Anesthesia and PN
 

I had a cardiac EP Study with ablation surgery on Monday. Due to my multiple medical problems, they chose general anesthesia for better control...instead of the versed/fentanyl cocktail. Immediately after waking I noticed my left leg was semi 'asleep'. I thought it was do to position for the several hour procedure (especially with the ganglionitis), but even after being up for a couple days, it hasn't gone away. It seems mostly sensory, but some very slight motor heaviness most noticeable when walking.

My question is whether anesthesia drugs effect existing PN in this way? I emailed my cardiologist who did the procedure and he felt it could be related to the anesthesia and hopes it will resolve in a few days...but to let him know. What seemed odd was it being one-sided where as all my regular PN problems are bilateral. I have had many surgical procedures with general before but nothing quite like this side-effect.

Thanks in advance for input.

I think it is hard to say.

Nitrous oxide... will affect nerves in one treatment.

But midazolam is a benzo... and those aren't typically hard on nerves. The benzos will have a anti-spasm effect, which may translate into soft muscles...but I would not expect one sided or only one limb. I would think all would be affected to some extent.

I am thinking it is a compressive thing. So many people have compressive issues, after surgeries. Just lying on your back may compress one side of your spine just enough if there were subtle problems there to begin with..

Midazolam does interact with other drugs however...so typing into a drug checker with your other meds would reveal that.

I'm guessing he just used the midazolam as an initial sedative, not the main course, so to speak. Would/could Nitrous oxide effect just one side?

I'm also starting to think it is from positional (compression), since it's not improving as the anesthesia wears off. Even the doctor made a brief mention of this as well. I think he's just hoping it was the anesthesia so it would be resolved in a few days.

In your experience with others having this type of problem, does it eventually improve...in a relatively short period of time?

If the nerves on that side were weaker or mildly damaged, I would think any Nitrous exposure would accelerate that.

The studies where Nitrous has caused problems were in people with marginally low B12 to begin with. People with good stores of B12 may not have a reaction from one Nitrous administration.

What other anesthetics were used? Any neuromuscular blocking agents?
This link shows neuromuscular blockade and how it works.
http://en.wikipedia.org/wiki/Muscle_relaxant

Unfortunately, I don't know what other anesthetics were used...until I see the operative report.

The only things I'm aware of were several cardiac agents used to induce arrhythmias as part of the EPS (like atropine, adrenaline, etc). They also needed multiple rounds of vaso-constrictors as my BP kept dropping (I have neurally mediated hypotension).

One other very odd post-op problem is some very significant nerve pain on the roof of my mouth and portions of my tongue when trying to eat. It is NOT an irritation type pain yet quite profound. Even something very soft causes significant pain. I have heard of PN including burning mouth issues, but have never experienced it before. Something neurally must have been triggered, compressed, irritated, etc. The leg issue (even a little of the same in the left arm/hand) seem more like compression in the neck to effect both, yet the mouth is above the neck so who knows, maybe it's more of a toxic issue. I'm confused for sure.

BTW, my B-12 sits around 900 so I doubt it's an issue.

Were you intubated?

Yes.

This could explain the mouth pain I guess (if he hit a nerve), but it doesn't look or feel "irritated". Actually the roof of my mouth almost feels numb. Oddly, when I eat it doesn't hurt as soon as the food touches it. It is a pain deep inside that seems to radiate above the roof of my mouth an inside my tongue after a couple bites. Very strange indeed. The throat was little sore for a couple days, but nothing abnormal after an intubation.


The leg thing must be compression somewhere...but the mouth, I have no idea???

Well a little good news. The leg is finally improving. Must have been a positional compression issue on the operating table. Not back to where it was, but noticeable change for the better.

The mouth is just strange but I'm thinking it is also from compression of sort. Maybe when intubated the tube itself put pressure and compressed some nerves in the throat....causing problems in the mouth, tongue, jaw, etc. Sound logical? Also seems it should improve in time...right???

At least the surgery was a success!!!

I am glad things are better...

I've seen posts over the years from patients who have left over issues in the mouth from being intubated. I think the "guide" is large and could compress the upper palate. They remove that huge thingey and just leave the tube.

People with "nerve" issues tend to be more sensitive I think to
invasive things. I know my teeth are always sensitive...and my dentist has written that in my chart in fact.

Glad the leg is recovering too.