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This question is for a highly academically qualified and

experienced Anaesthetist? There are two parts: 1)...
This question is for a highly academically qualified and experienced Anaesthetist?
There are two parts:
1) To your knowledge, have you ever had or known of a patient who has been afflicted with catastrophic brain injury following a general anaesthetic?
2) To the best of your knowledge, and this question may require research from articles published in medical academic journals, have you ever known of an incident of the anaesthetic drug Propofol been suspected or proven to have caused catastrophic brain injury?
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Answered in 9 hours by:
8/6/2012
Andy PhD DABT
Andy PhD DABT, Toxicologist
Category: Health
Satisfied Customers: 137
Experience: Board certified with 20 years in research or consulting
Verified
Hello,
I am a toxicologist and have 10 years of bio-medical research experience, including developing a new cancer treatment. I am not an anesthetist and do not treat people, so I can not answer your first question. However, if you would like I could help you with your second question.
If you would like me to help you, then please let me know. Can you tell me what happened and what kind of brain injury you are thinking occurred?
Take care,
Andy
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Customer reply replied 5 years ago

Thank you - yes. I would be very happy if you could examine carefully and provide an educated reply for me. It would be very helpful.

Following a general anaesthetic using Propofol required for surgery on one of my shoulders, I developed very strange and out of character behaviour as though I was psychotic. But I wasn't.

I was living in the country then and was transferred from one hospital to another and to another until eventually I reached the capital city Adelaide where I was further transferred to one private hospital and then to a second. It was while I was at this second hospital, still behaving most out of character, that I reached the decision that the problem of how I felt and behaved was organic in origin.

So I arranged to have myself transferred to the leading general hospital here, the Royal Adelaide Hospital, and my doctor (private) applied pressure to the public doctors whose care I was now under, insisting that an MRI of my brain be carried out asap. I remember this and it was taken at about 10.30pm of the day that I transferred myself. I remained quite deranged (and was aware that I was) as an in patient at the RAH. I asked and asked the doctors in charge please would they tell me the results of the MRI scan but they refused. And that was the situation for some weeks. Whenever I asked what the MRI scan showed, I was just brushed off by the staff, being told that something happened during the anaesthetic, or the anaesthetic caused my state of mind. I never ascertained in all the weeks I had to stay at that hospital what the scan showed. Eventually I was released and allowed to go back to my home in the country by this time being no longer psychotic. But I knew that my brain was far from 100% from working normally. So I sent away all over the world, spending a lot of money, for software and books that might help my brain mend itself. It took many months but finally I attained what for me might be called 'normal' functioning of my brain. Once I was getting close to that situation, after pestering him for months my private doctor under whose care I was again began to provide me with academic articles to read which all seemed to point in the same direction, that it was the Propofol anaesthetic that was the most likely cause of my apparent psychosis. Worse still, I was eventually allowed to view the scans taken by the MRI and it was plain to see that there considerable sections of my brain that were no longer there, and also that of what was left undamaged showed, in places, evidence of shrinkage. So finally the diagnosis as to what had happened was related to me - that I had suffered catastrophic brain injury. So what I was hoping you could investigate further for me is whether you have any evidence of Propofol causing such damage? I would be most grateful for any information you could provide to help me get to the bottom, scientifically, of this frightful experience. It is now more than three years since that operation. I was fortunate that I was one of those patients whose brain could 'change itself' as per the famous book. At first glance even with the last scan taken last year, my brain looks as though it was subjected to hypoxia. However, my private doctor is still of the opinion that it was more likely the Propofol that caused all the damage. I have made numerous approaches to the Anaesthetist who carried out the anaesthetic, by letter from me, in person I visited him when he agreed to provide a report but never did, and all letters from other experts sent to this Anaesthetist have been ignored. Naturally, his behaviour leads to some degree of suspicion but I am yet able to find the proof. I think that covers the essence of this most appalling experience for me. So I look forward to your considered reply - no rush - accuracy instead. Kind regards,

Caroline.

Hi,
Thank you for the background information, that really helps. I'll look into this for you, but it may take a few days.
I'm sorry that this happened to you. Nobody expects to go into surgery and come out with brain damage.
Take care,
Andy
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Hi,
Can you tell me a little more about your operation? Where you in a regular operating room of a hospital with a surgeon, anesthetist, and nurses or was this a procedure done in a doctor's office. Also, do you know if you were put on an artificial ventilator?
Take care,
Andy
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Customer reply replied 5 years ago

Dear *****,

Don't mind how many questions you need to fire at me if the answers can help provide the truth concerning whatever happened during this operation. I've been able to answer all but the last below as you will read. Will get back to you with the answer to that question in about 8 hours.

The operation was performed on my right shoulder because I was experiencing extreme pain - thought to be due to overuse. An ultrasound of the area revealed torn ligaments and almost completely torn tendons. The aim of the operation was to attempt to repair these tears. The surgeon told me afterwards that he had done the best he could but was not able to fix the tendons as well as he would have liked.

Yes, the operation took place in one of Adelaide's leading hospitals in a regular operating room with a surgeon (of course), anaesthetist, yes and I know their names, but I was not aware of nurses but I would assume that most likely there would have been a few, I just can't remember them. I am not able to answer whether I was put on an artificial ventilator but I will be able to find out later this afternoon when I will be able to complete the last question you asked here. Thanks for hanging in there with me - it's really important.

Kind regards,

Caroline.

Hi Caroline,
Sorry for the long delay. I looked at several scientific studies and it looks like propofol can cause brain damage in developing brains, but not in adult brains. There is a major difference in how the neurons in immature brains work compared to adult neurons, so just because this happens in developing brains does not mean it will happen in adult brains. So because of your age I don't think your problem was caused by direct toxicity to the brain. However, it does commonly cause loss of oxygen in the brain (anoxia). This is caused by lowering blood pressure and decreasing the rate of breathing. This should not be a major issue if the doctors expect to put you on an artificial respirator to counter the lowered breathing. Also, some studies suggest propofol can help protect the brain from anoxia induced brain injury, but the data is not conclusive and if the oxygen level is really low it wont be able to prevent damage.
The problem with propofol is that it's effects are not very predictable. A dose that causes sedation in one person could cause full anesthesia in another person. So doctors have to be experienced in using propofol and monitor the patent constantly as they can get worse and stop breathing pretty quickly. Doctors also need to be well equipped to deal with strong effects of propofol such as having an artificial respirator. This is a problem because in some places nurses are giving propofol not the doctors or a surgeon gives propofol without an anesthesiologist, so the surgeon gives the propofol then focuses on the surgical procedure and doesn't focus on the level of anesthesia, so may not notice when the patent is in trouble. So misuse of propofol is a common problem.
So I think it is more likely that you suffered from lack of oxygen rather than a direct toxicity of the propofol to the brain. Also your doctor said that they thought your MRI showed anoxic brain injury, which agrees with this. Since there was an anesthesiologist there I would not have thought anoxia would happen, but that seems like the most likely answer. None of the studies showed propofol causing direct brain injury to adults, just anoxic injury from low oxygen and blood flow.
I hope this helped you.
Take care,
Andy
Here are some papers for further reading.
http://www.ncbi.nlm.nih.gov/m/pubmed/20714114/?i=4&from=propofol%20toxicity%20brain
http://www.n cbi.nlm.nih.gov/m/pubmed/19526290/?i=8&from=propofol%20toxicity%20brain
http://www.ncbi.nlm.nih.gov/m/pubmed/18812886/?i=14&from=propofol%20toxicity%20brain
http://www.ncbi.nlm.nih.gov/m/pubmed/18499599/?i=15&from=propofol%20toxicity%20brain
http://www.ncbi.nlm.nih.gov/m/pubmed/18482023/?i=16&from=propofol%20toxicity%20brain
http://www.ncbi.nlm.nih.gov/m/pubmed/16960478/?i=24&from=propofol%20toxicity%20brain
Andy PhD DABT
Andy PhD DABT, Toxicologist
Category: Health
Satisfied Customers: 137
Experience: Board certified with 20 years in research or consulting
Verified
Andy PhD DABT and 87 other Health Specialists are ready to help you
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Customer reply replied 5 years ago

I would apply 'Good Service' to the doctor who comprehensively answered the second part of my question. I cannot apply 'Excellent Service' just for that reason, your organsation vouches that it is supplying a service. But your service was not able to provide a specialist who actually works in the field that my questions require answers for. However, as a toxicologist he did provide a comprehensive answer working within the confines of his expertise. I recommend that your service be equipped to have staff across the board so to speak so that there are no gaps in some answers because you lack the personnel you really need. And as a questioner, one has no knowledge that you may not be able to draw upon as much expertise required to satisfy the patient's enquiry. But thank you for a very good service. I will follow up by undertaking reading the papers which you provided the references for. It is possible that having done that I may have more questions. Best regards, Caroline.

Hi Caroline,
No problem, if you have more questions please let me know. You can ask for me specifically by asking for Andy_PhD_DABT or going to my profile (http://www.justanswer.com/medical/expert-andyphddabt/) or you can leave it open for other experts to try to answer. Sorry we didn't have the most directed expert for you. You might want to suggest to customer service that they add a list of active experts and their specialtese so customers can better gage how well their question might get answered. Currently there is no such list for customers or experts to see.
I hope those additional links help you, i'll be here if you need further help.
Take care,
Andy
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