Toxicity of anaesthetic and possibility of permanent destruction of hair follicles

[mmhce]

I would like to invite responses to some issues that I have read recently from a member of the forum:

 

It has been suggested that the anaesthetic epinephrine can cause permanent hairloss.

 

I always assumed that anaesthetics were meant to disrupt the transmission of chemical signals between nerve transmitters and receptors and not deprive the hair follicles of blood or oxygen? Correct me if I am wrong, please.

 

1. If epinephrine can cause permanent hairloss, why is it used, and can some other anaesthetic be used in its place?

 

2. What is the science behind anaesthetic causing permanent hairloss?

 

3. What is the toxicity of anaesthetics such as epinephrine and others on the human body?

 

Thanks for responses.

[mmhce]

I would like to invite responses to some issues that I have read recently from a member of the forum:

 

It has been suggested that the anaesthetic epinephrine can cause permanent hairloss.

 

I always assumed that anaesthetics were meant to disrupt the transmission of chemical signals between nerve transmitters and receptors and not deprive the hair follicles of blood or oxygen? Correct me if I am wrong, please.

 

1. If epinephrine can cause permanent hairloss, why is it used, and can some other anaesthetic be used in its place?

 

2. What is the science behind anaesthetic causing permanent hairloss?

 

3. What is the toxicity of anaesthetics such as epinephrine and others on the human body?

 

Thanks for responses.

[Maxxy]

Mmhce,

 

There is some info on it in the link below, which includes the possibility of the drug causing shockloss.

 

Epinephrine

[mmhce]

Thanks Maxxy,

 

"Conclusion

 

The use of large amounts of epinephrine for the purpose of establishing hemostasis in large hair transplant sessions is neither necessary, nor desirable. Because intra-operative bleeding in the recipient during site creation and graft placement can be controlled by simple methods, that are easy to administer and free from adverse affects, the reliance upon epinephrine in these phases of the procedure should be reconsidered."

 

So from the conclusion it would seem that epinephrine is not indicated as a component in anaestheticizing the donor or receipient area?

[Steven Gabel, MD, FACS]

mmhce

 

I am reading your post with interest. Can you please give me the source of your information concerning the adverse effects of epinephrine for hair transplantation? I would like to read the complete post. Thanks.

[mmhce]

Sure Dr. Gabel,

 

Take a look and please give us a recommendation, if you can, about the use or epinephrine in anaestheticizing tissue.

 

Here is the thread:

 

 

http://hair-restoration-info.c...&r=93010542#93010542

[mmhce]

Oh sorry.. if you meant the location of the scientific journal file.

 

here it is:

 

http://www.bernsteinmedical.co.../Epinephrine2000.php

[Dr. Alan Feller]

The body naturally produces epinephrine in the adrenal glands (located just above the kidney), so it is in and of itself harmless to follicles.

 

However, when too much is used to control bleeding in the recipient area THEN you can run into a problem. Amateur HT docs and their staffs tend to use LOADS of epinephrine, which is one of the unexplained reasons why there are so many poor HT results in the world. Now you know.

[glajo]

Thanks for the answer Dr. Feller.

[Dr. William Lindsey]

Dr. Feller is correct. Many years ago I once saw a "well-known" east coast doc attempt a hair transplant without epinephrine in an attempt to operate on a patient whose cardiologist wouldn't allow them to have epinephrine. It was like the parting of the Red Sea and I suspect very little was accomplished during the surgery other than giving the patient a scar and the doctor some boating money.

 

An appropriate dose of epinephrine is absolutely indicated and will do no harm. Additionally, when combined with very small blades, there should be virtually no bleeding during the procedure. That allows fast placement and quick healing without as much swelling postop.

 

Dr. Lindsey McLean VA

[Old Baldy]

Dr. Feller and Dr. Lindsey:

 

Are there instructional papers available to HT surgeons on how much epinephrine should be used?

 

Also, are there "manuals" for the pros to refer to regarding HT procedures?

 

You know, technical stuff that lays out the basic procedures, medications, etc?

 

If not, maybe you guys could prepare one and sell it to HT surgeons? (Or give it to HT surgeons? )

 

I wonder if too much epinephrine was used in John's procedure (i.e., the member who posted the thread entitled "butchered")?

 

I mean, something like the amount of epinephrine to be used should be standardized shouldn't it? And, all HT surgeons should know about it.

 

It's kind of irritating to an ordinary Joe like myself that this kind of stuff isn't known by all HT surgeons. It tends to make me think it is still the "Wild West" out there if you get what I mean. And, it shouldn't be the Wild West for Godsakes.

 

Edit: I just found this book is available from reading redkun's post - "Hair Transplantation", edited by Walter Unger and Ron Shapiro, 2004, Marcel Dekker Publishing.

 

Now, why in the world would an HT surgeon not have this book, or books like it, and MEMORIZE them?

 

Sorry for the rant guys but, Jesus Christ, some HT surgeons DON'T know how much epinephrine to use??!! And improper dosing can lead to graft death!!?? My God!

 

If I was like that on my job before I retired, I would have been fired on the spot. And should have been fired for Godsakes!

[glajo]

My doctor used lidocaine without epinephrine this time to place FUE's for free to make up for my original hair that was lost around donor scar and recipient site. He even mentioned to me during surgery that he didnt want to use epinephrine again not to take any more chances with my hair. From my last experience, FUE should be done with procedures of less than 500 grafts and not to get a strip for such a small procedure or you may risk damaging your existing hair surrounding donor strip scar.

[mmhce]

Old Baldy,

 

Have you read the scientific publication found here:

http://www.bernsteinmedical.co.../Epinephrine2000.php ?

 

If not, try that, and we can go from there....

 

I should think most reputable professional HT surgeons would have medical reference texts including "Hair Transplantation", edited by Walter Unger and Ron Shapiro, 2004, which I referred to in this thread I intiated,"Why is Dr. Unger not on the Coalition list?" found here:

http://hair-restoration-info.c...321015304#4321015304.

 

and which Bill says he is in the middle of reading.

 

P.S. Please refrain from Religious and Political references in this and any thread.

[Old Baldy]

Thanks for the info. mmhce and glajo!! (You also maxxy, I missed your initial link.)

 

I see the Dr. Bernstein article has been out for almost 10 years now yet some HT surgeons don't appear to know about it based on Dr. Feller's post.

 

There's no excuse for an HT surgeon to not know about controlling bleeding and the proper amount of epinephrine to use.

 

I mean, you are correct, in that, reputable HT surgeons should know about these things, and have appropriate reference books/articles.

 

But you read what Dr. Feller stated. That ain't good IMHO. There's no reason for that type of mistake. And it is a mistake that can directly affect graft survival. Inexcusable!

 

(Sorry for the religious adjectives, didn't mean to offend anyone.)

 

Edit: Interesting about allowing smokers to puff a little during surgery to control bleeding. Never knew that either.

 

Thanks again for the info.