Insider's Guide to General Anesthesia: What do you need to know before going "under"?
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General Anesthesia
For some procedures and surgeries, you may have a choice regarding the type of anesthesia that can be used. Many times, though, the only good choice will be general anesthesia.
Definition: General anesthesia implies loss of consciousness. If you are "under" with general anesthesia, you cannot feel, see or hear anything and you do not respond to even painful stimuli.
What to Expect Before Surgery: After checking in with a nurse and having an IV placed, you will meet your anesthesiologist to discuss your anesthetic. Midazolam or other sedatives are often given prior to other medications to "take the edge off". You may get this type of drug before
you even leave the pre-op room. These drugs kick in within a minute and make you forget anything that happens after you get them, although the effect varies from person to person. For this reason you may have no, or only vague memories of entering the operating room. After you go to the operating room, you will be given oxygen to breathe and will have monitors such as a blood pressure cuff, an oxygen monitor and EKG stickers placed.
Agents for Induction: Most commonly, your general anesthetic is induced with medicines injected into your IV. Anesthesia providers use a combination of medications that function as sedatives, pain relievers and hypnotics for the induction (getting you to sleep) phase of general anesthesia. You may or may not remember this if you were given a sedative in the pre-op phase.
After You are Sleeping*: Once you are unconscious, your anesthesia provider will make sure you are getting enough oxygen and anesthesia. To do this, he or she may most often will need to place a breathing device to help keep your airway open. There are various ways to do this including using just an oxygen mask in select cases, an LMA -- a soft rubber mask that sits inside of your mouth, just over the opening to your windpipe, or a breathing tube that slides into the windpipe between the vocal cords. The decision regarding the type of airway device is based on many factors including any medical problems that you have and the type of surgery planned.
(* although we use the word "sleeping", anesthesia is not like nightime sleep. You cannot be awakened until the drugs are removed/metabolized from your body. Recent articles online reiterate that general anesthesia is better thought of as a controlled, reversible coma-like state.)
Maintenance of General Anesthesia: Maintenance of anesthesia refers to the process of keeping you asleep for the entire surgery. Usually a combination of gas anesthesia, IV hypnotics and strong pain medication are used for this important stage of general anesthesia.
During this phase, your anesthesiologist stays with you, carefully monitoring your vital signs and keeping you safe. Your anesthesia is adjusted throughout the operation based on what is going on in the surgery. For example, your anesthesia will be "lighter" during the time that the nurse is washing the surgical area with sterilizing soap. You need less anesthesia because this is not painful or disruptive for your body. Too much anesthesia when it is not needed causes the heart rate and blood pressure to drop. When the surgeons are ready to begin, your anesthesia provider will adjust the anesthesia to make sure you have enough.
Your unconsciousness is maintained by watching your heart rate, blood pressure and breathing rate. Medications are increased or decreased based on your specific needs during that surgery. In other words, every anesthetic is customized to the needs of the patient.
Emergence: When the surgery is over, the anesthesia gases are allowed to dissipate. Titration of pain medication continues so that you do not wake up in pain. You move through stages of consciousness until, at last, you are awake and the breathing mask or tube is removed. Don't worry, you won't likely remember it, though. Most people don't realize they are awake until some time later in the recovery room.
After-Effects: Our anesthetics are much shorter-acting than even those of 10 years ago, but they are still going to make you feel pretty sleepy for the rest of the day, after your surgery. General anesthetics have the unfortunate side effect of nausea and vomiting. If you are particularly prone to nausea, for example, from motion sickness, make sure to tell the nurses and doctors in the pre-op area. There are meds they can give you to minimize this side effect.
The pain medicines you will take after surgery have many of the same side effects. So, if you are still sleepy and having nausea a couple days after your surgery, it more likely results from narcotic pain medicines than the anesthetic.
Common Questions about General Anesthesia
--How do you know I'm asleep? Anesthesiologists monitor all of your vital signs, continuously, throughout the surgery. Increases in heart rate, breathing rate and blood pressure all signal "light" anesthesia. This does not mean you are awake. Your autonomic nervous system reacts to the stressful stimuli of surgery long before you would wake up. Likewise, you would actually move involuntarily as a reaction to the surgery while still unconscious, as well.
--What is anesthesia awareness? Anesthesia awareness is an unfortunate situation where you are not fully unconscious during the surgery. People with true anesthesia awareness usually report that they could hear some of what was going on in the operating room. Usually, they can't feel anything, but may be very scared. Rarely, they can feel the surgery but can't move or speak. People who have medical or surgical issues where giving deep anesthesia is dangerous are at more risk for true anesthesia awareness.
--Why do you say "true" anesthesia awareness? Many, many cases where people think they have been awake during general anesthesia are mistaken. The most common scenario involves a surgery where they actually had sedation anesthesia or sedation in combo with a spinal, epidural or regional anesthetic. Those types of anesthesia do NOT (and are not supposed to) induce unconsciousness. It is absolutely normal to have memories and be at least, partially awake during these surgeries, but memories may be fuzzy due to the drugs used.
--Do you use a brain monitor? The various brain monitors have not been shown to provide protection from anesthesia awareness. Monitoring for sweating, tearing, increases in heart rate, breathing and blood pressure are much more reliable. The brain monitors may provide other valuable information so your anesthesiologist may use one, but not to prevent awareness.
--Why do I have to have general anesthesia for this surgery? Many types of surgery simply cannot be done with other types of anesthesia. Obvious examples would be brain and heart operations. But others, such as laparoscopic abdominal surgeries, require more explanation. When you have laparoscopic surgery, the surgeons use skinny tubes with cameras and their instruments on the ends to do the operation. This causes less pain than large incisions.
In order to be able to see into the abdominal cavity with cameras, the surgeons need to make room to operate. To do this, they inflate the abdomen with gas, usually carbon dioxide, to create a domed space in which to work. The other types of anesthesia -- epidurals and spinals -- that used to be used for abdominal surgery just don't cover enough of the abdomen to keep you comfortable. Also, the table is often adjusted into a "head-down" position to improve working conditions even more. The combination of an inflated belly and laying head down makes it very difficult to take deep breaths and keep your oxygen level adequate. With you asleep under general anesthesia, we can use the ventilator to help make sure your lungs are fully inflated, making oxygenation easier and safer.
--Why can't I eat or drink anything after midnight before my surgery? When you go to sleep with anesthesia, it's not like normal nighttime sleep. At the point that you become unconscious, you also lose the protective reflexes that normally keep your airway clear. For example, while awake, if something irritates your vocal cords, they would reflexively close and you would cough to clear the irritant. While unconscious with anesthesia, you may be more prone to regurgitation of stomach contents AND your vocal cords and the rest of your throat can't react to prevent the material from entering your windpipe and your lungs. This can lead to dangerous conditions called aspiration pneumonitis or aspiration pneumonia. Damage to or infection in, the lungs causes serious complications in some people.
So...the food or even water you have in your stomach could end up in your lungs. While some studies show that the usual 8 hours may be overly-cautious and some institutions are shortening the NPO (nothing by mouth) interval, some will not for another reason. Surgeries sometimes cancel or get moved around. If you are lucky enough to have your surgery moved earlier in the day, but you have eaten within the NPO interval, the operating staff will not be able to move your surgery earlier. If they move someone else up, you may end up getting delayed even later.
For information on other types of anesthesia...
- Insider's Guide to Spinal Anesthesia
Your anesthesiologist may recommend, or give you the option of, spinal anesthesia for your surgery. Use this page to learn what they are good for and learn the benefits and risks of spinal anesthesia. A...
- Insider's Guide to Epidural Anesthesia
Epidural anesthesia, best know for its role in alleviating labor pains, provides surgical and post-surgical pain relief for other procedures as well. Epidurals are sometimes used in hip and knee surgery and...
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Thank you :) I know anesthesia is scary and we anesthesiologists get all of 5 minutes to meet our patients, review the chart and labs and formulate a plan. We don't always explain the anesthetic very well. So I will do a series of hubs that I hope will help.
I recently researched & wrote a hub about Darwin. Pretty amazing to think there was no anesthesia a few hundred years ago (nor any knowledge about microbes), and 'surgery' was people getting limbs hacked off.
I've had 2 surgeries, and was knocked around quite badly - is it true it can take a month or more to get over the anesthesia? I've heard some say that the preservatives in it are the nasty part, and that preservative-free is available. Is this correct?
Is quite a freaky experience re-gaining consciousness again - hearing sounds etc, sort of like in a dream
Hi Baileybear- Love your Darwin hubs, and voted in that contest!
Local anesthetics have a preservative-free variety that we use in spinals and other sterile procedures, but there are not variants of the narcotics, hypnotics or gases that are different, for the most part (few exceptions). The preservatives are in the IV meds, mostly and are the same as in other medications. The anesthesia technically is out of your body within a day or so. BUT, having said that, there is SO much we don't know about how anesthesia works and the long-lasting effects. It's the best we can do right now and most people do very well with it. There's a topic that's an active area of research now (that I will eventually write a hub about) concerning "post-operative cognitive dysfunction". There are ongoing studies that are investigating how long the after-effects last. The interesting thing is that some of the long-term effects happen even with anesthesia other than general (like epidural or nerve block) that shouldn't affect the brain. There is likely some effect from just having your body disrupted by surgery, that there is some physiologic stress that occurs that makes it seem like it's residual anesthesia. Some people are more susceptible to different meds because of varied drug metabolism. It's possible that a combination of all of these things contributes in that sub-population of patients that don't seem to recover right away.
I'm researching it right now for a case that I'm reviewing and will write on it in a month or so after that's all done.
is the preservative benzoates? My son would have a high pitched scream & rage with the food additives sulfites and benzoates - he would have no recollection afterwards; apparently a neurological irritation. Some people on the food intolerance forum seemed to think that anesthetic has these kinds of preservatives. I get migraine from the same chemicals.
We both get "drugged" by food chemicals, even natural ones like salicylates in fruit. I don't tolerate histamine-rich/producing foods well - give me migraine, upset gut and allergy-like symptoms. No good with dairy or gluten either.
My son has never had a surgery yet. Was wondering if could be dangerous given that he has such severe neurological reactions to benzoates (assuming that is the preservative)
Yes. Benzoates are included as preservatives, mostly in local anesthetics, I believe. I will check the labels tomorrow or the next day and see what I find.
There are preservative free "locals". Even if your son has general anesthesia, point out that the local anesthetic may have preservatives he is sensitive to because they inject local anesthetics before or after surgery to help with pain relief. They should be able to find a preservative-free variety.
The other drugs, I will have to check. The propofol that is used to get people to sleep has either a sulfite type preservative OR a benzyl alcohol. I find that people with sensitivities do better with the benzyl alcohol ones.
If he ever does need surgery, contact me first and I'll see if I can get you a list of which medicines have which preservatives. I'll start looking into that, as well.
I'm sorry you both have such sensitivities. It's like dodging landmines, isn't it? Exhausting to have to think about every single think you do and eat. You have my sympathy and respect.
Yes, I was very sick for years and doctors didn't know what was wrong with me - some drugs they gave me made things worse.
Eventually, I figured out the food sensitivities, when I decided to see if the screaming in my son was diet related (he'd always been sick too, and I knew casein didn't agree with him, but doctors dismissed my ideas).
My thyroid was packing up and my health improved dramatically when I went gluten-free (no more bone pain, easy bruising etc). I am still allergic to dairy (life-long condition, I believe), but my other food sensitivities have improved a lot.
I still get more tired than most people my age (not surprisingly with my body in chronic inflammation for years), but I am doing so much better.
My son can enjoy a wider diet than me (tolerates A2 milk and butter, plus gluten). I've read about metabolism difficulties and those on the autistic spectrum (we've both learned we have aspergers).
I've written hubs about all this, in case others have similar mystery health issues.
I was bedridden for 2 days recently, because I ate some gherkins (in vinegar - histamines). My diet is rather bland, but I pay big-time if I eat something that doesn't agree with me.
Ibuprufen gives me depression, just the same as asprin and other salicylates. Even rubbed on a sore wrist gets into my blood stream and affects my brain for several hours. My boy gets depression and/or rage from these chemicals (and we both like fruit - we choose only the ones lowish in sals)
I have had four abdominal surgeries recently (using general anesthesia). My question is while on the operating table I'm given something while everyone is moving about and it makes me feel very warm and produces floating feeling and severe anxiety, so much that last time I grabbed the nurses arm and started crying (I'm in my 20's) and she assured me this was a normal reaction and I was okay. What might this drug be they are putting in my IV?
Hi Andrew. I have had 2 major abdominal operations myself (removal of my entire colon for ulcerative colitis, then reconstruction) so I send you my sympathies.
Usually, the first drug you get is Versed, generic midazolam, or some related drug. These are like valium in the IV. Usually, they make you feel like you've had a couple drinks, very relaxed and "floaty". They are anxiolytic drugs, meaning they usually take away anxiety. Some people (we see it more in kids, but adults sometimes too) have the opposite reaction and get more worked up and anxious. We don't know in adults if this is a reaction to the drug, or a reaction to not liking the feeling of the change in your body and mind. I don't know if this applies to you, but I've had patients tell me that they tend to be the more "control freak" type and don't like the loss of control that the drug makes them feel.
There are other medications given early in the process too, while you are still awake that can have the same effect, even some of the anti-nausea medicines, although their effects are usually described more as feeling flushed or warm, although I've seen a couple people get anxious with them.
If it's right as you are going to sleep, it could be fentanyl (a narcotic) or the propofol (the sleep medicine). Most people drift quickly and peacefully off to sleep, but some have a bit of an "excitement" phase right before losing consciousness.
The good news is that the nurse was right, these are side-effects and you are ok. They are not bad or dangerous reactions to the drugs.
If you have another surgery (and I hope you don't have to), tell the anesthesiologist about this ahead of time. Ask if he/she can give the meds one at a time and tell you what they are. You can then figure out what causes it and tell them when you don't feel right. It will probably make both of you feel better.
My best guess is the midazolam (versed).
Thank you so much for answering, and I hope you don't have to go through any more surgeries either! I hope you've fully recovered. I have another question for you, but it's a bit private regarding the medication and medication I'm taking already. Perhaps you could e-mail me or message me? If not I understand. i zaqb lue (at) yah oo is my e-mail. If you are too busy it's okay. Thanks- Andrew
Great hub here and very informative. I have been in a coma for a week due to one surgury and complications with almost all procedures. I have a rare form of leukemia ( mastocytosis) but now realizing my basophils are 20 percent on a wonderful day and the mast cells and basophils are what seems to be causing my allergic reactions (anaphalaxis many times a week) I would like to know more about what you do for your patients that require extra care. Thank you for your hubs and your time.
Happy New year
wishingUwell
Mia
Hi Mia, thanks for your comments. Your strength in the face of debilitating illness is inspiring.
I review the medical history of every patient before planning their anesthetic. Sometimes special monitors are used and sometimes the medication has be adjusted radically. For someone with frequent or severe allergic reactions, I would pre-treat with steroids (if there was no contraindication) and IV benedryl to suppress the reaction. I would monitor blood pressure more closely, maybe even placing an arterial line (iv in an artery for beat-to-beat blood pressure monitoring) and pay close attention to the resistance of the lungs, treating as necessary.
Unfortunately, those of us with health issues are the ones who keep getting slammed over and over. As anesthesiologists, we are constantly fighting physiology in sick patients. We cannot overcome every problem and sometimes, we let people wake up more slowly in the ICU instead of rushing it in the operating room.
My motto is "don't create more problems than you solve."Sometimes surgery is necessary, even knowing that there is significant risk and we do have to think very carefully about the least of all potential problems. It's not very satisfying or enjoyable when it's like that, but you do the best you can.
If you have specific questions, I can try to answer them if you'd like.
Thanks so much Tahoe Doc......
Benedryl is a very bad trigger for me....can that be replaced with allegra? My CNS has been compromised and many meds cause issues with my breathing. It appears these mast cells and /or basophils infiltrate my organs, so I have had liver failure, gall bladder rupture,, and removal, neurological tics,tremors an MS and parkinson type symptoms since age 40, Diabetes with insulin shots and just very sick with vast amounts of phlem and hives, I actually will out of the blue have an open lesion that looks like a scratch and then bleed. The immunonlogist(2) and masto specialist have all but given up on me .
However I have not ! My liver repaired, as did my diabetes is now competely gone ( normal blood sugars for 3 years . I have been told I should not technically be alive.
I am so allergic to almost anything that anyone can be allergic too. I live is a purified room at the moment and my family feels so helpless. MOld is a huge trigger... I have researched mold much...its not going away here in NC LOL....so my family thinks I should move to Arizona, however I have read that some people have worse asthma there............that is now an issue for me as well.... I am sharing all this for I see your compassion in your words and I know that kind of compassion has to be coupled with your passions. As a mommy myself, an a past of (10 years) as a nanny I know you kiss boo boos too .....as a doctor you desire to help as many as you possible can. If you have any advice for the patient that actually should be living in a bubble ( my docs tell me) I can't even go to the dentist for the local shots they give me.....causes seizure like body movements and head jerking....I can't visit most of my family ( as they dont understand my extreme sensitivities) and their clothes have mold attatched to their clothing........or worse have cats or dogs.....I now(4 years) eat all organic or all natural......no dyes, preservatives, monosodium glutemate ect. Purified water only and very little wheat or refined sugars. So as you probably can see I am an advocate for my heathcare and do not expect an instant cure from God or docs......I just would like to have a life outside my purified box.
Again thanks for your caring response and any help or advice you could give would be so appreciated.
Looking forward................always
Mia
Wow Mia, I'm so sorry for what you are dealing with. Mold is definitely more of a problem than people realized for a while, especially for people like you. Different people have sensitivities to different things. Arizona and other deserts are great for some, but others (like me, mild reaction only) react more to the allergens there. Here in Tahoe, some people find relief with the mountain air, but others are debilitated by the pine pollen in the summer. Sigh. I'm sure you have probably been on steroids at various times (prednisone, etc). I don't know what other options have been tried...biologic immune suppressant drugs? I don't know if they are indicated or worth a try for what you have or if they would just suppress you too much and cause more problems than they solve.
Yes, allegra or the like might be helpful, although maybe not as "powerful" if benedryl is not an option. Also, ask your doc if adding an H2 agent (histamine-2 receptor blocker) might be useful. These are drugs like zantac and pepcid usually used for acid reflux. I add them to benedryl when someone has, or is at risk for, a bad allergic reaction under my care.
Of course, your history is quite complicated and nothing I say should be taken as medical advice without consulting the docs who know your WHOLE history. I'm just trying to brainstorm with/for you in case I might be able to help at all. I fear, I won't have anything new or useful to add. I can at least send a ((hug)).
Thanks for the hug and the advice. I have only been on prednizone once ...for a 4-6 week period. Massive amounts of it. Worst muscle cramps i have ever endured....an I use to work out hardcore ...lol I tested positive with my ANA titer test and came back speckled as well..(My mom did as well and she has systemic lupus) Docs here say I don't have that. Test after test, no real answers but I know it lies within my basophils being so high. My tryptase comes back normal I was told. I feel a move to the beach would be helpful and I live a few hours from the coast here. I visited for a week last summer and did well. I carry my hepa filters and a de-humidifier.......but at the moment I am having to sleep in a bathroom , due to carpet I would guess. My skin gets all sunburned when I go into my bedroom so I am trying to build my immune system up the next week and head out for the coast.
Thanks again for all your help...means much that someone is trying.
Take great care and kiss the baby for me! They do grow so fast.
as always
wishingUwell
Mia
Good and informative hub. Thumbs up. I will read the rest of your hubs very soon. Thanks for the information.
Thanks Melpor. Loving your hubs too!
Thank you for a very informative hub. Recently, my Wife had eyelid surgery. She is 54 and weighs about 120. It was to be local only. She reported being in a lot of pain, but not being clear headed enough to say anything. We requested the records. She was given 2mg Versed, followed by 40mg propofol (IVP) and 8 mg etomidate (IVP) back to back at the beginning. No narcotic was used. She did not consent to a general. The center now claims that this was "moderate sedation." What are the chances that she was even conscious after these meds? Do things like this happen often?
Hi LLM, Local only would mean that NO sedation would be given and an anesthesiologist or anesthetist wouldn't even be present. She had a sedation, but I can't really say what she consented to or what effect it had. It sounds like the doses she got was a moderate sedation dose BUT some people depending on their metabolism (not just general metabolism, but specific liver enzymes responsible for metabolism of different types of drugs) and other meds and medical issues and level of anxiety, etc can range from wide awake to nearly unconscious with the meds you mention in the doses given (even at the same weight). It's really up to the anesthesia provider to titrate the drugs to a patient's need.
In a case of local or local plus sedation, the sedation is the anesthesia provider's responsibility, but it doesn't take away all or even most of the pain. Pain relief and control are provided by the local anesthesia injected by the surgeon. The anesthesia meds help with relaxation and altered consciousness of varying levels so that a patient is less aware of or doesn't care about the discomfort, but those drugs are not really pain meds.
I'm sorry for your wife's bad experience. My best guess is that she had some resistance to the local anesthesia and it didn't 'take' as well as it could so she was given the sedatives OR she got the sedatives as planned and they took longer to take effect OR she felt the injection of the local anesthesia and her brain, under the influence of the anesthesia drugs, didn't understand that she was just feeling the injection. Unfortunately, there is no way to know if the drugs are going to be enough until you try. You can start with what you think someone needs based on age and weight (as you seem to understand by providing this info), but cannot really give more than that to start as it would be dangerous since these drugs cause heart rate, blood pressure and breathing decreases.
I can't really say what happened without being there as there are many variables, so please don't feel insulted if I say something that indicates that I don't quite understand the situation.
This is great. Wanted to ask what anesthesiologist is but i can see it already. Good job again
Thank you very much. :)
This is an awesome article. Very informative. I am having trouble finding any articles as to how many times you can have general anesthesia in 1 month. I am having oral surgery on Feb 8 and back surgery on Feb 15. Trying to find out if this is safe?
Hi imagrandma8,
This should be safe for most healthy people. If you are having general anesthesia for both, you could be at increased risk for complications that relate to underlying medical conditions. Surgery and anesthesia are stresses on the body and so organ systems that are already not functioning well can take longer to recover after each anesthetic.
Having said that, we do sometimes have to give general anesthesia to people several times in the course of a week (burn dressing changes, irrigations and debridements of infected tissue, etc) and most people do very well. Talk to the doctor doing the back surgery and make sure they and the anesthesiologist will be ok with you doing these (after reviewing you medical history) close together. My guess is that they will say it's fine, but do bring it to their attention.
If the oral surgery is going to impede being able to open your mouth, the anesthesiologist for the back surgery will not be able to safely place the breathing tube so will DEFINITELY need to know. You should discuss this ahead of time with the anesthesia dept where you are planning to have these things done.
The other thing I can think of and it's more surgery related than anesthesia related... the back surgeon may have a minimum amount of time they need to wait after you have dental surgery. Surgery in the mouth (especially if it's for infected tissue or teeth) can release bacteria into the blood which may increase the likelihood of an infection at the back surgery site.
Again, this may very well be safe in your case (and it usually would be), but there are some things you should discuss with the doctors involved in your care. It's hard to find articles because there really isn't a standard answer that fits. Thank you for bringing your question here.
Good luck and I hope everything works out :)
Im having oral surgery, day after tomorrow, & scared out of my wits, I take methadone, no more than 10 mg a day, & cannot tell my oral surgeon, I really need to have this done, what should I do????
You REALLY need to tell your docs. They need to know for a variety of reasons including being able to treat your pain adequately and plan your anesthetic and post op course. What is the reason you can't tell your surgeon? The anesthesia provider? Methadone is something we deal with a lot in our patients and it doesn't usually cause problems if we know about it. the biggest risk is interference with or inappropriate management of your anesthetic or pain. If we are giving you anesthesia- including narcotics at the usual doses and you don't seem to be responding, the docs might think something else is wrong and start treating you for a problem you don't even have. Please disclose this info to your surgeon and anesthesiologist. They will most likely be relieved to know about it rather than judging you.
Very informative hub. Thank-you! I do have a question that I am having a hard time finding an answer to anywhere though. I had an elective surgery Last Friday, had a hematoma complication and had to have an emergency surgery that Sunday. Now- 1 week post-op, im still feeling very nauseous and vomiting at least once per day. I was first prescribed percocet, and I thought they were making me sick- so dr. switched me to norco- and i thought THAT was making me sick- but now Im only taking advil and still getting sick- even very light headed and dizzy . Is this a possible side effect from the anesthesia?? Im very concerned b/c I do have 3 daughters to take care of, and I hate feeling so out of sorts- is there anything I can do?
Hi dlopp- Sorry it took so long to answer...
I would also have guessed it was the narcotic pain meds making you sick. Since you are off of them, it is more likely that the dizziness, light-headedness and nausea are now a result of dehydration or low volume status from the blood loss after the hematoma.
It is unlikely this far out to be from the anesthesia, itself, but the physical stress of surgery, having received the anesthetics and the hematoma can certainly make you feel the way you describe, especially if you lost a fair amount of blood. Please make sure you are taking in a lot of fluids if you can keep them down. Your body is working hard to make more red blood cells to replace the ones you lost, in addition to trying to heal from your surgeries. That is a lot of physiologic stress on your body and it will take time to happen.
Either way, call your surgeon and tell him/her that you are light-headed and ask if you should have your blood count checked again (it doesn't hit its bottom number until a few days after the bleeding sometimes) and if it is or they suspect it is low, ask if you could possibly need to get some IV fluids (especially if you can't keep fluids down).
If you have a fever, swelling or warmth around the surgical site, you should also call right away as infection can also make you feel sick.
Hope you feel better soon. I know what it's like to have to care for others when you should be taken care of yourself! You must get some rest, though, so if you have any help or offers for help- use them! Good luck to you~
I have experienced waking from surgery feeling great, alert, relaxed and calm. When waking from anaesthesia two out of three of my last surgeries I experienced none of the above. One was a day surgery. Dis ease then uncontrollable shaking. Returned to hospital. Maxeran was suspected to be the cause. Given Ativan and antihistamine. Second experience was when coming out of anaesthesia. Shakes, spasms (jerking arms and legs), put on antihystamine I.V..
Anaesthsitist was called. He said not an allergic reaction. Another surgery in a month and making sure all know my concerns. Please, anything you might add to what I have experienced would be appreciated.
Hi Misty. The shaking after surgery can be an anesthesia reaction (NOT an allergy or concerning reaction) that just happens to a certain subset of patients. We don't really know why, but often it will be treated with meperidine (Demerol) if there are no contraindications to it.
Maxeran (metoclopromide) is often given to prevent or treat nausea. It causes a different kind of abnormal movement-including a type of spasm, and is treated differently.
I'm not sure what kind of movements they saw (although your descriptions are good) or if they were the same both times, but do let them know that the metoclopramide (Maxeran) may cause these reactions in you. If you have the shaking this time and they don't give you that medicine, then it is probably a general anesthesia reaction that they may be able to treat with meperidine before you leave the hospital.
I hope this upcoming surgery is smoother for you. Make sure you get to talk to the anesthesiologist BEFORE they start giving you medicines like the Maxeran so you can relay all this info. Write the events/sequence/suspected meds down. As you know, your time with the anesthesiologist is short before surgery and there is a lot going on. It would be really easy to forget something that you want them to know.
Good luck!
Thank you. My son exhibited spasms in recovery after back surgery a few years back. We shared the lack of control and degree of arm/leg jerking. His reactions seemed more pronounced and unsettling and mine were quite scary.
I did speak to anesthesiologist before last surgery. I will be sure to share my concerns well in advance of "going under" this time.
Thank you again. Hopefully I will be blissfully waking from this surgery forearmed with knowledge that if I must undergo another in future ......all will be good.
Thank you very much for your straight forward information, a great read.
Does the risk of anesthesia lessen after repeat surgery?
I am 26 years old and have had 15 surgeries under general anesthesia (shunts, can't live with them - can't live without them!) I still get affair amount of anxiety about "going under" but since I'm a frequent flyer no one seems to bother asking any more. They just assume I don't have any questions or concerns because I've seen it all. Other than puking my guts out after surgery I've never had a complication, what are the chances that number 16 might give me trouble?
Hi Ally,
You may be correct, the team may think that you have had all your questions answered in the past or that you are 'comfortable' with the process now and that you just want to get on with it. Not saying this is the way they should approach you, but it may be.
Please do express your apprehension and ask questions even if they don't seem to think you need this. I sometimes ask patients if the process gets easier or harder with more procedures. I get both answers. So do bring it to their attention, you may be helping other patients too. :)
Each anesthetic carries its own risks, BUT by now it seems you ...
1) don't have malignant hyperthermia or other life-threatening reactions to anesthesia
2) have an 'easy' or manageable airway
3) tolerate anesthesia fairly well (except the puking)
So, the team already knows a lot about you and feel comfortable. You should be able to feel comfortable, too. Speak up even if they don't ask. Like I said, it will be a good education for them too, not to assume you don't have anxiety or questions just because you have been through it before.
Sorry about all the surgeries and issues. I hope you stay out of the OR as much as possible. :) Good luck to you.
Thank you very much for your quick response to my question. Its nice to know there is someone as informative as you, keeping us informed. When you only get a few minutes with the figure at the other end of you IV, sometimes your left with more questions than answers.
...???? Post op kidney surgery 2 1/2 wks--no pain med for 2 wks. Lightheaded and nauseous feeling---?normal? Thanks
Hi CM,
Nothing related to the anesthesia should last that long. It's possible that there is normal healing that could be still making you feel that way, but it can also be a sign of infections, dehydration, issues related to underlying medical problems.
For this, given that it was kidney surgery, follow up with your doctor. He/she may want to do a physical or order some blood tests to check your hydration level or electrolytes and other things as these can be disrupted with kidney disease or kidney surgery.
Hope you feel better soon!
I had extreme pain before surgery, feeling like i was going ro have a baby pains, from endometriosis and adheadsions, but the nursing staff when trying to find out if i could have something from the anesthesiologist said I couldnt have anything as this would effect the pain meds i could have after surgery. So i was left in extreme pain for two hours. I dont know if this is correct, as I have had this surgery before and was given 10mg morphine the last time before surgery with only medium pain. what do you think?
Hi Lauren. I'm sorry you were in pain prior to your surgery. Unfortunately, different anesthesiologists handle this differently. Some of us will allow the pain meds prior to surgery to keep the pain (and heart rate and blood pressure) to tolerable levels. I usually fall into this category.
Other anesthesiologists handle this differently. Some will not give pain meds because they feel it makes it harder to figure out what medications to use to get you to sleep. Others still, feel that giving pain meds before they meet your or before the nurses or surgeons have done your full assessment prevents you from giving full informed consent because the meds can make you 'cloudy' and sleepy. They may cause you to forget later that you really did give INFORMED consent if you don't remember what was discussed with you right before surgery. Personally, I think being in pain creates the same issue and I give meds in MOST, but not all cases like yours. Sometimes, though, there are still some medical considerations that will prevent me from doing so.
I cannot say, however, that another anesthesiologist is right or wrong in their decision without knowing all the facts and their reasoning, but it seems that you should not have been left with so much pain and again, I'm so sorry you had to go through that.
I had a question.I'm having inguinal hernia surgery Friday.Everybody tells me i'm gonna be fine and I know I will but I worry about everything.I don't think it's the actually surgery it's the anesthesia I think I fear the most.Now I've never had surgery before but I've been under twice with General anesthesia(I assume i was unconscious)before when I was 15-16 I'm 31 now.I have no obvious health problems plus my mom and dad had the same procedure done at one time.Does it sound like I should stop worrying and that I have nothing to fear.
Hi Robert, I think it's pretty common to fear the anesthesia more than the surgery- even for me as a patient. The fear, I think, often stems from the lack of control. When you are unconscious, your safety really is in the hands of a stranger and you can't make decisions or contribute to your care. it is understandable to be a bit apprehensive.
Having said that, for perspective, tens of thousands of anesthetics are given every single day -millions per year- and serious complications are quite rare. It's actually quite amazing when you think about how far we've come and how safe anesthesia really is. It is pretty common to have a side effect or two, but rare to have a complication that requires further care. Anesthesia is not perfect, and there are still things we are learning, but we should really be grateful that we live in a time where we can undergo surgery without pain or a high risk of problems.
You have a personal history of tolerating anesthesia (why did you have anesthesia without surgery?), your family history does not suggest a problem and you sound healthy. You have everything going for you to do well with your procedure!! You are the type of patient that I LOVE to see on my roster for the day. We can never make any guarantees (don't I sound like a typical doctor there?), but statistically, you should do well. Even people who have serious medical issues or other problems do well most of the time- you I wouldn't worry about. :) Practice deep-breathing or relaxation techniques between now and the surgery. I definitely notice that your attitude going into anesthesia affects your whole experience and how you feel coming out of anesthesia.
Good luck and let me know how it goes or if you have any more questions before or after your surgery.
Thanks that makes me feel a little better now.When I was 15 they thought I had a hole in my heart I went in for surgery and they said their wasn't one, and prior to that they went down my throat to see my heart i guess, thus that explains my adventure being under twice.
Very informative site. I need to have arthroscopic surgery on my knee, and from my research it appears that this can definitely be done with local anesthesia plus sedation if necessary, but so far I am unable to find a surgeon in my area who will do anything but general anesthesia. I would like to avoid that if possible due to a history of a heart attack and intermittent atrial fibrillation, as well as general problems with fatigue and pain, and I suppose to be fair fear of the unknown having never had general. Any advice would be welcomed.
HI Pete- I get where you are coming from and I agree. IF this can be done with local, then it would likely be better. However, there are several things that determine whether arthroscopic surgery can actually be done with local.
If it is just a diagnostic scope without a lot of work being done, then most of the time, it is amenable to local. BUT, if the surgeons are actually doing some work- especially on the inside or outside of the knee, many will not do local. It just isn't possible to get the local to cover those areas and there is a maximum dose that can be safely used. These are the factors that surgeons consider before agreeing to local anesthesia. There may be other issues as well, and I try not to second-guess the surgeons. And, also, to be honest, some surgeons just aren't that good at doing these with local. Either they haven't done a lot of it in their training or they have become accustomed to general anesthesia on their patients. Either way, you don't want them to do something they aren't comfortable with.
When local can't safely or adequately be used, general might actually be the better choice, even in light of cardiac issues and here is why: If the local isn't adequately covering the painful procedure, you will be uncomfortable or in pain. Pain causes heart rate and blood pressure to go up and 'stress' hormones to be released. Cardiac risks are increased and preexisting issues are exacerbated by these stress-induced changes. Anesthesiologists are aware of this, and it may play into the decision as to whether or not to recommend local anesthesia vs. general.
Epidurals and spinals can also be used, but are falling out of favor a little bit because in many cases, general is as safe or safer for many patients (and it cannot be done if you take blood thinners for the a-fib). They also take longer to 'wear off' than general anesthesia and cause more problems with things like urinary retention that can keep you in the hospital unexpectedly.
Here is what I recommend: If you can find a surgeon who thinks local is ok, then great.
If not: See your primary doctor or cardiologist to get a 'medical clearance' (I don't like the word 'clearance as it sometimes implies that there are no issues, rather than indicating that issues have been addressed and optimized which is our goal) or evaluation prior to your procedure. Make sure the doctor is aware of your cardiac issues and tell them about any new or ongoing symptoms you have - chest pain, shortness of breath -with exertion or during sleep, lightheadedness, palpitations, etc. Ask if you need a new EKG, echo, stress test or whatever if you haven't had one in a while. If you are on blood-thinners, ask your surgeon and primary/cardio how to handle that approaching surgery. Make sure whoever is doing the pre-op medical eval knows you are having surgery and that you need to be 'optimized' before the procedure.
If these things are done, then general should be as safe as possible for you and the anesthesiologist will have the info they need to monitor and treat you as needed.
As to the fear of the unknown- this is one of the hardest things to conquer. All I can tell you is that we give general anesthesia for very long, complicated procedures to people with a history of multiple heart attacks, congestive heart failure, etc and people do really tend to do well if they are 'optimized' and the anesthesiologist is aware of the current state of health, beforehand. Of course, I can offer no guarantees, but that general statement is true- even very sick people most often do just fine with general anesthesia.
Good luck to you - you already have the fact that you are quite educated about your medical status on your side! That really is huge. You wouldn't believe how many people come in and don't know much about their medical history.
Let me know how it goes.
Its appx. 1 and a half yrs of my marriage and we have been trying for baby for past 1 year but i am not being able to concieve. Docs have asked me to undergo ultra sounds and few injections and all. I have gone through the complete cycle but my egg did not rapture. Now i have been asked for laprascopy. What do you suggest for the same?
Hi Supriya. This is a good question and I'm sorry you are having difficulties. Unfortunately, this is not the area of my expertise. If you have a doctor you trust, they probably know what will give you the best chance of having a baby. If you aren't sure, it may be necessary to try another doctor for another opinion.
I'm guessing the laparoscopy is to look at the internal organs and see if there is any visible reason for your difficulty. Please ask your doctor if there is any other test you could have first before surgery if you are nervous about it. Good luck.
I would like to know why my oxygen saturation dropsn and oxygen has to be used while waking from anasthesia?. I keep being told to breath and so forth. What is going on?
Hi Trudy,
Both anesthetics and pain medicines decrease the rate and depth of your breathing. In addition, any surgery around the torso or abdomen will cause pain and further decrease breathing depth.
Sometimes during general anesthesia, a ventilator has been assisting your breathing. As you wake up, you take over this function on your own. As your body adjusts to this, you sometimes need to be reminded to breathe deeply.
So, the combination of transitioning to being awake, any pain from surgery near the lungs or breathing muscles, the leftover anesthetics and the pain medicines that you get as you wake up all contribute to decreasing breathing rate and depth. When your respiration decreases, so does your oxygen level. Usually, with an occasional reminder to take a deep breath and the temporary use of oxygen, this corrects quite quickly.
Hope that answers your question. :)
Hi TahoeDoc:
My son will be having an orchidopexy shortly (he will be 15 months old). Despite being a very rational person, I am extremely scared of putting him under general anesthesia (I am constantly thinking of worst case scenarios) and generally driving myself crazy. I have been reading everything I can find to understand the risks and found your hubpages. Have a few questions: If this was your baby, would you be concerned and what would be your biggest concern? What should I ask the pediatric anesthesiologist pre-surgery? Can you explain what the factors are in deciding whether a baby needs to be intubated or not? Also, my secondary concern is the potential impact on my baby's developing mind particularly given new APA release on this subject (understand this applies to multiple instances of general anesthesia). Any views on that? Look forward to your reply.
Hi Tina,
As luck would have it, my son had general anesthesia with a breathing tube at 19 months old for bilateral inguinal hernia repairs.
Believe me, no matter how much you know, it is NOT easy to turn your baby over to someone for anesthesia and surgery, so I TOTALLY get your apprehension.
I comforted myself with the thought that little ones do very, very well with anesthesia if they don't have other health problems and if they aren't ill (fever, productive cough, etc).
As far as the development issues, I don't have a lot of guidance beyond what you've said. It's unlikely that one short anesthetic will cause problems. It's a valid concern, but if he need surgery, there's not much you can do, except know that it's unlikely to cause problems with this procedure and the short length of anesthetic.
I wish I could reassure you further. General anesthesia with a breathing tube is most likely for this (it's how I've done them) and what my son had for a similar procedure. In babies, it is difficult to provide sedation, maintain spontaneous ventilation AND keep them still for the surgery without general anesthesia. I wouldn't have had them try it any other way for my boy's operation. It is just safer to have everything under control from the beginning. If they have developed a way to do this without general or a tube (or laryngeal mask airway-which some people like for babies, and some don't, all for valid reasons), then great. If not, then you want them to do what they usually do and are comfortable with. I find that problems happen when you stray from what you already know to work. Does that make sense?
I think the best thing you can do is look at the big picture (it's what I had to keep reminding myself). Many kids have longer anesthetics for more complex surgeries and do just fine (in fact, while my kid was having his procedure, the little girl of one of my friends was under for a 4+ hour open heart procedure. She did great).
Really, the biggest thing is just getting through it. It will be traumatic for you, but he will have no memory of it. I sought out a center that had a pediatric anesthesiologist instead of anesthesiologists who also do anesthesia on little ones, because they are more experienced with little kiddos. So I guess that was my biggest concern.
The waiting for this, and getting him ready the morning of the surgery will really be the hardest part. I know how relieved you will be when this is behind you. I barely remember it now.
I really do feel your fear and worry. It's normal and means you are a good parent. Wishing you the best and peace for your mind and heart.
I had surgery today and was under general anethesia. Feeling great other than having lots of anxiety. So much that it is hard for me to sit still. It feels like I am on a caffeine high and unable to rest or sleep. Do you know what would cause this feeling?
Thanks, Kim
It is quite possible that this is a side-effect of medication. Sometimes, we give medicines to counter-act the negative effects of the anesthetics. For example, the beginning of anesthesia may cause heart rate and blood pressure to decrease. If we anticipate or see this, we may give medicines to slightly increase them (ephedrine or glycopyrrolate are commonly used, as examples). Some of these medicines can make you feel jittery for a while.
Other people just seem to have a bit of jitteriness and anxiety after surgery and anesthesia.
If you have a fever, or if you check your pulse and it is seems very fast, or you have shortness of breath or other concerning symptoms, call or go to your urgent care.
The good news is that if it is a medication side effect, it should start getting better shortly.
Good luck and let me know if I can help further :)
They put Demerol in my IV during surgery because I always wake up with shakes. They had to give me another dose when I woke up because I was shaking really bad. Could this also be the cause of the anxiety? 11 hours have past since my surgery, should still be feeling like this?
Thanks so much! Kim
Demerol is one of those medications that speed up the heart rate and raise blood pressure and may contribute to feeling the way you are. Eleven hours seems like a long time and it may be a combination of medications that are doing this. If you have a history of nausea, they may have used a steroid in your IV to help prevent this. Steroids are longer acting and may keep you feeling exactly the way you describe for a longer time. Steroids are also sometimes used to help prevent inflammation, especially for surgeries around the airway (tonsils, for example). There could be other things contributing (type of surgery, etc) to this feeling as well.
It is also possible that there are other contributing factors. For example, some surgeries cause hormone release that can contribute (thyroid surgery, as an example). So, of course, I'm speculating only. I can't begin to make an actual diagnosis or pinpoint the cause without knowing everything that happened/was given.
I hope you are able to get some sleep tonight and that you feel better soon. If you are really uncomfortable, feel like you heart is racing or anything else, please do call/go the ER.
Thanks so much for you help and time. I really appreciate it! What a great site!! I had the Leep procedure done today. Hopefully I can get some rest tonight and I know I will feel much better tommorow.
Thanks Again,
Kim
I should also mention that if the doc uses local anesthesia (which they do for lots of different surgeries), there is adrenaline (epinephrine) added to the local anesthesia to make it last longer. That's another possibility for 'that' feeling.
Night-night and pleasant dreams!
Hope you have a great night and thanks again!
Thanks for your prompt response regarding my son's upcoming surgery/anesthesia concerns. It was very helpful. He will be having his surgery at a children's hospital and will have a pediatric anesthesiologist so I guess that is good. A couple of additional questions for you: (1)does the anesthesiologist usually perform pre-surgery check or is it some other attending doc/nurse? (2)I assume they will be using some anti-anxiety medication (Versed?) prior to surgery? Is that standard practice to your knowledge for kids? Any potential side effects of that? (3) Now for the crazy mom question-I know its very uncommon but have you ever had or heard of a patient experiencing malignant hyperthermia? How low are the chances?
Hi Tina- Good questions!
1). In most places, both the prep nurse and the anesthesiologist will talk to you and examine your baby prior to surgery.
2). Sometimes on little ones, they do not use Versed or other anti-anxiety meds. This is really decided by the individual preferences of the provider and there are very good and equally valid reasons for either one (not needed=anxiety or separation reaction are so brief because anesthesia is induced rapidly, so avoid extra medications VS. needed to decrease crying, anxiety and maybe risk of vomiting post op, etc and worth the minute risk and extra time spent in recovery). The biggest thing I've seen with these meds is a paradoxical reaction where some kids actually get 'revved up' instead of sedated with them.
3). In my career of 14 years and thousands of patients, I have seen MH once and it wasn't in my patient. By most estimates, each anesthesiologist will have an MH reaction once in their career. I have had a few patients come with either a personal or family history of MH and then adjusted the anesthesia accordingly for them. None of them had any bad reactions to anesthesia in this situation. It happens, but is extremely unlikely without a known history in the family. If anyone in your family has had fevers, organ failure, etc after anesthesia, do alert the anesthesiologist to this (actually alert EVERYONE remotely connected to the surgery). Otherwise, this is probably one of the least likely events.
Most negative experiences after anesthesia are side effects rather than complications. Even when complications do occur, they tend to be minor and short-lived. My baby had a little laryngospasm (narrowed airway that made a little extra oxygen necessary) as he was waking up. There were no repercussions of this at all. I did not consider this a problem as these little things are just par for the course sometimes and pediatric anesthesiologists are used to taking care of them.
thanks so much for your reply.
Hi dr,
My 3 year old daughter got her Tonsils & Adenoids removed a month ago since having this fine she has been waking up screaming through the night, having really itchy skin around thighs and bub checks. She is also waking up in pain struggling to walk in morning, and also hand sometimes falls asleep during the night and she wakes screaming my arm my arm. They have told me that it may be inflammatory arthritis but I'm not convinced, she was a perfectly normal bubbly girl before the opp. They have put her on endomethacin 5 Mls morning and night this helps with the pain but now having tantrums and saying very silly things. What should I do can you please help me?.
My 6 month-old is having surgery under general on Monday. He is healthy as far as we know (just went for his 6 month check-up last week and all was well) but what "unexpected complications" can arise in children who appear otherwise healthy, and how are those managed? I'm told by my doctors that the only risk is really his age, which really scares me. Is he more likely to have problems with anesthesia because of his age, or is the risk associated more with not having an adequate medical history? Thank you!
I just had a scheduled laparoscopic gallbladder surgery done that was supposed to be an outpatient procedure.(This was approx my 13th surgery total in my life.) They ended up keeping me overnight because I was not responding after being in phase 1 post op for 4 hours. I was told they ended up doing blood gasses, a ct scan and called in a neurologist to make sure I was ok. I don't remember any of this. Once I did start remembering things, I remember my heart rate was low(39) and my blood pressure was 86/56.(abnormal for me).This was 12+ hours after the surgery. I went into surgery very dehydrated and malnourished. I had recently had a NJ tube placed to help, a few days prior. I have never had this amount of difficulty with anesthesia. Could this have been a reaction from the anesthesia because my state of health before surgery? I am afraid to ever go through surgery again thinking this might happen again.
Luisa- this is tough to answer. The honest answer is that I know of nothing that would cause this reaction that would be related specifically to the anesthesia.
It sounds like the timing of this was pretty clearly after the surgery. The most likely answer you will get is that this is coincidence. This is because we don't have a better explanation for you. I know that is frustrating.
Having said that, there are many diseases/disorders/conditions that have both a genetic component and an environmental trigger. For example, I had ulcerative colitis. It is generally believed that a person inherits the gene that makes it more likely to develop the disease. Then, some environmental factor (virus, bacteria, pollution, food additive...who knows) triggers the expression of the gene. That is, the person begins experiencing sypmtoms/develops the disease.
I will never know what the environmental trigger was that set off my colitis. Likewise, you may never know for sure if there was something about the surgery, anesthesia, stress, tonsillitis, etc. that set off your daughters symptoms.
I am so sorry, though. As a mother, I can imagine how hard it is to see your daughter in pain and then to not even really know what's going on.
Has your daughter been seen by a pediatric rheumatologist? Or any specialist, rather than just a general pediatrician? That would be my next move...ask if there is some specialist you could get a referral for, to see if they have any other ideas.
Good luck and ((((hugs)))). I really feel for you.
Hi there picklesmommy. I'm sure you are getting very anxious. It's so hard to turn your baby over to have surgery and anesthesia. I had to do it, so I know it's scary.
Healthy babies do very well with anesthesia. Of course, there can always be 'unexpected complications' and as the mommas, we can't help but think of those "what ifs". These would be things like slowed heart rate, low blood pressure, allergic reaction or malignant hyperthermia, etc. These are rare. The more serious they are, the more rare they are too.
One of the reasons anesthesiologists train so hard for so long is to be able to handle little bumps in the road (or giant bumps, if necessary) during the course of the anesthetic. Most of the time, these special skills aren't needed as most anesthetics end up being routine. But, the training is there if any issues should arise.
His age puts him in a category of 'increased risk', but 'increased' just means more than baseline. Baseline is low risk, so statistically, the risk of anything serious going wrong is still very, very small.
Knowing he is healthy and having a recent physical exam do help so much! The worst scenario is when you don't know a patient's medical status and something goes wrong and you are trying to diagnose and treat it all at the same time. Having the medical history and physical ahead of time is really helpful!
Good luck to you and your little guy. These are the worst days just waiting for it to be over. Hang in there.
Hi Cat. Sorry you've been having such a rough time.
It does sound like your state of health probably did influence your reaction and seeming slow metabolism of the drugs.
Dehydration and malnourishment really do affect your anesthetic. We can give IV fluids pretty easily, but the nutrition can't be addressed very well in the short-term. So if, for example, your protein, calcium, potassium, magnesium, etc were low or altered, your ability to clear the medicines will be affected. Also, all of those blood chemicals are involved in regulation of blood pressure and heart rate. Yes, this could very well explain what happened.
I hope you don't need another anesthetic,but know that the pattern of 'no problems' after is more likely.
Take care!
Getting ready to go for my ninth abdominal surgery. I am using a surgeon that has done the last 4 and knows my history. IV drug user for years then in a methadone clinic on 120+ mg of methadone for 6-7 years. The last surgery I woke up hurting pretty bad it was 4 years ago, and I told the nurse but the anesthesiologist said I have given u enough fentanyl to knock down a horse, and wouldn't give me anything. Finally the surgeon came out and gave me dilaudid and ketamine which was oh so nice (lol I'm not gonna lie) and did the trick. For this next surgery the surgeon knows ur should I inform the anestheologist of my high tolerance? I wear fentanyl patch now 75mcg every 48hours no iv drug use in years but I seem to soak opiates up like I'm 250lbs. I'm only 150lbs. And I always seem to wake up shaking like hell every time seems like a normal thing to me not sure though. And as for versed that stuff makEs me mean as hell and I don't forget anything just get mean my first surgery with this doc I tried to tell the nurse I guess she didn't believe and gave it to me anyway, I woke up in the recovery room strapped to a bed and mad as hell still they finally in strapped me and I ripped out the 3 rd iv all the monitors and Walked out wouldn't let them wheel me out I walked, so I have been more vocal since about the versed or any benzo they alll seem to make me really mean. But I have noticed without the versed I don't seem to have the shakes as long when I wake up.
Hi Steve. That's good that the surgeon knows your history. But, still, tell the nurses, the anesthesiologist, ...anyone who will listen or is otherwise within earshot. Approach it very matter-of-fact like, but make sure you give the examples of what has happened to you in the past with pain meds, what they had to do and the experience with the benzos.
I'm sure you understand the complex issues you have with sedative and narcotic medications. Be as kind and calm, but as direct as you can about your history and previous experiences. If you ask for no benzo, they should not give you one. The pain meds are going to be tougher, but telling the anesthesiologist ahead of time (with previous examples) is VERY helpful. If we know that we have an uphill battle against your pain, we can get a head start while you are still sleeping/waking up and sometimes do better in recovery.
GOOD LUCK to you! I'm sure you don't look forward to all of this. You are quite brave!
I never had anasthesia.So no personal experience. I never knew that we couldn't eat anything the night before. A very useful hub.
Hi, ive got really bad hayfever and have allergies to cats and dogs. i just wondered if i went under general anasthtic..would i have more of a chance have having an alleric reaction to it??than someone who hadnt got allergies. i want a breast reduction but the storys ive read about GA are scaring me! thanks
Hi Janne.
It's hard to say, but people who are more 'allergic' in general are more likely to have allergies to medications and so on.
Having said that, I see people every day who have seasonal and animal allergies. I don't think I've ever seen any of them with a bad allergic reaction to anesthesia. Every once in a great while, I've had to give someone a dose of benedryl because they got hives after certain meds. But, I haven't seen a bad allergic reaction.
Breast reduction is a big surgery, and any surgery requiring anesthesia should be considered carefully, but I don't fear of general anesthesia should necessarily stop you from finding out about this surgery. Every single person I know who has had it has been incredibly happy with their results and their decision.
Good luck!
thanks.. just GA scares me so much incase i dont wake up
hello,
I have a delayed type iv sensitivity to PABA, and preservatives in local anestethics. My reactions usually appear a few days after the injection, and include hives and uticatia. After learning this, my Allergist and Dentist decided using single dose mepivicaine would be best. No topicals, no estherhello,
I have a delayed type iv sensitivity to PABA, and preservatives in local anestethics. My reactions usually appear a few days after the injection, and include hives and uticatia. After learning this, my Allergist and Dentist decided using single dose mepivicaine would be best. No topicals, no esthers can be used. I had a positive skin test to Lidocaine 2%. I had a C-section done in 2009, before I found out about all of this. During that labor, I was given a spinal erpidural. All seemed to be fine, except the huge rash that developed on my core after surgery. First question is, do you think the original epidural could have triggered my allergy, and my second question is, how will I be able to hsve a future surgery knowing I now have this allergy to presetvatives in locals as well as Lidocaine?
Great hub! I had laparoscopy surgery a little over a month ago and about to have another one in 2 weeks. I wish I had found this before my first surgery...it was exactly how you explained it. Thank you for taking the time to help all of us who have questions!
Kate
Hi Jen. That must be frustrating for you (and the docs)! That's tough being allergic to almost all types of local anesthesia. Sorry.
So if the records are available, I would start by finding out what locals (exactly) were used. When I do them, I use lidocaine 2% to numb the skin, then I use bupivicaine IN the actual spinal fluid. Have you been skin-tested for bupivicaine? If not, you should be. There aren't many choices, so it would be good to know which ones, if any, can be used.
For some reason, you are allergic to these things. I think the spinal/epidural was the demonstration of this allergy, not the cause of it. Not sure if that is what you were asking.
Also, from the insider's point of view. A lot of patients think they are allergic to local anesthetics. We have many who had elevated heart rate after a dental procedure and call that an allergy, when it's really just a normal side effect of the epinephrine in the local anesthetic.
I tell you this because you have REAL allergies. It's important that you make sure everyone 'gets' that. So tell them what you told me. Tell them the reactions you have had, and tell them or show them the results of any skin testing you have had done. It helps everyone realize that your reactions are truly an allergy.
Good luck! and let me know if you have other questions.
Aww, thanks Kate- let me know if there's anything else you would like to know about. Good luck to you!
Oh! Thankyou for your informative and speedy reply. Im not sure if I had a skin test to bupivicain but I will be sure to double check. Also, my C-section was over two years ago, will I be able to gather info from then on what was used? It was very scary going through, trying to find reasons for my symptoms. Everyone was clueless at some poin. We put it together after a year of continued injections. Like I said before, no esters, no preservatives, no epi or vasoconstrictors and Im good to go. Thanks again for your hub. Its helped a great deal!
Im sorry, I forgot to ask. What would be considered a precautionary "work up" to prepare allergic patients for surgery if needed. I heard of this but am not clear on it. Thanks again!
Hi, I'm considering going for surgery on my eustachian tube in the ear as it is causing my hearing to be lost. The surgery should last 15 mins max. I was just wondering what risks I will have to be aware of.
I'm a 16 year old female with no previous health problems.
The only thing holding me back from the surgery is fear of the anesthesia. (is it more dangerous that the surgery itself?)
How long will I have to stay in the hospital after the operation?
Charlotte
Hello, I have a fairly sensitive question, and was wondering if there were any similar cases to mine with anesthesia or surgery. I got my wisdom teeth removed two years ago. I was put under with an IV and everything went well except I had terrible shaking and it took a long time for me to wake up. Bur the main thing I'm concerned about is that I developed an eating disorder following my surgery. It seems far fetched, but it was such a coincidence, and I don't have any history of mental or physical disorders.
I had my labrum repaired and remember waking up screaming from the pain.It felt like someone cut a nerve the size of a pencil in half with a pair of bolt cutters.I remember it like it was yesterday.I'm guessing I wasn't put out all the way.Now I need basal thumb joint surgery and I'm scared I'll wake up again or be awake.Not to mention my modesty issues I'm very nervous going under again.I like to be in control of situations.Any advice
I'm sorry everyone! I usually try to answer questions quickly, but these either didn't show up consistently or I missed this for some reason.
I will be back to answer soon. Apologies.
Titan- Are you saying you think you woke up during the surgery? If so, that is awful. If you had a nerve block and sedation, it would not be unusual to remember BUT you should not have been feeling pain, in any case- no matter what kind of anesthesia you had. I don't know if this will help, but check this article out...
http://tahoedoc.hubpages.com/hub/Anesthesia-Awaren
If you haven't had your thumb surgery yet, you should make sure your surgeon and anesthesiologist are aware of this problem. You really can have post-traumatic stress reactions to this type of event (if you had actual intraoperative awareness) and it should be addressed as soon as possible.
Good luck to you!!
Actually, your allergist would be able to figure out what to test for, although they may need to speak to an anesthesiologist to know what drugs may actually be used.
Sometimes, allergic patients are given precautionary benedryl and/or steroids before other medications are given to prevent or minimize any allergic reaction. It's probably best to be tested, though, so that the allergies are better clarified.
Hi Charlotte. Many times these surgeries are done with short-acting general anesthesia. I don't know if they still do them with sedation or not. In any case, a healthy person your age should have minimal risk.
Find out if you can talk to an anesthesiologist beforehand to have your questions answered or if they can explain exactly what they will need to do. You will likely feel much better after a talk like this.
The time you spend in recovery will depend on the type and amount of anesthesia you get, but should not be very long.
Good luck to you!
Hi Elizabeth. I certainly don't know of any cases of eating disorder developing as a direct result of surgery or anesthesia. I don't know if anything associated with the event was traumatic enough to trigger mental changes.
I'm sorry I don't have a good answer for you. The shaking is a common side effect of anesthesia, though.
Hope you are getting better!
I had a very traumatic experience a few years ago with conscious sedation (midazolam & fentanyl) for an outpatient procedure. I was merely told I would be given a "sedative", with no mention of the amnesia, which in my case, lasted ten times longer than the procedure did. I "became aware" in mid-sentence, and freaked out. I was also not told I would be given narcotic pain medication (which I cannot tolerate), and had extreme vertigo & nausea following the procedure. TWO QUESTIONS: Why is the amnesia not always explained to the patient in advance, and do I have the absolute right to refuse an amnestic in the future ? (I find it profoundly disturbing, and would rather be completely "out")
I had major surgery 20+ years ago without Versed, was allowed to see (& remember) the OR, and I "went under" peacefully when asked to count backwards...and I was treated with compassion by EVERY medical person I encountered...)
FYI: My consent form (of which I have a copy) does not name or explain the drugs I would be receiving.
Hi Polly.
First, I am sorry you had an unsettling and less than acceptable experience.
I think that most people prefer NOT to have memories of being in the operating room and most people who have had amnesia of the experience don't have a problem with it. Not to say that your feelings of being disturbed by it are wrong- they are not - but they may be the exception and not the rule. I'm guessing that's probably why it has never become 'tradition' or standard of care to mention that you won't remember.
It would be quite difficult to give you a sedation OR an anesthetic without using an amnestic OR a narcotic. In fact, both of these things are part of most sedations, and definitely part of general anesthesia.
So, to answer your first question, I think we don't always think to stress that amnesia is part of sedation because most people either don't care or welcome it. If you prefer, you can ask to not have amnestic for sedation, but to be honest, it might be very, very difficult for the anesthesiologist to fulfill that request. The drugs that aren't amnestic tend to be narcotics, which it sounds like you also don't want.
If you have general anesthesia, you can absolutely ask to NOT be given versed before induction of anesthesia. I get this request from time to time. It's not usually a problem. But, obviously, the general anesthesia will be amnestic. Also, narcotics are almost always used as part of the anesthesia. I like to use narcotics during anesthesia for lots of reasons, including allowing a smoother wakeup if my patient isn't in pain as they wake up.
I hope that answers your questions. The best thing to do would probably to explain to your next (if there is a next) anesthesiologist what you did and didn't like about your past experiences. Ask what is and isn't possible in these areas and come up with a plan together that is acceptable.
For their part, they may need to understand that you don't necessarily want, like or need what other patients do. For your part, you may need to realize that some things are not possible and some of these medications will need to be used.
I have never seen a consent form that lists all the possible drugs that may be used. Anesthesia is a dynamic practice, meaning that what works for one person may not work for another. If we didn't have the option to change plans midstream and do what needs to be done to keep our patients safe and comfortable because the drug we need wasn't listed on the consent, it would be nearly impossible to do our job well. I'd say there are a couple dozen possibile medications we use fairly regularly for a general anesthetic. Trying to list all of these and anything else we might need would be confusing at best.
Does any of that help at all? I hope it didn't make the whole thing more confusing!
Let me know if you have other questions.
Thank you for giving me a thorough explanation from the "doctor's" perspective. I think the fact that the amnesia was not explained to me was more upsetting than the amnesia itself. From the "patient's" perspective, not warning the patient about the memory loss makes the doctor/anesthesiologist look sneaky. We patients do not approach surgery with the same expectations, just as we do not all have the same medical histories. We don't even know what questions to ask, and put our total trust in you. Causing a loss of trust is just as harmful as causing physical harm. And there are many more people who feel like I do than you know, we just aren't acknowledged. Take a few minutes to talk to the patient, please. Thank you again.
Thanks Polly. Actually, my lack of time with patients to discuss these types of things is one of the reasons I get frustrated with my job. I've had more than one surgeon completely lose it with me because I was spending too much time talking to the patient. In fact, one even said to me "What do you have to talk about, it's not like they'll remember any of it". Nice, huh? Luckily most doctors are really not that nasty. Many don't realize, however, that what we don't tell patients can be as important as what we do say.
My pre-anesthesia talk mentions that "you will likely not remember much after I give you the sedative here in preop." I know not all of my colleagues do this. I am certainly not defending the lack of communication. I was more trying to figure out or explain why that may have come to be. I will definitely remember what you have said here and keep in mind that this IS a big deal and it is not to be taken for granted that all patients WANT to be amnestic before having anesthesia.
I hope this at least helps a little as you have helped me see your point of view. I certainly would not withhold information to trick a patient or be cruel and I don't know of anyone who would, for what it's worth. We practioners definitely need to be more careful not to have omission of information make us seem that way! Thanks again for your insight- it will help me for sure and I will remind my colleagues, as well!
It looks like I may need my gallbladder removed, and after having an emergency appendectomy, an ectopic preganacy surgery due to a ruptured tube, and a hysterectomy, I'm really bummed to be needing surgery again. I have asthma and allergies, and after the hysterectomy, I noticed some chest tightness and worsening of my asthma when I got home the next day. I remember the anesthesiologist telling me that he would be "irritating my bronchial tubes" with the breathing tube before the surgery. I had not had the asthma issue with the other surgeries that I've had previously, and I remember the anesthesiologist for the ruptured ectopic surgery telling me that she would keep me "sleepy" a little longer because of my asthma, and I never had an issue with it. I should also say that I don't use albuteral due to heart rhythm issues. I use atrovent for a rescue inhaler. I am just super upset that I will probably be needing this surgery and I am wondering what can be done to minimize any problems with my asthma? Do different anesthesiologists use different size breathing tubes? I just thought the comment about irritating my bronchial tubes was kind of strange, and I really don't want them irritated!!!!
Skarnick- I certainly understand your apprehension.
The phrasing about irritating the bronchial tubes seems odd. I usually say "Sometimes, the breathing tube that is necessary for your surgery and the anesthesia gases, along with the cool, dry oxygen can irritate the airways and cause airway reactivity. Sometimes, this just causes a little coughing, but people with asthma can have an asthma attack or notice their sypmptoms worsening for a few days after surgery."
Sometimes, the breathing tube irritates the airways, and sometimes it does not. As gentle as we are when we place it and as improved as our medications and treatments are, the airways can just be so sensitive. The size of the breathing tube may not matter much either.
Unfortunately, there is no good way to predict when this irritation will happen and when it won't. Let the anesthesia doc know that you had issues before. This tells them that you are more likely to have bronchospasm, and they should do whatever they can to prevent it. No guarantees, obviously.
Probably, if at all possible, you and the anesthesiologist should discuss you puffing your atrovent just before surgery. This seems to help in a lot of cases, even if you usually only use it for rescue.
As hard as it will be, you will have to do your breathing exercises after surgery. Your gallbladder, as you know, is in the upper right quadrant of the abdomen. The fact that the surgery is near the chest, and that it will likely be laparoscopic (compresses the lungs a bit more) may make this more of a challenge, but will help you a lot if you can do this (have they given you an incentive spirometer in the past?) Take deep breaths, hold them for just a second, then blow out slowly. This helps keep the lungs expanded.
Also, don't know if you saw this, but I wrote specifically about asthma. There may not be much in there that you don't already know, but maybe something can help you.
http://tahoedoc.hubpages.com/hub/Anesthesia-and-As
Good luck to you and stop back here if you have other questions.
Hi. I've had had many surgeries (approximately 55 if not more) since I was seven years old, I'm 20 now. I haven't really had much problems, most of my surgeries have been done under general accept for this year where I had a few done just with local. The only issue I have is the fact I'm such a hard stick for IVs that I've actually had to have a few surgeries rescheduled simply because the anesthologist didn't know how to deal with this issue and simply refused to do anything about it, such as possibly sedate me as other past anesthologist have so they can poke as "much" as they'd like without me being in pain for it. I have had times where literally I would be poked for three hrs straight by like five different people. My question is, what can I do to maybe make getting my IVs easier since not every anesthologist out there seems to have a crasp on what to do?
Thanks
Hi! I am having a TAH with my ovaries being removed on may 23rd. Two questions.
1- what is the likely hood of being under and actually feeling and hearing everything that is going on?
2- after surgery will they give me something to reverse the anesthesia or will I just be waking up on my own?
Any insight would be fantastic, because for some reason one of my biggest fear is feeling everything and hearing everything and not beagle to do anything about it, silly I know but I am scared about it:/
Oh and another thing I am concerned about, in 2009 I had surgery under GA and from what I understand they had to keep me under longer because my blood pressure dropped scary low, this is what they told my husband, so for this surgery I went and got the surgery paperwork from the surgery in '09 to bring to this surgery and the surgeon wrote nothing about the blood pressure just said I handled everything great. This also has me very concerned.
Hi Million- The difficult IV stick is frustrating for everyone (and painful for you!) and I'm sorry that's been an issue.
There isn't much you can do, unfortunately. You must stop eating and drinking at the designated time, but make sure you are well-hydrated until then.
I'm wondering how they sedate you adequately without an IV? Do they give you oral medication? There are definitely pitfalls and dangers to this, so I can see why they wouldn't make this a routine. This is going to be at the discretion of the individual that day. Unfortunately, if he or she feels it is unsafe, they aren't going to do it. It's hard to say what the issues could be without knowing your whole history, etc.
The best thing you can do is to ask to talk to the head of anesthesia well in advance of any procedure. Sometimes, a little pow-wow and a plan of action that the anesthesiologists can agree on will help. They may be able to assign someone who has cared for you before or brainstorm some ideas about the best plan. They might have you come in early to have an IV placed under X-ray if they are equipped to do that (most places don't, but they also could refer you to a hospital, perhaps an academic center, where this is available).
I don't know your history, so I am absolutely not saying that any of these things SHOULD or COULD happen- just trying to think of potential things for you to ask about before you go through the frustration of being canceled again. That's really aggravating, I'm sure!
Good luck and if you know where your surgery is schedule, ask to be put in touch with the anesthesiologist in charge, or ask if someone could talk to them for you about this issue in advance of your surgery.
Hi TPH.
Hope you have a very smooth surgery and recovery!
Your answers (as best I can do in a "generic" setting, anyway.
1). The likelihood of having some intraoperative recall has been quoted at 1 or 2 in 1000 general anesthetics. Other studies have put this number at 1:10,000 or higher. There is some discrepancy due to study methods and definitions. I have personally given thousand and thousands of anesthetics and don't know of this (legitimately) ever happening. I say it that way because some patients have thought they had recall, but really they had a sedation anesthesia and didn't understand that some memories are within normal limits for that type of anesthesia. Even people who do have recall don't usually feel anything, even if they hear. The brain can process and perhaps remember sounds when every other sense is 'deadened'.
It seems to me that real intraoperative awareness or recall is pretty rare (see my hub about this), although possible and devastating when it *really happens.
2). At the end of surgery, the anesthesiologist turns off the anesthesia gas or infusion they are using. The anesthesia is allowed to 'wear off'. In addition, sometimes, reversal agents are used for certain medications (muscle relaxants, benzodiazepines and opioid pain medicines can be reversed if needed) if they aren't wearing off on their own.
So... the answer is the anesthesia is ALWAYS allowed to dissipate or wear off and SOMETIMES, reversal agents are used, if needed.
3). You did the right thing by getting the operative note from the surgeon. Unfortunately, their notes are focused on the surgical procedure. Your anesthesia record should have any intraoperative events (if they were significant or prolonged). Contact medical records at the surgery facility and get a copy of the "intraoperative anesthesia record and any anesthesia notes" if you can. Take this to the surgeon, and bring a copy to the anesthesiologist, as well. It may not even be noted on there if it was a brief event. Even if you don't find any specific notation, tell the anesthesiologist about this to the best of your (husband's) recollection.
The best bit of preparation we get as anesthesiologists is information! Anything you tell them or show them will be very helpful! Let me know how it goes :)
OOps, here's the link for you to the hub about intraoperative awareness in case you want more info..
Usually they poke me till they get my IV, sometimes after they've poked me for about an hr or so they realize it's not going to be easy so they either give me a shot of ketamine or nitrous through the mask. For the past like five years thats been pretty rare. I simply suck it up till they've found a vein that works.
That time they canceled my surgery (it was to be done in an ambulatory center) they rescheduled it to be done in a hospital facility because there they would be able to use an ultra-sound. Sadly, I went there and they poked me for an hr THAN used the ultra-sound and they were only able to find veins for a central line which was also not easy to get in because of my burn scars. But thankfully they did get it and finally knocked me out.
My original place where my main doc is they know me and my situation so usually they sedate me without questioning it if they feel the need to. The place I had that surgery where it was canceled I had one previous surgery and they poked me for about 45 minutes to an hr and they finally decided on nitrous gas because they said it expands the veins. But when I went in for my second surgery, I had a different anesthesiologist who when the nurse suggested doing the nitrous again, she said no which I didn't understand why not. Third surgery in that place I ended up having to do the surgery under just local because that same anesthesiologist that refused previosly was there and refused to even try to get my iv in for conscious sedation. which ended up to a not so pleasant experience which has made me a little reluctant to even going back there. Unfortunately I have a surgery there in a few weeks, they're saying it will be done under conscious sedation but I don't really know if that's true or not, since what happened last time. All I know I've done it under local three times and I don't plan I doing it again that way.
One question: if they do end up doing conscious sedation, what should I expect? I'm a little nervous it won't work or I end up saying something embarrassing or mean.
Thanks
Thank you so much for your words. I feel much better than my first message. I am still nervous, but starting to feel better about it.:)
Manutdmumto4 17 months ago
This an excellent, informative Hub!! For those of us who find anesthesia scary, it really puts your mind at rest!! Thank You, I look forward to reading more of your Hubs x