Biopsies and Anesthetics

[eggcentered]

I am a 53 year-old woman whose recent mammogram showed < 1cm mass in my left breast. Nothing appeared in the follow-up ultrasound. Upon meeting with a surgeon to discuss (and subsequently plan for) a biopsy I mentioned that I take an MAOI (Nardil) and could not be administered Epenephrine during surgery. When the surgeon said he used Lydocaine, rather than Epenephrine, I realized he did not know about Nardil's contraindications (as neither Lydocaine/Epenephrine are safe for me). I cannot take anything that clots blood.



I know I am stressed from the anticipation of a biopsy -- as it seems most of us are -- and also by a decision to put a few life decisions on hold until I have closure/can proceed with whatever follow-up up is required post-biopsy.



That being said, I'm very concerned about the surgeon's ignorance. I've successfully been awake for surgery with only local anesthetic in the past -- Carbocaine, or some variation thereof -- and the procedures to which I'm referring were longer and more invasive than the biopsy is to be.



On one hand I believe doctors and patients need to educate each other; on the other, I believe I have the right to want a surgeon that I trust going into this procedure. I am so tired of defending myself for taking Nardil and being perceived as overracting when I'm merely "self-advocating."



Any advice here would sincerely be appreciated.



I am concerned that what for me is self-advocacy might be perceived as overactive.

[CCF-RN,MSN-rf]

Dear eggcentered:  The following is general information regarding people who are taking Nardil and contemplating surgery.  "Persons taking Nardil should not undergo elective surgery requiring general anesthesia. Also, they should not be given cocaine or local anesthesia containing vasoconstrictors vasoconstrictors. The possible combined hypotensive effects of Nardil and spinal should be kept in mind. Nardil should be discontinued at least 10 days prior to elective surgery."  In many institutions, an anesthesiologist is the person who makes the decisions regarding anesthesia and administers this.  If your surgeon will not be using the services of an anesthesiologist, you have a couple of options.  Relay to him the information you have relayed to us or obtain an opinion from another surgeon with whom you feel more comfortable.

[japdip]

There is nothing wrong with seeking a second opinion ...... or just consulting another surgeon since you don't seem comfortable with this one. EVERYTHING is your choice after all. I had a somewhat similar experience before my bx but with the anesthesiologist who interviewed me pre-op. He was banned from my OR as a result. Do whatever you must to achieve peace of mind .... don't be shy !!!

[Christie2004]

Get the doctor who is prescribing the Nardil to write a letter detailing which of the "caines" are not contraindicated.  Or a letter from your pharmacist.



It is a sad fact that many doctors will not listen closely to a patient who is advocating for him/herself.  They will listen to someone who is licensed.  And if it is presented in writing, you will at least have documentation of your concern.

[surgeon]

The problem seems to be a misunderstanding of what the doctor said, I'm guessing. Lidocaine is not an issue with MAOIs; epinephrine is. Some lidocaine comes with epi in it, other doesn't. The doctor may have said he uses lido without epi, which ought to pose no problem. Lidocaine is a local anesthetic; epinephrine is a blood-vessel constrictor that slows the rate at which the anesthetic "washes away" from where it's injected. It still lasts plenty long without using epi.