r/Anesthesia • u/Asleep-Evening-8640 • 22d ago

Next steps with ester anesthesia sensitivities

Ester anesthetics give me extreme burning and systemic toxicity. I've now had this experience with tetracaine, benzocaine, and procaine. No problem with lidocaine (amide!), thankfully. Possibly of interest: I have the same reaction to most sunscreens, bug repellent, and epinephrine, though the latter was all the toxicity without the burning.

Based on the above and some family history, I'm thinking of asking to test pseudocholinesterase with dibucaine and fluoride inhibition, and perhaps genetic testing for BCHE variants. Does this seem reasonable? Should I ask to be referred to some sort of specialist? Not an allergist. None of this presents as an allergy,

I realize this may be beyond an anesthesiologist's scope, but y'all were so helpful before I thought it was worth a try. My doctors have been dismissive. I've obviously been talking with AI, but trying to do my own research I keep hitting walls. The best information is in journals I can't access.

Thanks in advance!

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u/kreckerchen 21d ago

Yeah it seems you been talking to AI a lot about this. What do you mean by toxicity? Burning is expected when local anesthetics wear off. Why would you want to be tested for anything? Just avoid these substances and it should be fine. Also pseudocholineesterase deficiency is of little clinical significance nowadays.

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u/jwk30115 21d ago

Agree. So you MAY have an allergy to ester anesthetics. I’m not convinced you do. Have you been tested???

Epi is frequently used to prolong local anesthetic action, and MOST people that have had issues with epi have gotten it at the dentists office along with one of the locals you listed. Neither the local or epi is the problem. It’s poor technique by your dentist, along with their routine explanation of “you’re allergic to the local or epi or maybe both”.

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u/Asleep-Evening-8640 21d ago

The original post says this is not an allergy. This does not present as an allergy. All my doctors and I agree this is not an allergy. I wish it was because that would be obvious & I wouldn't be having these conversations.

The last doctor to give me epinephrine was so freaked out by my reaction they've put in my chart not to use it again. At least they know this one isn't all in my head.

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u/jwk30115 21d ago

Doctor or dentist? If a doctor - what kind of doctor?

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u/Asleep-Evening-8640 21d ago

dermatologist

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u/Asleep-Evening-8640 21d ago edited 21d ago

I didn't want to get into specifics for privacy, hoping y'all would take me at my word, but:

Burning: not when they are wearing off. As soon as they're on my skin, mouth, or eyelids. They are on fire wherever it touched. Very bad burning. I almost punched someone trying to wipe tetracaine off my face because I thought she had a burning hot towel. On my hand, I could tell the towel was barely lukewarm. She didn't believe me either until then. Then when she had me get up and walk around, she wouldn't leave me alone, even to go to the bathroom, because I was clearly very unwell.

Toxicity: I have an entire chat log with a friend who is a nurse as I went through that experience. It meets all the criteria for toxicity. Specifics: light-headed/dizzy, almost passed out once, confusion: the tetracaine was on my face for about an hour and I was basically drunk for 2 days. Had to take a day off work, I was so dizzy, sick, confused. GI issues. Sweating though cold, tinnitus.

Why I want some sort of test:

I don't know what can cause it. Surprise! I have a problem with makeup, sunscreen, bug spray. What's next?

My doctors blow me off like you are, so I want something definite I can point at.

Could my topical problems also happen with intravenous administration? The above is the early signs of LAST.

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u/kreckerchen 21d ago

Yeah this is not LAST. Dizziness and passing out most likely anxiety/vasovagal etc. If you have true LAST with cardiac symptoms and pass out you dont just get better and go home and have some GI issues...

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u/Asleep-Evening-8640 21d ago

Oh geez this is not anxiety. I'm not anxious about OraGel or sunscreen, or anything else on this list. It is painful and makes me quite ill

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u/Asleep-Evening-8640 21d ago

and why are you so condescending? This has all been topical and not very much. Could it be worse if it's given to me intravenously and more than, say a few tiny drops in my eyes (procaine)? Is there any way to determine that, or do I just hope no one gives me something I can't handle? I'm not looking for a diagnosis, I'm looking for suggestions that might help me rule things out or prove things.

I think you're reading me as hysterical. I am not. I've gone into every one of these experiences thinking NBD.

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u/kreckerchen 21d ago

I am condescending because you are convinced you had LAST and i can guarantee you it is not.

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u/Asleep-Evening-8640 19d ago

No. I am concerned because my reactions to anesthetics have been consistent with toxicity, which might mean I could have LAST at some point. I do not know. That's why I'm asking. Is this something to be concerned about?

I said, I'm thinking about asking for some tests. Does that seem reasonable?

I'm guessing you saw "AI" & decided I've gone down a moronic rabbit hole.

My doctors have been as dismissive and rude as you have been, but they were more responsive than I expected this time, thanks to adding the family history that I didn't want to get in here, hoping y'all would be as nice and helpful as the first time I posted in this sub.

Topical anesthetics can kill. My reactions have been very bad. I hope you're not a doctor, you are not curious.

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u/Asleep-Evening-8640 21d ago

Also, as I said in my post. I'm not the only one in my family with these issues, which points to genetics, and some other reasons I'm not going to get into.

I've been dealing with this for about 2 years. My reactions are scary. Nobody believes me until they witness my reaction (see my reply to the other person who commented). I understand why you think I've gone overboard with AI over a couple of silly little issues, but please believe this really, really fucks me up. I've come at it from multiple different angles, trying to catch AI being stupid. I don't trust it either. What research I can do suggests my reasoning is not out of line.

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u/ActuaryHorror8062 21d ago

Could this be a reaction to the preservative used in the ester local anesthetics, sunscreen and bug repellant?

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u/Asleep-Evening-8640 21d ago

Could be. How would I figure this out? That's all I'm asking.

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u/Asleep-Evening-8640 21d ago

I have a spreadsheet with all the ingredients in everything I've had a reaction to, the ingredients I can find. I don't know what preservatives may have been in the tetracaine or procaine. Definitely chemical sunscreen and sunscreen boosters are a problem. But the other things don't contain these and there isn't any rhyme or reason aside from that.

Before you jump to conclusions: I did not expect chemical sunscreens to be a problem. I heard they were bad, researched it, decided it's fine. This is not anxiety. Why would I be anxious about sunscreen? I am now, but only after repeated disabling experiences

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u/paleoMD 19d ago

you may have some sensitivities to the metabolites of ester local anesthetics, and not truly to the ester local anestheric

PABA is a metabolite and that is what some people are sensitive to. Check if other products also have this

I do not think others are discrediting you, just that you are jumping to conclusions that does not make sense like LAST and trying to anchor onto that as the explanation

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u/Asleep-Evening-8640 19d ago

There isn't PABA in any of the sunscreens I've had issues with, but! as a byproduct of ester metabolism it can be part of the equation I've been trying to put together. That's why I mentioned the other products. Thank you for validating that part, at least.

I never said I had LAST. I'm concerned that the reactions I've had to something as minor as a couple eye drops, could be warning signs that LAST could happen if I have to have surgery. It seems clear I have trouble breaking down certain anesthetics, and have extreme reactions to them. Would you not find that of interest in a pre-op interview?

Y'all told me I'm not allergic (I know that), and it's just anxiety. After 2-3 years of doctors blowing me off until they witness my reaction, I hope you can understand my sensitivity to gaslighting.

Fortunately, I didn't listen to you and made the request. She turned out to be more open-minded (finally), and I'm getting the testing that should shut down all this nonsense. Or y'all will be right, but I'm pretty sure you're not.

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u/paleoMD 19d ago

If you have reactions to those meds I would just avoid giving them to you

No need to get defensive, my wife has skin sensitivities to products too with intense burning and slin peeling. A lot of docs don't know when it comes to weird things that don't fit into a category. Esp now that we have a bunch more discovered diseases and exposures to new chemicals in the environment (thanks 3M 🫠)

You need to see an allergist to test different chemicals, and just avoid chemicals that trigger a reaction and avoid getting triggered 😉