On Anaesthetics Call recently, we were administering spinal anaesthetic to a female patient for Cesarean section. She was a friendly redhead who reminded me a lot of Eleanor from Rainbow Rowell’s Eleanor & Park. She told us a lot of things, like that we would have to take the para-median approach to the spinal (we didn’t need to) and how it was impossible to get an IV-line up on her hands (it wasn’t), so when she told us that she was resistant to anaesthetic, we felt kind of resistant.
But fifteen minutes after the spinal, she still had sensation of her lower limbs. Thirty minutes later too. She had pins and needles, but otherwise normal pain sensation. It had been a perfect spinal performed by the registrar, and there was no doubt that she had been in the correct place. The decision was made to convert her to general anaesthetic, because this was an emergency list and we had a primigravida with foetal distress waiting for us too.
We probably should have suspected that something was weird when the normal dose of muscle relaxant didn’t make intubation any easier. Or, when her heart rate skyrocketed the moment the obstetrician made the incision.
It was incredibly difficult to maintain the Minimum Alveolar Concentration for her. Twice, she seemed to be “waking up”, gagging, and her arms flailing out. I have to admit that it was a very scary experience.
At that stage, the registrar told us of a study she had read regarding redheads and anaesthesia. It seems that the mutation on the melanocortin-1 receptor gene makes redheads less susceptible to anaesthesia, and they need on average 19% more anaesthesia than dark-haired individuals. The reason this isn’t taught in Anaesthesiology classes is that other studies have been confounding, stating that no difference exists between redheads and dark-haired individuals in terms of anaesthetic requirements.
But, for what it’s worth, I’ve witnessed a great amount of surgeries over the past few years, and the only time I’ve ever seen this phenomenon has been with this red-haired patient.
As for our patient: she did well afterwards, with no recall of the events.