CFS and Anaesthetics
(By Dr Sarah Myhill and Craig Robinson)
Stylistic note: Use of the first person singular refers to me, Dr Sarah Myhill. One can assume that the medicine and biochemistry are mine, as edited by Craig Robinson, and that any classical and mathematical references and quotes or historical and linguistic notes are Craig’s!
Anaesthetics are a problem for patients with CFS for many possible reasons.
CFSs are much more likely to experience idiosyncratic (i.e. unusual) reactions to drugs compared with the normal population. This may be because they are often slow detoxifiers. This may be a congenital problem or secondary to micronutrient deficiency or because their detox system is already overwhelmed by internal toxic stress (eg fermenting gut) or overwhelmed by external toxic stress. One example of this is that nearly all my CFSs react badly to any amount of alcohol (see Alcohol intolerance in CFS - gives us a clue as to the mechanisms of fatigue ) and to normal doses of antidepressants. So anaesthetics may result in a slow recovery time with a flare of fatigue and other symptoms associated with that fatigue. Also see Detoxification - an overview.
Many CFSs have a problem because of multiple chemical sensitivity. These patients react in an allergic way to chemicals. Thankfully it is very rare for this to manifest with life threatening reactions such as anaphylaxis.
The problem in CFS is poor energy delivery at the cellular level. This means energy delivery to organs is slow and so organ function is impaired. So for example in severe CFS the heart is in a state of low cardiac output often bordering on heart failure. This means there is less scope to react to stressful situations.
A related problem is that CFS and hospitals do not combine easily! The quality of food in hospitals is poor with little provision for allergy problems or fermenting gut problems. The beds are uncomfortable, there is no peace from light, noise, heat and disturbance (least of all at night), there are all sorts of chemical smells, but worst of all there is an almost complete lack of understanding of the problems of CFS patients with "helpful" nurses encouraging you to "do it all yourself" and "start exercising as soon as possible"!
Some patients have a problem with the adrenalin in local anaesthetics. This is easily got round by not using it (adrenalin makes the anaesthetic last longer).
The above factors mean it may be difficult to predict how you will react to an anaesthetic. You are more likely to get problems if:
You have had a previous bad reaction to an anaesthetic;
You have MCS and react to chemicals such as perfumes and cleaning products;
You have food allergy problems;
Your CFS is severe;
Your CFS was caused by chemical exposure (organophosphates, drugs, etc)
Ideally you want the smallest dose of anaesthetic possible. Use local anaesthesia wherever possible. Anaesthetics are used for two reasons - firstly, to knock you out so that you sleep through the whole proceedings (this is obviously an excellent stress blocker but I suspect partly so the surgeon and assistants can have a good natter without you listening in!) and secondly to block pain. If the pain blocker can be done with local anaesthetic, then the total load of drugs can be reduced and reactions lessened accordingly.
The commonest reaction to anaesthetics will be a worsening of your CFS symptoms.
At one stage there was a suggestion that CFS induced by organophosphates could result in idiosyncratic reactions to muscle relaxants which caused a prolonged paralysis for hours after the anaesthetic, requiring ventilation. This was investigated by the Royal College of Anaesthetists, who concluded there was no greater risk than one would expect compared to the normal population.
There is an excellent guide produced by the Grace Charity on INFORMATION FOR PATIENTS AND HOSPITAL STAFF REGARDING TREATMENT OF PATIENTS WITH M.E.
- CFS - The Central Cause: Mitochondrial Failure
- Alcohol intolerance in CFS - gives us a clue as to the mechanisms of fatigue
- Detoxification - an overview
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