Anesthesia Immunity: Concerns for Breast Surgery Safety

Q: Anesthesia Immunity: Concerns for Breast Surgery Safety

Hello： The possibility of intraoperative awareness can indeed be a significant source of stress for patients undergoing surgery. <br>While there are cases of intraoperative awareness, they are relatively rare. <br>For patients who have previously undergone general anesthesia with

Is there an immunity to propofol or isoflurane?

My daughter wants to undergo breast augmentation surgery, which requires general anesthesia.
I previously read a report about a Russian woman who experienced intraoperative awareness during breast surgery and suffered fatal pain.
The report suggested that the cause might be insufficient depth of anesthesia or the patient's own resistance to anesthetic agents.
I have researched that the induction and maintenance of general anesthesia typically involve propofol and isoflurane.
If her body is resistant only to isoflurane, could it be possible that she falls asleep with propofol but wakes up during the procedure due to her resistance to isoflurane? I am very worried that this could happen to my daughter.
Although she underwent general anesthesia two years ago for a fracture after a car accident, it was only for one hour.
I heard the nurse mention that a fever occurred due to the anesthetic being administered into the lungs, so isoflurane was likely used.
However, I wonder if she metabolizes propofol more slowly, which means that even if she is resistant to isoflurane, she might not wake up during the one-hour surgery.
How can we determine if she has any resistance to anesthetic agents? I tend to be quite anxious and overthink things, so I hope the doctor can provide me with detailed answers.

dorry, 40~49 year old female. Ask Date: 2017/05/18

Dr. Lin Xiuying reply Anesthesiology

Hello: The possibility of intraoperative awareness can indeed be a significant source of stress for patients undergoing surgery.
While there are cases of intraoperative awareness, they are relatively rare.
For patients who have previously undergone general anesthesia without experiencing awareness, the likelihood of experiencing it again during a subsequent surgery is very low, so there is almost no need for concern.
Here are a few recommendations:
1.
Understand the anesthetic agents used previously.
If you are to undergo anesthesia again (breast augmentation typically requires general anesthesia), referring to the previous drug combination is a good choice.

2.
If you are only effective with propofol, you might also consider total intravenous anesthesia! Isoflurane is a gaseous anesthetic and should not be included in the drug combination.
You can use propofol along with analgesics administered continuously or intermittently via intravenous route.
3.
There is the option of using EEG monitoring to assist with intraoperative awareness.
However, this is generally out-of-pocket and can be quite expensive, so it is not usually necessary and is not typically recommended.
As for whether it is possible to know in advance if the anesthetic will be ineffective, the honest answer is...
it is not possible! It is fortunate that your daughter has such a loving mother! However, do not forget to consult a qualified anesthesiologist for an evaluation before the surgery.
They can provide comprehensive answers to any anesthesia-related questions.
Wishing you a successful surgery!

Reply Date: 2017/05/18

More Info

When considering anesthesia for breast surgery, particularly in the context of your daughter's upcoming breast augmentation, it's understandable to have concerns about the safety and efficacy of anesthesia, especially given the rare but alarming reports of intraoperative awareness. Let's address your concerns regarding anesthesia immunity and the potential risks involved.

First, it's important to clarify that the phenomenon of "anesthesia awareness," where a patient becomes conscious during surgery, is extremely rare. The majority of patients undergoing general anesthesia, including those for breast surgery, do not experience this. The risk is particularly low for patients who have previously undergone anesthesia without incident, as is the case with your daughter. The medical community has made significant advancements in monitoring and administering anesthesia, which further reduces these risks.

Regarding your specific concern about "anesthesia immunity," it's crucial to understand that while some individuals may have varying responses to anesthetic agents, true immunity to anesthetic drugs is not common. The two primary agents you mentioned—propofol for induction and isoflurane for maintenance—are both widely used and effective for the vast majority of patients. If your daughter has previously undergone anesthesia without issues, it is unlikely that she would suddenly develop an immunity to isoflurane or any other anesthetic agent.

In the scenario you described, where a patient might initially be sedated with propofol but then awaken due to an inadequate depth of anesthesia with isoflurane, this situation is typically mitigated by careful monitoring and dosage adjustments by the anesthesia team. Anesthesiologists are trained to assess the patient's response to anesthesia continuously and can adjust the levels of anesthetic agents as needed to ensure the patient remains unconscious and pain-free throughout the procedure.

If there are concerns about how your daughter metabolizes these drugs, it would be beneficial to discuss her medical history with the anesthesiologist prior to the surgery. They can review her past experiences with anesthesia, including any side effects or complications, and tailor the anesthetic plan accordingly. This might involve using alternative agents or adjusting dosages to ensure her safety and comfort.

Additionally, if your daughter has specific fears or anxiety about the anesthesia process, it is essential to communicate this to the healthcare team. They can provide reassurance, explain the procedures in detail, and may even offer preoperative medications to help alleviate anxiety.

In summary, while your concerns about anesthesia are valid, the likelihood of your daughter experiencing intraoperative awareness or having immunity to anesthetic agents is low, especially given her previous experience with anesthesia. Open communication with the anesthesiology team will be key to addressing any fears and ensuring a safe surgical experience. It’s always best to discuss any specific medical concerns directly with the healthcare providers involved in her care, as they can provide personalized guidance based on her unique medical history and needs.

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