Anesthesia

A comment from an anesthesiologist:
As a practicing anesthesiologist I can only reiterate that communicating with your doctors is key. I have yet to have a patient on Suboxone or their primary doctor contact me prior to surgery. I have had to cancel cases because nothing was done with the Suboxone dose prior to surgery. This is a simple fix as long as you communicate with your anesthesiologist ahead of time. I think a lot of this has to do with a lack of knowledge in the primary care arena about Suboxone.  Eric Swetland MD
Response:
Thanks Dr. Swetland for your comment.  As a former anesthesiologist I try to get patients to plan ahead and foster communication with me, the surgeon or OB, the anesthesiologist… but it still is often left for the morning of surgery.  One of my patients had a C-section a couple months ago– she told her OB to call me and I called once and left a message, but he did not call until the morning of her stat c-section, after the case was done and she was writhing in pain in the recovery room as her SPINAL wore off.  He asked what he should do, and I said ‘an epidural would have been nice….’.  I ended up recommending that they put her in the ICU and give her mega-doses of narcotics, and that is what they did.  She was fine, but an epidural would have allowed greater comfort and less expense.

“

Another patient had a vaginal delivery of a healthy baby;  the hospital, though, was not ‘comfortable’ with Suboxone and so a neonatologist was involved.  The patient begged him to call me–  I did not know at the time that this was going on– but he told her that ‘he knew what he was doing without calling some other doctor’ (oh, the ego!).  Against her wishes he put her baby on a morphine infusion to treat withdrawal;  the nurses were curt and rude, a couple making statements to assure she felt guilty about her baby’s ‘withdrawal’.  The nurses gave a number of conflicting statements about her wish to breastfeed her baby while taking Suboxone.  Afterward she told me that her baby looked like all the other babies before the morphine and after it was finally stopped– didn’t cry more, sleep less, etc… and I shared articles with her about the fact that newborns of Suboxone-using moms show minimal if any signs of withdrawal, and that breastfeeding is fine and results in no significant buprenorphine exposure for the infant.
I had a 67-y-o patient sent home from the ER after going in with a temp of 102 degrees F and sharp pains in the side of his chest– the doc told him ‘it was probably from the Suboxone’!!  I told him to go back, and I called the ER and told them it was NOT the Suboxone– they did x-rays this time and diagnosed his pneumonia!
Doctors have a bad habit of blaming symptoms on things they don’t know much about;  patients have their own problems by keeping their use of Suboxone to themselves, too embarassed to let their doctors know about their use.  I encourage everyone to communicate– this is a new drug and new paradigm, and it is important that everyone knows what they are dealing with.  OK… so much for the soapbox…
SD
Suboxone Talk Zone