Linda Johnson66 said:Hey, how do doctors actually know if I’m ready for surgery just by looking at blood work, chest X-rays, and urine tests? I’m going in for a cyst removal on my ovary, but what happens if I have some issue with my large or small intestine that I don't even know about—like, something undiagnosed or just some general illness I'm totally unaware of???
In reality, nothing is ever absolute in this field...
The whole idea behind running these tests is to get a sort of "snapshot" of what's happening inside your body right now, much like when you go in for a standard physical, and it also serves to "document" your baseline health status before surgery in case anything goes sideways later on—though whether that's actually useful is a bit debatable...
On the other hand, there's been a growing movement lately in the medical community toward a more liberal approach, where they don't bother with a laundry list of tests if the patient doesn't have any existing comorbidities; instead, if issues *do* exist, they aim for much more "targeted" testing, mostly to cut down on costs and, secondarily, to avoid bothering the patient unnecessarily... Regardless, old habits die hard, and frankly, it's a nasty habit to break, but as an anesthesiologist, I feel I have every right to demand whatever tests I deem necessary before I take responsibility for someone's life...
Personally, I try to stick as closely as possible to risk assessment protocols (the ASA classification), and after performing a physical exam, I usually decide exactly what I want the patient to have tested. This can range from absolutely nothing (for instance, a child needing a minor procedure or a healthy young adult without underlying conditions) all the way up to an echocardiogram or a CT scan of the abdomen if we're dealing with someone who has cardiac issues or a massive tumor—and obviously, if those haven't already been done by the surgeon, because no sane person is going to order a repeat CT without a damn good reason if one was performed just a month ago...
Jamie Ross7 said:This is such a great topic; my hat's off to the experts here who take the time to answer our questions...
...I'm going to throw out a variation of a question that's been asked before, because honestly, I am absolutely miserable with how much nausea and vomiting hits me every time I wake up from general anesthesia...
...can this be something that develops over the years?...
It certainly can....
Jamie Ross7 said:Does it have anything to do with the dosage, the ratio of fat to muscle tissue, or maybe an issue with the liver?
We don't know for sure... I mean, we can look at statistics to see who has a higher probability of being hit by nausea, but nobody can tell you with 100% certainty the exact mechanism of why it happens to one person and not to another...
🤷
Jamie Ross7 said:either it's those opioid components in the cocktail—if I wrote that right—because I’m usually the type who reacts aggressively to them; once, because of a massive headache from my sinuses, I was given Tramadol and immediately felt nauseous.
It could be—but it’s definitely part of it... Opioids absolutely ramp up nausea, just like N2O and a whole bunch of other stuff usually (I say usually, not always), though the anti-nausea meds they give you generally work pretty well, at least in the short term...
Jamie Ross7 said:I mean, I don't really have experience with whether it can happen without that blood pressure spike, but honestly, I’d just settle for being a puke machine.
I'm trying to figure out what changed and if there's anything I can actually fix myself, potentially.
(I really hope this doesn't mess with me again.)
It's tough, unless you loudly emphasize during every single surgery that you suffer from REPETITIVE postoperative nausea and vomiting, so that whoever is handling the anesthesia "beefs up" the preventative measures... otherwise, I don't see what else you could do, like how you're supposed to "desensitize" yourself to PONV with something you do on your own...🙂
Linda Johnson66 said:Hi, I have a laparoscopy for a clear ovarian cyst coming up in ten days, but I caught a cold this week—it's been going on for about 4 days now. I've got a cough, I'm hoarse, and my nose is stuffed up every morning, though I don't have a fever. Does this mean they'll probably postpone the surgery??
Look, the answer is way more complicated than it might seem, or honestly, it should be according to any kind of logic... So let's start with the head...
The reason why anesthesiologists hate it when patients have a cold is the exact same reason they hate heavy smokers—airway irritation. An irritated airway is far more prone to reacting to extra stimuli by spasming the vocal cords and bronchi, triggering coughing fits, or producing excessive mucus that then clogs up the airways, whether those are natural or artificial...
The problem is that in anesthesia, we mess around with the airway quite a bit, especially when we're inserting tubes (which is standard for laparoscopy), and furthermore,
after a "cold," excessive irritation and airway reactivity can linger for up to two months after the other symptoms vanish... even if someone is functioning perfectly fine on a daily basis, they can still react to being "poked," so whether you had a fever during the cold or not has absolutely NOTHING to do with it and isn't a predictor of how reactive the airway will be at a given moment following an infection, which brings us to the next point...
Complications... First things first, here’s the intraoperative data...
Bronchospasm... just one of those things that hits you like a freight train when you least expect it, leaving you gasping for air while everything else seems to just grind to a halt... It’s such a relentless, suffocating sensation, isn't it? One minute you're fine, and the next, it feels like someone's tightened a vice around your chest, making every single breath feel like a desperate struggle against an invisible weight... It’s honestly exhausting, both physically and mentally, trying to fight through that tightness while your lungs feel like they've completely shut down on you... You know, there are certain things that can go absolutely sideways right on the operating table, and it’s enough to completely ruin the day for both the anesthesiologist and the patient, no matter how well everything else goes... And honestly, even with some surgeries, just a simple, violent coughing fit can turn into a total disaster—like if you’re having a hernia repair and a massive cough causes everything to just snap from the sheer strain. Then you've got laryngospasm kicking in right after they pull the tube out, which is terrifying... Plus, we have to face the reality that once you've gone under general anesthesia, your body's natural ability to clear out secretions from your airways is going to be compromised for a few days. Even if we don't give you extra meds that mess with things, the inhaled anesthetic gases themselves actually interfere with the function of the cilia on the bronchial and tracheal cells... and that can lead to real symptoms or even full-blown pneumonia because general anesthesia frequently causes those tiny parts of the lungs to collapse—what we call atelectasis—which temporarily, or sometimes permanently, tanks your lung capacity and leaves you struggling...
Discussion... Look, obviously there are all sorts of anesthetic techniques out there—some higher risk, some lower—that can be used to get the job done depending on the circumstances, and if you make the right call from the start, you can seriously cut down how often things go sideways or how bad those complications actually get... every single anesthesiologist knows this, and honestly, they usually have several different ways to tackle the exact same problem, but before anything else happens, there is always one fundamental question that has to be asked first...
Why on earth would anyone even bother exposing themselves to an increased risk of complications if it isn't absolutely necessary... I mean, seriously, what is the point of taking that gamble when you don't have to... And that goes both ways—it’s just as true for the anesthesiologist as it is for the patient, because at the end of the day, we're talking about the patient's actual life and their long-term health... so really, the whole debate over whether you should go under the knife while fighting a cold or not is just one big, complicated question that doesn't have such a simple answer...
How much does it actually matter if you get the procedure done right this second? I mean, really... how critical is that timing when everything feels like it's hanging in the balance..."
Look, there’s a massive difference between facing a malignant tumor that’s actively threatening to spread and grow—or if you're dealing with a procedure that you've been stuck waiting months, or even years, for—or maybe someone who actually risked their entire career by using up their single annual vacation just to get surgery because their private employer won't let them take medical leave... that's one thing entirely... but if we're talking about something that can be pushed back a month without anyone breaking a sweat, then we are talking about something else altogether...
Look, at the end of the day, it really just boils down to the agreement between the patient and the anesthesiologist, and honestly, everyone is entitled to their own perspective on this kind of thing... you can't just force an opinion on someone because they're the one ultimately carrying the weight of the decision, and they have every right to turn down a treatment if they aren't feeling it—unless, of course, we're talking about those absolute emergency situations where the patient's condition is crashing and the doctor feels like things could be stabilized through therapy or just waiting it out instead of jumping straight to a procedure...
My personal take on this... Look, as I made clear before, I can't exactly speak for my colleagues who are actually running the anesthesia on the day of the procedure... they have every right to use their own clinical judgment and set their own criteria based on what they see in front of them, and honestly, that’s just how it works in an American hospital... Personally, I rarely ever pull a patient from the schedule unless we're dealing with an "active" cold involving heavy coughing and specific lung sounds—which usually points toward tracheobronchitis—but even then, I always make sure to walk the patient through the potential complications... If I truly feel the risk is unacceptable, I might even demand an extra signature acknowledging they understand the risks before we proceed with anesthesia, though obviously, if it's an emergency or if postponing the surgery would be a massive logistical nightmare, I'll just lean heavily on proper premedication to minimize any issues and carry out the anesthesia with every necessary precaution in place... 🤷
Look, you absolutely have to make sure you tell the anesthesiologist who’s handling your case about that cold, no matter what... because if it happened just a day or two before the surgery—which, let's be honest, is usually how these things go—and they don't take the initiative to swing by and check on you in the afternoon before the actual procedure, you really ought to mention it to the nurse... just suggest that someone from the anesthesia team comes by to give you a quick look and maybe adjust your premedication so it actually works the way it should...