CFS and Anaesthetics
From DoctorMyhill
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This is a problem for patients with CFS for three reasons.
Firstly CFSs are much more likely to get idiosyncratic (i.e. unusual) reactions to drugs compared to the normal population. This is because they are 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 symptoms of this is that nearly all my CFS patients react badly to any amount of alcohol and to normal doses of antidepressants. So anaesthetics may result in slow recovery time with a flare of fatigue and other symptoms associated with that fatigue. Also see Detoxification - an overview.
Secondly, CFSs have a problem because of multiple chemical sensitivity. These patients react in an allergic way to unrelated chemicals.
Thirdly, any anaesthetic is a stressful event and CFS patients do not tolerate stress well.
A related problem is that CFS and hospitals do not combine easily! The quality of food in hospitals is usually diabolical with little or no provision for allergy problems (food allergy does not exist in conventional medicine!), 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 for the problems of CFS patients with "helpful" nurses encouraging you to "do it all yourself" and "start exercising as soon as possible"!
Local anaesthetics
Some patients have a problem with the adrenaline in local anaesthetics. This is easily got round by not using it (adrenaline 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 know you get bad reactions to chemicals;
You have food allergy problems;
Your CFS is bad;
Your CFS was caused by chemical exposure (organophosphates, drugs, etc)
The surgeon and anaesthetist can be told that 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 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 main 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 some excellent information in the form of guidelines for hospital medical staff about problems of hospitalisation and anaesthetics in patients with chemical sensitivity. You can access it at http://www.ctaz.com/~bhima/hospital.htm
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