Dear doctor, how can I avoid adverse reactions to the anesthetic during my upcoming surgery?

Dear Dr. ROACH: I’m scheduled for cataract surgery next month. The procedure was approved by my cardiologist and my primary care physician. I’m pretty healthy and feel like I’m doing well. My doctors told me that too.

My problem is that no one seems to listen to me. I have repeatedly said that I have a problem with the anesthesia (fentanyl and midazolam). I have numerous allergies, including drug allergies. Nobody seems to take me seriously. Can I request a different anesthetic? — SS

ANSWER: The term “narcotic” is derived from the Greek word meaning numbness or stupor. The term is currently no longer used medically as it has a negative connotation due to its association with illegal drugs. So “opiates” are specifically used to refer to natural derivatives of the poppy plant (like morphine), while “opioids” are synthetic drugs (like fentanyl) that act on the same receptor. The term “opioids” is used for the entire class.

Allergies to opioids are rare, but an adverse reaction to them is common. Nausea or vomiting, constipation, dry mouth, confusion, and itching without a rash are common side effects of opioids, but are usually not allergic. True allergies are often accompanied by a skin rash, wheezing or swelling. It is estimated that 90% of people with a medically documented allergy to opioids experience a non-allergic reaction.

Your anesthetist will take a careful history of what medication you have taken and what your reaction to it was. There are several chemically distinct classes of opioids. So if you are one of the rare people with a true allergy, you can purchase a chemically unrelated alternative.

Midazolam belongs to a chemically unrelated family of sedatives called benzodiazepines. These are used during surgery to keep people calm and relaxed.