DANGERS OF GENERAL ANAESTHESIA
 General Anesthetics: a particular risk for cosmetic surgery patients. Apart from the well described immediate possible complications, research and experience suggest that surgery under general anesthesia may carry severe long term dangers. In various studies, the risk of Alzheimer's disease, cancer, heart attacks and behavioural problems are all implemented. The fact that these findings have so long been ignored, is a vivid illustration of the scientific "conflict of interests" that arises when anesthesiologist are scientifically reporting on their own activities, and sole source of income. Some examples: Decline in cognitive ability following surgery was originally recognized as a complication of heart surgery, particularly in the elderly. It’s now been studied in a range of other situations, including major non-cardiac operations and more minor procedures.These studies provide a patho-physiological basis linking the more acute process of delirium and post operative cognitive dysfunction (POCD) following volatile-based general anaesthesia, with the longer term consequences of dementia and Alzheimer’s disease (AD). In a recent study from Columbia University the authors used databases to review cases in which children had hernia surgery in the first four years of life. They found that these children, compared with a control group, had almost twice as much risk of subsequently developing behavioural or developmental disorders. In a second study from the Mayo Clinic, the risk of learning disabilities in children after a single anaesthetic was not different from a control group but the risk did increase after two or three anaesthetics and in the cases where the duration of the anaesthetic was longer than 2 hours. In a Dutch study of children who had urologic surgery, “neurocognitive” development was evaluated by means of a questionnaire completed by parents. Children who had their procedures before the age of two years had lower scores. These studies will be presented at the annual meeting of the American Society of Anaesthesiologists in October 2008, so the details aren’t available and the studies haven’t been extensively peer-reviewed. Alzheimer’s disease The age of onset of AD was inversely related to the cumulative exposure to anaesthesia before age 50. A recent study also reported that patients having CABG under general anaesthesia were 70% more likely to develop AD, compared to those having percutaneous transluminal angioplasty under local anaesthesia.21 If larger studies confirm these findings, it would imply a 20 to 60% increase in AD as a result of surgery under general anaesthesia. Personal risk factors. The risks increase with the length of anaesthesia (more than 2 hours) and the number of anaesthetics received. This makes general anaesthetics particularly risky for cosmetic surgery whereby the use of meticulous techniques lengthens the procedure and patients will often want several procedures during the course of there lives. In general, the risks associated with anaesthesia and surgery increase in older people. Certain medical conditions such as heart, circulation, or nervous system problems, increase your risk of complications from anaesthesia. Some medicines can raise your risk of problems. If you smoke, drink alcohol, or use illegal drugs, you may be more likely to have problems from anaesthesia. Hypothermia consequent to anaesthesia. Various risk factors for long term (defined as three months or more) postoperative cognitive dysfunction have been investigated, including type of anaesthetic agent, general versus regional anaesthesia, use of anti-cholinergic agents such as atropine, or the physiological effects of the anaesthetic such as hypoxia, hypotension, or hyper-ventilation. In the light of these burgeoning scientific insights, people who say every repeat anaesthetic detracts 6 months of life expectancy may all too often still underestimating the detrimental after-effects on both the quality and the quantity of life. When representatives of the anaesthetic lobbies are asked to respond to these disturbing facts, they tend to minimize them and add that "there is no alternative" to a general anaesthetic to do surgery in comfort for both surgeon and patient. After more than 15.000 light intravenous sedations in combination with large volume local anaesthetic and loco regional nerve blocking, I am the living proof of this alternative. You can read more on this technique on www.HOFFkliniek.be Conclusion: THERE IS NO COSMETIC SURGERY, single or combined, THAT CANNOT BE MORE SAFELY AND COMFORTABLY DONE WITHOUT THE USE OF GENERAL ANAESTHESIA. The long term effects of general anaesthesia on brain function and the immune system warrant priority attention in INDEPENDENT clinical research. Long term outcome is a new safety concern, since a number of recent studies suggest that peri-operative events and care decisions may affect the patient adversely months or even years after surgery. This is particularly true of patients at the extremes of age, and patients requiring long and repetitive anaesthetics. They appear to be more vulnerable to the subtle and dramatic longterm adverse effects of general anaesthesia. These are very important subgroups in cosmetic surgery. As there is no need for a general anaesthetic, even in the most advanced of cosmetic combination procedures, cosmetic surgeons should be trained in local anaesthesia techniques to a standard level that makes general anaesthesia widely superfluous. |
