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Can anesthesia cause Hair Loss

anesthesia-hair-lossAnesthesia is simply defined as the inhibition of sensation.  Its origins can be traced backed to ancient times as Egyptians, Greeks, Romans and Medieval Age Muslims have documented their attempts to pacify individual’s pain during the early attempts at surgery.

Crawford Williamson Long has been formally credited as discovering  anesthesia in the western civilization in 1842.  During his years at medical school, Long observed the effects of nitrous oxide, also known as laughing gas and ether at social gatherings where participants, including presumably himself would inhale such gases for entertainment.  He observed that attendees often would fall or bump into things but seem to feel no pain until the effects of the gas wore off.

In the years leading up to 1842, Long had the opportunity to observe and participate in several surgeries as part of his medical training.  These surgeries had a profound affect upon Long as they were agonizing experiences.  Patients were not sedated and often experienced excruciating pain.  Up till then, doctors used alcohol, hypnotism, or other relaxation modalities to relax patients before surgery, however these attempts were futile1.

In eastern civilization, Seishu Hanaoka has been credited in performing the first successful surgical treatment under general anesthesia 38 years before Long’s trials.  Hanaoka had made many efforts to develop the optimal mixture of the anesthetic called mafeisan for almost 20 years prior.  Mafeisan was a mixture of different ingredients which is believed to have include cannabis and datura, a hallucinogenic plant.  Hanaoka sought to recreate the work of another Chinese surgeon from the second century whose success with anesthesia was known but whose records were lost2.

There are various forms of anesthesia.  The type of anesthesia used depends on the type of surgery and medical condition.  The different types of anesthesia include local, regional, spinal, epidural and general.  For the purposes of this discussion we will refer to general anesthesia as our focus.

General anesthesia is an anesthetic used to render a patient unconscious during surgery.  The medication is either inhaled through a breathing mask or tube, or administered through a thin plastic tube inserted into a vein.  A breathing tube may be inserted into the patient’s trachea or windpipe to maintain adequate breathing during the surgery.  Anesthesia is administered by a specialist called an anesthesiologist who will stop the anesthetic after the surgery is completed and monitor the patient during the recovery process.

Anesthesia, like most medications, has reported side effects.  Nausea, vomiting, low body temperature, loss of coordination or judgment, sore throat, muscle aches, itching or hives and agitation have been reported as common yet infrequent side effects.  It has been hypothesized that hair loss is another potential side effect from anesthesia based upon sporadic reports.  It has been debated if hair loss is directly related to anesthesia or if it is influenced by other factors during the surgery.  This article will review the available research investigating this hypothesis.

Hair loss after surgery

It is well known that certain medications have been reported to cause hair loss.  Since there have been several post-surgical reports of patients suffering hair loss after general anesthesia, the probability of anesthesia as another cause was raised.  Several cases were cited which involved individuals suffering localized hair loss during prolonged surgery. alopecia areata

In these cases, hair loss resembled alopecia Areata, which is the most frequent cause of inflammation induced hair loss and is associated with autoimmune disorders.  However, upon further investigating, the cause of the patient’s hair loss was attributed to a phenomenon called pressure alopecia.  Pressure alopecia is the term used to describe hair loss that occurs following the reduction of blood flow to the tissues of the scalp, similar to pressure ulcers in bed ridden patients.

The constant pressure on the scalp upon the surface of the bed or stretcher is the cause and is believed to be triggered by reduced oxygen or blood pressure during the procedure.  There appears to be a link between the length of time spent under anesthesia and the development of permanent hair loss.  Additionally, there have been reports which confirm that regular head turning schedules eliminates the problem3.

Saudi Arabian researchers reviewed several cases of postoperative hair loss to determine if alopecia Areata could also be a factor due to its similarities with pressure alopecia.  They determined that despite pressure alopecia occurring most often, psychological stress, which has been known to trigger alopecia Areata could also be a factor in some cases4.

Traditionally, alopecia Areata has been regarded as a stress induced disease.  The psychological  impact of surgery upon the patient may be significant enough to incite the inflammatory and autoimmune changes known to cause this specific type of hair loss5.

Another type of hair loss, called Telogen Effluvium, has been linked to the physiological impact of the surgery.  It has been known that severe physiological stress may increase the conversion of hair follicles actively in the growth or anagen phase to the resting or telogen phase.  When the resulting increased numbers of hairs are shed at the end of the resting phase, a diffuse thinning of scalp hair occurs.  Afterward, the normal hair cycle is again resumed and hair regrowth will occur.  Desai and Roaf presented a case of a woman who had surgery under general anesthesia who developed diffuse thinning of hair after surgery which regrew and was unnoticeable after several months6.

Anesthesia directly causing hair loss?

There are no studies directly investigating the various medications involved with anesthesia and hair loss.  Again, the review of side effects of commonly used anesthetics do not list hair loss as a reported side effect.  Further, several of the medications used in anesthesia are indicated for other non-surgical conditions and despite removing the influence of surgery, hair loss has not been reported which such medications.  Hair loss has been reported after surgery under anesthesia.  The cause of the hair loss can be attributed to pressure alopecia, alopecia Areata and Telogen effluvium.  Theses specific causes are not directly linked to the use of anesthesia.  More research is needed to exclude anesthesia as a indirect cause and possibly impacting the body’s immune response.

 

Works cited

  1. http://www.georgiaencyclopedia.org/articles/science-medicine/crawford-long-1815-1878
  2. Izuo M.  Medical history: Seishu hanaoka and his success in breast cancer surgery under general anesthesia two hundred years ago.  Breast Cancer.  Nov 2004; 11 (4): pp 319-324.
  3. Davies KE and Yesudian PD.  Pressure Alopecia.  Int J Trichology. 2012 Apr-Jun; 4(2): 64– 68.
  4. Khalaf H, et al.  Postoperative alopecia areata: is pressure-induced ischemia the only cause to blame?  Transplant Proc. 2004 Sep; 36(7): 2158-9.
  5. Gilhar A, et al.  Alopecia Areata.  N Engl J Med 2012; 366: 1515-25.
  6. Desai SP, Roaf ER.  Telogen effluvium after anesthesia and surgery.  Anesth Analg. 1984   Jan; 63(1): 83-4.