Posts by Alexander Wright

Adam Thomas14 said:I think I read somewhere that Mayo Clinic has the best anesthesiologists in the States.🙂

😍😍😍😍

Mark Edwards13 said:just Synthroid (thyroid, low daily dose) (and oral contraceptives like Yasmin)

Thanks for the input 🙂

You could technically skip that day—though I wouldn't recommend being too reckless about it—but you absolutely have to let the anesthesiologist and the surgeon know you're on birth control. You want them to be fully dialed in regarding your thromboprophylaxis protocols.

Mark Edwards13 said:So... I’m heading in for thyroid surgery soon (they’re removing the right lobe). Since—unfortunately—I won't be able to sit down with the anesthesiologist until just six days before the procedure, I was wondering if there are specific rules I should follow regarding smoking, alcohol, or supplements... I already know about stopping anticoagulants and salicylates ten days out (and obviously the whole "don't eat or smoke on the day of" thing).
I'm 22 and otherwise healthy—aside from the thyroid issues—hyperthyroidism, which is why I'm on medication.
Thanks in advance for any insight. 🙂

Anyway,

If you can manage it—even if it sounds impossible—try to go at least six weeks without cigarettes; it’ll significantly cut down on the mucus buildup in your airways.
If you absolutely cannot quit, then at the very least try to hold off for three days before the surgery to let those methemoglobin levels in your blood drop.

On the actual day of the surgery, you absolutely have to be perfectly fasting—nothing in your mouth for eight hours. You might be able to take certain medications with a tiny sip of water more than two hours beforehand, but for your specific thyroid case, skipping the meds that morning shouldn't be an issue—so just stick to being fasted.

Are you taking anything else besides the standard stuff?

Kate Taylor59 said:18

Well, if that's the case, you definitely aren't dealing with any atherosclerosis issues here.
I'd say—if the tingling sensation persists—you might want to go see a neurologist or perhaps a physical therapist to get a professional opinion.

As far as the anesthesia goes, you seem perfectly fine for it.

Kate Taylor59 said:My left leg goes numb all the time, and my hands and feet just feel like ice blocks...
I used to get these killer headaches because of circulation issues—apparently, oxygen wasn't quite making it to the brain... I get this ringing in my ears quite often too.🤷They told me I really ought to start getting some exercise in my life..

It's possible; it isn't actually that scary... how old are you anyway?

Kate Taylor59 said:Does anyone know if someone with circulation issues can go under general anesthesia?

Of course they can... you just need to make sure you end up in the hands of an anesthesiologist who actually knows their stuff. 🙂

You'll have to define "circulation issues" for me first...

rowdyraven23 said:She’s asking for a little clarification:
A few days ago, I underwent a relatively minor gynecological procedure at a private clinic here in the States (not sure if I should name them).
Basically, even though they originally scheduled it under local anesthesia, during the exam on the day of the surgery, they told me they were going to switch to general anesthesia and that I might need to stay overnight. All in all, everything went quite smoothly—especially considering this was something that caused me significant trauma, so I was incredibly anxious.
The anesthesia lasted exactly thirty minutes; I was conscious immediately upon waking up, and after about 7 or 8 hours, I was actually cleared to go home.
Now that the dust has settled, curiosity has kicked in, so I was wondering if anyone could explain what exactly happened—given that I was too overwhelmed by nerves and discomfort to really follow along properly.
They first inserted a plastic catheter into my left arm—I assume that’s how I received intravenous anesthesia, and from what I’ve read on this thread, it was likely Propofol.
They asked me twice if I was feeling dizzy right before I actually started feeling lightheaded, and they also stuck some kind of large patch/sticker on my right leg... I'm dying to know what that was and what its purpose was?
And it seems to me—though I can't say for certain—that once my head started spinning, they placed a mask over my face... is that possible?
I woke up exactly after 30 minutes; I remember the clock in the OR showing 11:45, and the very first question haunting me when I came to was: "What time is it?"
I don't want my questions to come across as though the gynecologist, the anesthesiologist, and the nurses weren't being fair or didn't tell me anything about the procedure—it’s just that I was far too nervous to ask anything... they gave me brief explanations of what they would do and what would happen, they asked me a few things... but yeah, it's only now that I'm back home and feeling okay that I've become curious....

They most likely administered a short IV anesthesia using Propofol (which is essentially the gold standard anesthetic for procedures like the one you described).

If that "patch" had a wire attached to it, it was almost certainly a grounding pad for an electrosurgical unit (electrocautery). These tools use electrical current to cut tissue and cauterize vessels to stop bleeding (they are significantly more efficient than the standard scalpels used just for skin incisions), but when using a monopolar setup, you need a wide electrode adhered somewhere to complete the circuit. In abdominal surgeries, it’s usually placed on the right shoulder blade, while for cardiac procedures, it might be on the lower back or similar, because the current travels from the surgical tool to that electrode to close the loop.

As for the mask, they applied it because Propofol, in that initial induction dose, tends to suppress respiration (what foreign medical literature refers to as suppressing the "hypoxic drive"), so they had to ventilate you (meaning the anesthesiologist was essentially breathing for you using a manual bag) until your spontaneous breathing returned. Later on, they likely just held the mask in place and lifted your chin to open the airway, allowing you to breathe in either pure oxygen or perhaps a mixture of oxygen and nitrous oxide (an IV Propofol plus N2O/O2 mask combo is a pretty solid setup for short-term IV anesthesia).

One of the major perks of Propofol for these kinds of outpatient procedures is its antiemetic properties (it helps prevent nausea), the fact that patients wake up feeling quite lucid, and the way it metabolizes rapidly in the body, which is why people can often head home the very same day.

Eric Moore8 Asks:
Hey there. Just checking in. 🙂
So, I’ve got an endoscopic ultrasound on the horizon. After that first attempt went south—and let's just say it wasn't exactly a walk in the park—I've decided to go under full anesthesia this time around. Honestly, I don't think I could handle it any other way. Could anyone walk me through what the actual process looks like? Also, if the whole procedure takes about 45 minutes, how long am I realistically going to be out cold afterward? Thanks in advance. 🙂

Look, let's be real—for those elective procedures, patients usually get handed at least a little something to take the edge off—anxiolytics like Xanax or Ativan, for instance—so it’s no wonder they end up drifting off for a few extra hours afterward.
Honestly, you’re probably better off just asking the anesthesiologist who'll be handling your sedation whether they plan on giving you any premedication beforehand. It's worth a quick word—better to know what's coming.
At my hospital, it isn't really the standard practice to give premedication to outpatients coming in for things like gastroscopies or colonoscopies—though, honestly, that seems to vary quite a bit from one medical center to another.

Laura Hernandez49 said:I know a woman who had an appendectomy and had to have it removed... unfortunately... listen... when you have to take off nail polish if you're wearing it... well, regarding the aparatic... you can probably figure that part out yourself... though maybe check with the doctors first.

The nail polish thing is mandatory because of pulse oximetry—it filters certain light frequencies, which can feed the oximeter some seriously fake data, lol.

As for the aparatic, that’s a different story. In theory, you might run into an issue if the surgeon uses a monopolar cautery without a grounding pad (you know, that thing they stick under your shoulder or hip before surgery) while the aparatic is wired directly to the ground—which, let's be honest, is basically impossible in a real clinical setting.

If the aparatic is fixed in place and isn't going anywhere, there's really no reason to strip it off. Removing it right before an elective procedure is more about following established routine than any actual physiological necessity.
It’s similar to wearing masks in the OR—technically, only the lead surgeon, the assistants, and the scrub nurse need them; everyone else could get by with just a surgical cap (assuming they aren't nursing a cold)—but everyone wears a mask anyway just to avoid the lecture from the cranky scrub nurses who won't stop nagging.

Regarding inhalation versus IV... for the aparatic, it doesn't make much difference.

Amanda Sanders44 said:They say there’s no such thing as a stupid question...😁

Is it okay to go into surgery—specifically under general anesthesia—if I have a fixed dental appliance?

I know you have to take off all the metal—rings, earrings, piercings (probably just in case they need to use defibrillators🤷).
We're looking at a potential eye surgery that would likely run about 3 or 4 hours...

Thanks for any insight.🙂

It shouldn't be an issue, provided it doesn't interfere with your ability to open your mouth properly. The real headache comes with loose teeth or removable dentures, since those can pose a serious risk to a patient's airway during the procedure.

Robert Campbell63 said:Help!
My mom was taken off the table today right after full anesthesia following heart surgery because of an emergency.
They are planning to redo the anesthesia this coming Monday.
Is it actually safe to administer them so close together—especially considering her heart isn't exactly in top shape?
Any potential consequences?
thanks

It's fine... by Monday, her body will have metabolized those drugs entirely. Honestly, if yesterday's induction went smoothly without causing any major hemodynamic issues, there’s really no reason to expect anything different on Monday.

Sam Hall15 said:I’m curious about your personal experience—or anyone else who has dealt with patients like this. Why avoid relaxants if they respond well to antagonists? There isn't any real long-term risk of worsening the underlying disease by using them, either.
They get neostigmine, spend a little time in the PACU, and if everything looks fine, they head back to the ward.

Well... my own experience (which matters less) and the experience of more seasoned colleagues (which matters more) suggests that deep anesthesia with sevoflurane is usually enough to achieve adequate relaxation.

About a month and a half ago, we had a patient with myasthenia gravis who was on a regimen of Decortin and Mestinon. She was scheduled for a laparoscopic cholecystectomy, so we went with a standard induction—etomidate, fentanyl, and leptopantrol—followed by a bit more fentanyl and inhalation (MAC around 1.5). The relaxation was perfectly adequate (and let's be honest, our surgeons are constantly complaining... we’ve spoiled them 🙂
The emergence was absolutely seamless.

copperraven53 said:I have a procedure scheduled for tomorrow—it could be done under local or short general anesthesia, though my doctor hasn't actually decided which route we're taking yet.

Since I had surgery a year ago under general anesthesia where they had to intubate me, I'm wondering—is intubation always a requirement when you're going under general?

The thing is, I woke up today with a sore throat that’s been getting progressively worse throughout the day, and now I've started coughing. I’m worried—could this interfere with the intubation process? 🤷 I really wouldn't want them to postpone the whole thing just because of this. 😢

1. Intubation isn't a given with every general anesthesia case... for quite a few minor procedures—think cosmetic work or smaller orthopedic surgeries—a laryngeal mask or an i-gel is often perfectly sufficient.

2. An upper respiratory infection shouldn't necessarily prevent intubation unless it's particularly severe; however, if I were tasked with anesthetizing a patient dealing with an upper airway inflammation, I would absolutely opt for intubation to ensure secretions don't migrate down into the lower airways.

3. Personally, if a patient shows up with a respiratory infection for an elective procedure, I am definitely pushing for a postponement... it’s nothing urgent, so the surgery can wait. My priority is patient safety first, and their convenience comes second.

Mark Rogers4 said:Just a quick question—is it normal for my urine to have this intense, weird smell after being put under general anesthesia and then getting a painkiller injection? I could almost swear it smells like some kind of medication. (I just had tonsil surgery, so I’m wondering if I should be worried, or if it’s just because I haven't been drinking enough water?)

There are probably several factors at play here... they might have used Propofol during induction... I know that can sometimes tint urine green, though I can't say much about the scent—not that I make a habit of sniffing patients' urine—(certainly wouldn't do that for my current salary 🙂
. It's also possible the analgesic used was Tramadol, which occasionally leaves a yeast-like scent in the urine—though there isn't any hard scientific data on that, just things I've heard passed down from older colleagues)

But... the most likely culprit is the simple fact that almost every patient heading into surgery arrives completely dehydrated. Often, even after the procedure, they aren't getting enough fluids to compensate—post-op nurses in the recovery rooms aren't always quite as proactive as the staff in the ICU—so the urine ends up concentrated, darker, and carries that sharp, intense ammonia smell

Sam Hall15 said:There’s a distinct possibility that patients might take a little longer to wake up from anesthesia—essentially, the neuromuscular blockade lingers. That said, muscle relaxant antagonists work quite effectively for patients dealing with myasthenia, so there really isn't much to fear. Depending on the specific procedure, an anesthesiologist can simply opt for anesthesia without any relaxation at all, which effectively brings the risk down to zero. At least, that's my take regarding the direct negative impact on myasthenia.

hm... honestly, for someone with myasthenia, the smartest move would be to ditch non-depolarizing relaxants entirely... you know, induce with just enough to get the tube in, then transition to high-dose Sevoflurane, and you’ll achieve adequate relaxation for pretty much any surgery.
If we're talking about something intense like a Whipple procedure or major neurosurgery, you could probably toss in 2 milligrams of Neostigmine and call it a day—it's not like it matters much when the patient is heading straight into shock anyway, right? (relatively speaking, of course).

Well, obviously... it all hinges on how severe the myasthenia actually is. If someone is living a perfectly fine life on just Mestinon, then maybe under-dosing Norcuron is an option. But if they're stuck taking steroids or even undergoing plasma exchange? Then you should stay far away from non-depolarizing agents—run the other way, if you will.

hollownomad482 said:So, I just came out from under general anesthesia after having my gallbladder removed laparoscopically—and honestly, I’m baffled. Why did my shoulders hurt more than the actual surgical incisions? I couldn't even sit up straight. The pain finally started letting up today, but I've been living on Tylenol since my surgery on Tuesday... thanks anyway! 🙂))))

It's entirely possible it was due to how you were positioned on the table during the procedure.
When dealing with a patient who is completely relaxed—which, mind you, is mandatory for all abdominal surgeries—proper positioning while under anesthesia is absolutely critical to prevent nerve injuries caused by compression or stretching.

Also, one has to wonder if the discomfort is truly centered in the shoulders or if it's actually radiating from the neck... it's possible the intubation was a bit tricky, leading them to use significant cervical extension just to get a clear view and successfully manage the airway.

I really owe a debt of gratitude to the veteran anesthesiologists for all their wisdom... I’ll certainly do my best to make sure some of it actually sticks in my brain 🙂

Michelle Cook83 said:Yeah, I saw—the kid was still on the ventilator for another two or three hours. It was just a tonsillectomy. Apparently, the patient had some minor cholinesterase deficiency, which is why they were extubated so early.

Well, it really depends on what kind of deficiency we're talking about—whether it's homozygous or heterozygous.
If it's the homozygous type, you might want to buckle up and plan for at least eight hours before they actually regain any strength.

Though, honestly, trying to get a quantitative reading on serum cholinesterases isn't exactly the gold standard—it’s notoriously unreliable. It would be much more sensible to run a dibucaine test; that way, you can clearly distinguish between the homozygous and heterozygous forms without all the guesswork.

Sam Hall15 said:I don't know—Propofol isn't my first choice, perhaps because Americans seem to overrely on it, but if my volume looks decent, I might consider it over Thiopental or Etomidate—though it seems like everyone has stopped using the latter, which feels like a bit of an exaggeration regarding side effects. Personally, I’d rather combine several drugs, even during RSI, than just hammer them with one massive dose, which is how most protocols seem to go nowadays. Dormicum would be fine, but it's too slow; maybe a little Fentanyl and then some Thiopental—that’s a solid combo.

How often are you guys actually administering relaxants during RSI? And when you're staring down a textbook difficult airway case, do you usually bite the bullet and give them, or do you play it safe?

Dormicum mixed with Nespodal is a solid pairing; if you give 5 mg of Dormicum alongside 150 mg of Nespodal, an 80 kg patient will drift off pretty quickly.
As for relaxants, I stick strictly to Lepto, unless there's a nasty contraindication—then I'll go with Esmeron... honestly, I've seen people use Lepto even with potassium levels above 6, and everything turned out just fine.

Michelle Cook83 said:Fellow anesthesiologists—please, tell me, how often do you actually run into cases involving cholinesterase deficiency?

We had a patient like this recently; his serum levels were sitting somewhere around 3,000 units per liter.
It was his first time ever going under the knife, so we had absolutely zero history to go on—no prior surgical issues, nothing at all in the family history, either.

In the end, we just put him on a ventilator, kept him sedated, and managed to extubate him the following day.