Anaesthetics adverse reactions

Anaesthetic adverse events - can they be prevented?

There are no studies and few research papers looking at adverse effects that occur in the days and weeks following surgery. We are looking for cases to be written up by Dr Anita Holdcroft or your own anaesthetist, to submit for inclusion in medical journals. We have three mothers, including myself and Clare Milford-Haven, who are willing to support this initiative and recently held a meeting with Dr Holdcroft.
All three cases were mania, psychosis or suicide that occured 7 days after surgery.

We are all off the anaesthetist's radar once the surgery has been completed. GP's and psychiatrists may not link the sudden onset of depression, mania, aggressive or suicidal behaviour to the recent surgery - thus reports to the Royal College of anaesthetists or the MHRA are few.

Please inform APRIL charity and send a patient Yellow Card to the UK regulator

IMPORTANT - Check the Liver and kidney function of patients suffering psychiatric disturbance following surgery.

It has been brought to our attention that a person who became violent following surgery was suffering from liver failure which would exacerbate or even cause adverse reactions due to toxic levels of drugs building up in his body.

APRIL has been informed that another patient who became psychotic following surgery, possibly due to the anaesthetics and pain killers, has never had liver and kidney function checked.

This man is still seriously ill over 2 years later and has been given so much psychotropic medicine and now drugs for neurological disorder that his wife is in despair.

We are informed that the first man recoved mentally and physically following a period in Intensive Care.

Many people do recover well as long as they are not overdosed with psychotropic drugs.

The founder of APRIL experienced her own daughter, Karen suffering a sudden onset of psychosis 7 days following surgery and anaethetics for removal of her wisdom teeth. The full story is in the left menu link'About Us'.

The following abstract is by Dr Anita Holdcroft from her presentation at the APRIL conference on 6 November 2008.


Anaesthetic adverse events – can they be prevented?

Dr Anita Holdcroft

Since the last APRIL conference in 2004, there have been significant developments in identifying anaesthetic drug reactions as well as on line availability of information on adverse events. For example, the Royal College of Anaesthetists ( has developed a series of patient information files of which the one on confusion after surgery sets out its frequency, the causes such an event and how patients can avoid it.


Since 2005, the Medicines and Healthcare products Regulatory Agency (MHRA) has allowed patients to report on so-called ‘Yellow Forms’ to add to the data collected and summarized in Drug Analysis Prints

The MHRA have furthermore made available to our research team additional data from which we were able to produce more detailed analyses of hazard signals for pain relieving drugs used during anaesthesia [1]. Two analgesic drugs, fentanyl and nalbuphine, had particular hazards for psychiatric reports. Since there are many limitations in reporting data collected on the yellow forms these hazard signals need verification by further research. One limitation is in the identification of the causal agent because of the quantity of drugs given during anaesthesia, including prophylactic antibiotics.

Interestingly only this week, recurrent acute psychosis with confusion, agitation, hallucinations, delusions and disordered speech caused by such antibacterial agents was reported with full recovery of the patient (BMJ 2008;337:996). Another patient may not have such a good outcome and in yet another, this type of event may have been prevented through a detailed medical history. The MHRA reports suggest that similar symptoms occur in relation to many of the anaesthetic drugs used daily. Hence it is proposed that there may be recurrent and/or delayed onset of effects which up to the present have not been sufficiently recognised or reported.

References from the presentation

1. Richardson J, Holdcroft A. Results of forty years Yellow Card reporting for commonly used peri-operative analgesic drugs. Pharmacoepidemiology and Drug Safety 2007;16:687-694.

2. Richardson J, Holdcroft A, Results of forty years yellow card reporting for commonly used peri-operative analgesic drugs. Br J Anaesth 2006;96:276P

3. Holdcroft A. UK Data Analysis Prints and Anaesthetic Adverse Drug Reactions. Pharmacoepidemiology and Drug Safety, 2007;16:316-328