthetic to maintain unconsciousness. The depth of anaesthesia caused modern levels of anaesthetic is too low to cause effective anaglesia (pain relief), it is safer to maintain light anaethesia and use other drugs to control pain and muscle rigidity.
the nightmare scenario is this.. muscle relaxant stops any movement, anaglesia due to the opiates is too low to control the pain, the pain causes you to wake from the light anaesthesia during surgery, you're conscious and in serious pain but you can't move, or do anything to indicate you are suffering.

especially as you will have to listen to the surgeon saying things like:
"this is an ugly one, don't like the look of this"
"what's that bit? could someone page Mr XXXX"
"bollocks I've cut <insert critical artery> NURSE help now"
"and has anybody seen my watch"
:\

I have been in on a couple of ops, and the banter is rather interesting.

qwe
23-07-2007, 17:49
^i saw a show on discovery health about cases where the anesthesia prevented people from moving but did not have them unconscious, so they were fully aware and in extreme pain through the whole operation

sometimes you can move your thumb or finger a little, so sometimes they hook up a device to detect if you do, and if you do they increase the anesthesia

sometimes

sorry if i scared you chicpoena :P

hussness
23-07-2007, 17:50
^Did you ever find your watch? ;)

Adrenochrome
23-07-2007, 18:33
Tell them you got like a 100mg/day oxymorphone tolerence
they'll put you on the nod side of narcosis!! LOL!! :D

chicpoena
23-07-2007, 23:54
you must tell the anaesthetist, modern general anaesthesia relies on opiates for analglesia (Pain relief), a muscle relaxant and a sedative/ and or inhalational anaesthetic to maintain unconsciousness. The depth of anaesthesia caused modern levels of anaesthetic is too low to cause effective anaglesia (pain relief), it is safer to maintain light anaethesia and use other drugs to control pain and muscle rigidity.
the nightmare scenario is this.. muscle relaxant stops any movement, anaglesia due to the opiates is too low to control the pain, the pain causes you to wake from the light anaesthesia during surgery, you're conscious and in serious pain but you can't move, or do anything to indicate you are suffering.

That is exactly what I thought. I have seen that show on the Discovery Channel too and I can't imagine anything more frightening. Bluelight is the most knowledgeable forum on prescription drugs that I've found. People here know more than most doctors about chemistry, dosage etc. I got into an argument with my friend whose having surgery in a month and he said it wouldn't matter that he has a high tolerance since they use different drugs. So to settle it I decided to ask here.

He is legitimately prescribed opiates for pain, but has a higher tolerance than he should if you know what I mean. If he takes only the prescribed dose for the month leading up to the surgery, should his tolerance drop to normal levels? Or should he go cold turkey all month and take his prescribed dose for the week leading up to surgery?

What would you all suggest? I already told him to be honest with the anesthesiologist but he said its out of the question since the hospital where he's gonna have surgery is where his pain clinic is. I'm trying to help him figure out some options.

Thanks so much for your help. Also, can anyone tell me what the names of the various drugs that are used in anesthesia so that I can argue with him better and appear more knowledgeable so that I will be more convincing?

Reminisant B
24-07-2007, 22:48
If I was in such a situation I would be tempted to reduce intake of all opiates a number of days beforehand - possibly even go cold turkey to increase the relative effect during the op.

A few days withdrawal sounds better than being paralysed, conscious and in pain.

^ I'm sure however its more complicated than this and I'm not sure whether this is good advise to give so don't accept it as such. Anaestesiologists only become fully qualified near the age of retirement I thought! certainly takes a long time - which makes sense - you are solely responsible for peoples consciousness every day.