Do Redheads Need More Anesthesia? Will Your Hair Complicate Surgery?

Redheads can be more difficult to operate on. In fact, a surgeon I used to work with tried to not operate on them in the first place. Patients often ask me: are redheads resistant to anesthesia? Do redheads require more anesthesia? Does red hair complicate anesthesia and increase risk of surgery complications?

Do red heads need more anesthesia? Yes and no.

The answer is both yes and no. It depends on your type of surgery, the type of anesthesia you receive, and other factors. Let’s break it down: 

Redhead Gene Mutation and Anesthesia

Red hair appears to be linked to mutations for a particular receptor (melanocortin-1), and this mutation may play a role in increasing anesthesia requirements for redhead women. So why would a gene mutation for hair color influence anesthesia requirements? 

We don’t know. But, since the human body is a highly interconnected system of hormones and nerve signals, changes in seemingly unrelated body parts can produce surprising results. That means that genes for red hair may impact other genes expressed in the brain. This is similar to the far reaching impacts of the foods we eat and the stress we experience - they affect all parts of our body.

It could also be that redheads, particularly women, often have lower pain tolerance, meaning they are more sensitive to pain. This lower tolerance often appears in thermal pain, like the pain from extremes of hot and cold.  

While this may be true, it’s important to recognize that this can cause undue stress from anticipation of greater pain in women, especially those with red hair.  

Heightened Fear of Pain For Redheads During Surgery and Anesthesia

The fear and anticipation of pain relating to the red hair can be far more harmful than the pain itself. This is seen in one of the most common medical procedures: dental care. Redheads are more likely to report fear of pain and are twice as likely to avoid dental care! 

Additionally, anxiety from fear of pain can result in taking more pain medication. This in turn increases the risk of overuse and addiction. 

But even though there may be slight increases in anesthesia requirement, this doesn’t necessarily mean the experience of the patient or their doctor is any different. Luckily, these requirements are simply too small to matter clinically. 

Furthermore, your anesthesiologist will likely use several different types of anesthesia for your surgery. Even if one type of anesthesia is resistant due to red hair, the other types of anesthesia will come to the rescue.

Red hair or not: a positive attitude is more important before surgery

Ultimately, this means that it is unlikely that any anesthesia changes for red hair will result in more pain or complications. Instead, focus on approaching your surgery with a calm and positive mindset. Being a redhead doesn't change your surgery or anesthesia risks as much as your mindset does! Learn about your anesthesia ahead of time so you can take control!

References

Liem, Edwin B., et al. "Anesthetic requirement is increased in redheads." Anesthesiology: The Journal of the American Society of Anesthesiologists 101.2 (2004): 279-283.

Liem, Edwin B., et al. "Increased sensitivity to thermal pain and reduced subcutaneous lidocaine efficacy in redheads." Anesthesiology: The Journal of the American Society of Anesthesiologists 102.3 (2005): 509-514.

Abdel-Malek Z: Melanocortin receptors: Their functions and regulation by physiological agonists and antagonists. Cell Mol Life Sci 2001; 58:434–41

Binkley, Catherine J., et al. "Genetic variations associated with red hair color and fear of dental pain, anxiety regarding dental care and avoidance of dental care." The Journal of the American Dental Association 140.7 (2009): 896-905.

Helmerhorst, Gijs TT, et al. "Risk factors for continued opioid use one to two months after surgery for musculoskeletal trauma." JBJS 96.6 (2014): 495-499.

Gradwohl, Stephen C., et al. "Intraoperative awareness risk, anesthetic sensitivity, and anesthetic management for patients with natural red hair: a matched cohort study." Canadian Journal of Anesthesia/Journal canadien d'anesthésie 62.4 (2015): 345-355.

Sessler, Daniel I. "Red hair and anesthetic requirement." Canadian Journal of Anesthesia/Journal canadien d'anesthésie 62.4 (2015): 333-337.

Doufas, Anthony G., et al. "Bispectral index dynamics during propofol hypnosis is similar in red-haired and dark-haired subjects." Anesthesia & Analgesia 116.2 (2013): 319-326.