Cetkat Posted April 10, 2015 Share Posted April 10, 2015 Does anyone have any experience or knowledge when it comes to having surgery with Emsam? (Or I guess pain old MAOIs in general?) I'm mostly looking for any research or warnings that could be of help when it comes to talking with my anesthesiologist at my pre-op for sinus surgery. Since I've had sinus surgery once already, I knew to tell the surgeon NOT to use cocaine (cause that's the main method used to suppress bleeding for that). But trying to find out the different types of anesthesia and how they may or may not interact is proving a pain in the butt. I know we could/can figure this out during the pre-op... but that could make for a very long appointment & extra billing. Ideally if there's an obvious "do" or "do not", that would be helpful to find out ahead of time -- because, frankly, I'm more familiar with Emsam than the non-psych docs are - so it would significantly cut down on the internal system "google-fu" and pharmaceutical phone calls. The ENT will be using "lidocaine/epinephrine iontophoretic topical" instead of the topical cocaine (if that matters). He's going to titrate out of caution though, and it's listed as non-systemic... so I don't see it as an issue. Link to comment Share on other sites More sharing options...
Egads Posted April 12, 2015 Share Posted April 12, 2015 Basically general anesthesia is a giant cocktail of drugs. The main ones to look at are propofol, ketamine, isoflurane. The anesthesiologist can cater what drugs they give you based on your medical history... That's generally what their aim is. Usually they are more concerned with patients who have an arrythmia or other heart problem because most anesthesia drugs are anti-rhythmic. As long as they know what you are on, I wouldn't worry much beyond that. Know who your anesthesia attending doctor is.. As much as you want a good surgeon, the anesthesiologist keeps you alive during surgery! I wouldn't worry about it, I have seen a lot of patients with many complex medical histories and problems sail through surgery. Basically I wouldn't research it too much yourself, there are just a ton of different drugs they can and will give you while you are asleep or going to sleep. As long as they know what you are on, they will cater to you. They are some of the smartest and well-trained medical personnel I've worked with.. Trust me your anesthesiologist will know what every med is you are on.. They are the best bio-chemists around, much better than a pdoc . Link to comment Share on other sites More sharing options...
Cetkat Posted April 17, 2015 Author Share Posted April 17, 2015 I'm not too worried about the actual procedure/sedation. I've been under four times already. That said, I'm liking your last sentence. It would be great if he already knew the MAOI interactions, or could at least extrapolate based on avoiding vasoconstriction and increased catecholamines (or would sympathetics make more sense?). Do you think if they aren't immediately familiar with MAOIs, saying it that way would be helpful? I'm sure the anesthesiologist will be good. They always have been, and this surgery will actually be at Mayo, so it'll be one of the better ones in the area. For the first time I'm actually having a pre-op appointment where I speak with them directly. Before it was just a few minutes right before surgery. If anything, that and the other pre-op stuff is more overkill, IMO. But - with the Emsam, that one element is good in my case. Though, come-on... pregnancy test?! I'm on Depo-provera at Mayo that they give me every 10 weeks! It's in the chart! LOL Talk about physically impossible... Yep, *totally* needed. Another reason (beyond billing time) on why I kinda want an idea of what's normally used is due to my other meds though. I already looked up l-dopa, and the ideal time to stop it before any surgery (in general) tends to be two weeks prior - which, I can do with that one. But, the pre-op appointment is only one week prior. So, although I think that timeframe is likely greatly overestimated considering how I'm taking it, it's still good to find out now so I have the option to make things as uncomplicated for them as possible. I'm betting Modafinil and Lyrica are less problematic, but a cursory interaction look ahead of time isn't a bad thing either, for the same reason as above. Thanks for your response! Do you by chance know the alternatives to the ketamine? Link to comment Share on other sites More sharing options...
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