Posts by urbanscout50

wanderingcrane said:Hey there,🙂
I have a quick question about laparoscopic gynecological surgery.
I know general anesthesia is used, but does the patient actually get intubated during the procedure?

Basically, yeah. That’s the safest way to go. You could technically get by with a laryngeal mask or even just a regular mask, but honestly, that's basically playing Russian roulette with anesthesia. We just pray to God everything goes smoothly.

Susan Ramos96 said:Hey everyone on the forum, greetings from a new member!

I'm working on my final thesis at a health sciences university here in the States, and I've been looking into testing for malignant hyperthermia, but now I've hit a bit of a wall.

Basically, I can't find any info on whether they actually perform the CHCT (Caffeine-Halothane Contracture Test) here in the US, or if they do—where would that even happen?

Thanks for the help!

Nope.

analogmason13 said:I just stumbled upon this thread today and I've got a question for urbanscout50 or Anthony Dubledore.

So, I ended up having emergency surgery for an ileus. It was one of those wild situations where I actually remember parts of the conversation happening in the OR—I must have been in that weird semi-conscious limbo, though thankfully, I didn't feel any pain at all. But man, the real nightmare started when I was coming around. There was this terrifying moment during the recovery phase where I felt like I couldn't breathe on my own. I definitely remember that sensation, and honestly, it was absolutely terrifying.
I’m not going to name the hospital I was at, but they basically kicked me out in record time—and of course, they didn't mention a single thing about what actually happened in my discharge papers. One thing they did suggest while I was still there, though, as a potential reason for everything, was some kind of genetic predisposition toward being "hypersensitive to anesthesia." (Not sure if that's even the right way to put it, but you get the gist.)
So, I was wondering—is there actually a way to find out if I’m allergic to a specific ingredient in what they gave me? Or was this just some kind of mistake on the anesthesiologist's part?

Hey there! How's it going?
Man, I am so sorry you had such a rough time with that. Seriously, I really hope it doesn't happen to you again.
When it comes to that semi-conscious state you experience while you're in the operating room—and those conversations you think you heard—you really have to look at it through two different lenses:
So, here’s the deal: what you heard probably happened during that initial induction phase right before the surgery kicked in. Since you were coming in as an emergency case, there's a good chance you didn't get—or didn't get enough of—that specific sedative meant to relax you and wipe the slate clean. Because of that, those snippets of conversation in the OR before you went under, combined with the hazy chatter while you were groggily waking up from anesthesia, just blurred together. Your brain basically stitched those two moments into one long, continuous memory, making it feel like you were actually awake during the whole procedure. Honestly, it’s totally understandable how much these pre-op jitters can mess with your head. When you're dealing with all that fear, anxiety, or even a little shred of hope, you're mentally raw. You're hyper-sensitive, so those sounds and voices cut much deeper into your consciousness than they normally would if you were feeling chill. That’s how we end up with this version of events. I wouldn't necessarily blame it on some weird genetic thing or being "overly sensitive" to meds, and I don't think it's a mistake by the anesthesiologist either. In emergency situations, things move so fast—and the patient's condition is often so critical—that they sometimes skip the anxiolytic (you know, the stuff that takes the edge off and helps you forget) to get straight to the induction. It's just how it goes sometimes when things are moving at high speed.

So, there's this second possibility: you were actually semi-conscious during the procedure. If that’s the case, you could probably recount some of the conversations happening in the OR while you were under. Honestly, that’s a much scarier version of events. For you, it might have felt relatively harmless since you didn't actually feel any pain, but I get why it would leave you feeling pretty anxious about any future anesthesia. I wouldn't go so far as to say you have some genetic predisposition to being "hypersensitive" to anesthetics, though. It’s more likely just a miscalculation on the anesthesiologist's part regarding the right dosage for you. Look, I’ll say it again—in an ER setting, things move fast. Sometimes, because of a patient's overall condition, the doctors might underdose the anesthetic just to make sure they don't destabilize the patient even further. That’s how you end up in that weird half-awake state. Since our operating rooms aren't always decked out with high-tech gear to monitor the exact depth of anesthesia, we really have to rely on the anesthesiologist's experience and gut instinct. You can see how easily a misjudgment can happen, especially when things get hectic in the room. At the end of the day, we're just human beings, not machines immune to stress and emotion.
Another possibility is that you were just metabolizing the anesthesia way faster than the anesthesiologist was expecting. Basically, you might have drifted out of deep sleep and into that weird, semi-conscious "twilight zone" much quicker than planned. Since they had you on muscle relaxants, you wouldn't have been able to move or even twitch to signal that you were waking up, so the doctor didn't realize you were drifting toward consciousness. Plus, since you weren't feeling any pain, your vitals—like blood pressure and heart rate—stayed steady and calm, so there were no red flags on the monitor to tip them off that something was wrong. As for why your metabolism would kick into overdrive like that, it could be anything from certain medications you’ve taken lately (like specific sedatives or antibiotics) to alcohol. Those things get processed in the liver and can actually prime it to break down other substances, including anesthesia, at a much higher rate. Or, honestly, it could just be how you're built—some people just have livers that process drugs faster due to genetics. In those cases, the doctor really needs to tweak the dosage or the timing to match the patient's unique chemistry, but when you're dealing with an emergency case, that kind of fine-tuning isn't always possible. That’s just another way your experience could have gone down.

So, that terrifying feeling when you wake up and suddenly realize you can't move, can't breathe properly, and can't follow any commands? It actually happens more often than you’d think. Usually, it’s what happens when the sedative—the stuff used to put you under—starts wearing off, but the muscle relaxant is still hanging around in your system. You're essentially stuck in a body that won't obey you because those muscles are still totally paralyzed. Once we administer the reversal agent for the relaxant, the block finally breaks and your strength starts coming back. But man, that transition is rough. Even after the paralysis lifts, you're left with this intense, overwhelming sense of discomfort while you wait for your motor skills to fully reboot. Most patients breeze through it without a second thought, and honestly, most don't even remember it happening because the anesthesia keeps things pretty hazy. But for the rare few who do catch that moment? It's definitely not something you forget easily.

Why didn't they mention those incidents in your discharge papers? Honestly, it’s probably because they don't see them as anything that would impact future anesthesia. Basically, the ball is in your court now. Next time you head in for a pre-op screening or any kind of procedure, just be upfront with the anesthesiologist about what happened and the anxiety it caused you. They'll do their best to make sure you don't have to go through that again. Usually, the stuff they actually bother putting in writing are things like a nightmare intubation or a clear allergic reaction to a drug—neither of which happened to you.
Look, a real allergic reaction to a filler isn't going to look like the symptoms you're describing. Trust me on this—if things were actually going south, people would be shouting it from the rooftops and telling you straight up. We’re talking about life-or-death situations here, not just some minor irritation.

So, long story short: I don't think you actually need more testing. Honestly, it’s probably just a matter of being upfront with the anesthesiologist about that awkward situation next time around. Given how urgent the procedure was, there's a real chance the anesthesiologist just misjudged things—not even calling it a "mistake," really, but more like a miscalculation based on your overall health and what medications you were already on. It’s one of those things that happens to everyone eventually; you just happened to have the bad luck of being the one on the table when it went down this time.
I really hope you never have to deal with anesthesiologists ever again. But if life throws that at you down the road, I truly hope it’s smooth sailing—no weirdness, no discomfort, just drifting off into a deep sleep and having some genuinely beautiful dreams.

Scott Hall47 said:how much does dental anesthesia usually run?

Honestly, any decent dentist's office should have a price list hanging up somewhere on the wall that breaks down all their services, including what they charge for numbing up.

Sam Hall15 said:It’s totally doable—I’ve actually seen it happen. 😁
The blood flow gets cut off in the arm, but I think things start loosening up after maybe 10 minutes or so. Plus, honestly, you probably never even hit a high enough concentration of relaxants in that specific arm to trigger a full-on neuromuscular block. I've got a link if anyone wants to nerd out on it. 😁

Both Eva and I are definitely down for that link.

electricpanther82 said:I read on some random international forum that a woman who was terrified of waking up mid-surgery actually made a deal with her anesthesiologist. She asked them to leave one hand unrelaxed with the muscle relaxants, so if everything else fails—the machines, the whole works—she could still use that one hand to signal that she’s awake. So, basically, the rest of her body is relaxed, but not that one hand. Is that even possible, or just total nonsense🤷?

Using general anesthesia along with muscle relaxants???? No way!!!!
Muscle relaxants are drugs given intravenously (into the vein), so they travel through the bloodstream to the neuromuscular junction (where the nerve meets the muscle) to do their job. Basically, wherever the blood goes, the relaxant goes. How on earth are you supposed to tell a drug to go everywhere in the body except, say, your right hand? Those kind of "smart" relaxants don't exist—or maybe they do somewhere out there, but I've certainly never heard of them.
Unless, of course, their anesthesiologists have superpowers and can use mind control to steer drugs through the bloodstream wherever they want. Honestly, that sounds like some straight-up snake oil stuff to me.

There is a thing called monitoring neurological functions by having the patient move their hands or legs, or follow other motor commands. But those procedures are done under local or regional anesthesia. If you're under general anesthesia, the patient would have to wake up, wait for the relaxants to wear off, and then perform the test.
A good example would be surgeries on the carotid arteries that supply blood to the brain. These can be done using a regional block, where the patient is asked to periodically squeeze a hand or grab something (like a squeaky toy). That's how they check if the procedure is causing issues or if a stroke is occurring. In many ways, that's actually the best way to monitor neurological function, because it catches issues early so doctors can jump in and fix things immediately.
Another example is neurosurgery near specific nerves or on the brain itself, where the patient is woken up mid-procedure to make sure no nerves or vital brain centers were damaged during the operation.

Sadly, all you really have is to trust the anesthesiologist handling your case. Just sit down and talk to them before the surgery and lay out your fears. I'm sure they'll have something kind to say to put your mind at ease. And hey, try not to overthink it too much. Everything we do in life comes with its own set of risks and potential complications.

mellowraven32 said:Just don't forget who actually carries the weight here—who’s really in charge and holding the bag...
When things go sideways with patient care, who's the first person people come looking for to blame? It's always the same story...

In my neck of the woods, an RN has a salary coefficient of 3.2, putting them at roughly $1400
while a GP is sitting at 3.5 with a paycheck around $1533

And yeah, that’s before any overtime or bonuses. Honestly, the pay gap is embarrassingly small.

I see it firsthand at work every day... they spend half the shift messing around and just counting down the minutes until they can clock out.

As a director, my coefficient is 4.5 😁

How is a director even supposed to watch their staff slack off like that?
Maybe those "poor souls" with less schooling and zero accountability think that if the director messes up, they might as well mess up too, right?

cosmicowl64 said:alright. urbanscout50 can push all they want, but does the surgeon actually have to say yes?
Are there any patient rights regarding this if someone won't agree to general anesthesia—like, what can they actually point to in terms of legal standing?
And is it even possible to switch surgeons at this stage, since they're heading into the hospital today?
😕

Look, the surgeon really ought to honor the patient's request to skip local anesthesia, or at least work it out with the anesthesiologist to do some kind of "light" general anesthesia combo. Especially for a procedure that drags on this long and was already incredibly painful last time.
If a patient is fully conscious and lucid, they have the right to refuse any medical intervention—especially one that could be done in a much more "comfortable" way!
The absolute dealbreaker here is if the patient simply refuses local or regional anesthesia. That’s where they draw the line.
Plus, if the device they had implanted before is working fine, then the risks associated with anesthesia this time around should be lower than they were previously.
But hey, I'm just a surgeon, right? What do I know?
Of course, they can always ask for a different doctor, though honestly, they probably should've done that sooner. The only catch is if this specific surgeon is the only specialist in the area who handles these kinds of implants. If that's the case, they might be stuck with them.

cosmicowl64 said:Hey everyone,
My dad finally had heart surgery after waiting about ten years for it.
He needed an ICD (implantable cardioverter-defibrillator) because his arrhythmias were so bad that the only thing that could jumpstart him was emergency intervention from doctors using manual paddles.
It happened about three times—he even experienced clinical death once... I’m just mentioning this to show how heavy this whole situation is and the trauma he's been carrying since he was a kid due to this rare, poorly understood heart muscle disease.
After years of various medical "attempts"—there were even books written about cases like his—and a bunch of unsuccessful treatments and trials,
the day finally arrived. The device meant to fix his biggest struggle in life was ready for implantation.
Everything would have been smooth if we hadn't spent two months basically badgering him to go through with it... He eventually went to the hospital in a state of disbelief, just grabbing his pajamas and stuff, looking totally frustrated.
Since the surgery was high-risk, we were sitting on pins and needles waiting for the doctor to call us. We were losing our minds.
The call finally came, saying the procedure took 2.5 hours and everything went fine—we all broke down crying tears of joy.
But later that same afternoon, once we visited his room and gave him some love, his very first words to us were, "If I knew it was going to feel like this, I never would have agreed to it. I would've rather died."
So, what happened?
Before the surgery, they had him strapped to the table and gave him some local anesthesia that only seemed to last about 20 minutes. For the rest of the time ("about 2h"), the surgeon was essentially working on him while he was awake, using a scalpel to make the incision and manually threading the leads to the heart before tucking the device under the skin.
There were issues during the operation too, specifically when pulling the leads out of the heart—they have these anchor-like ends, so once they're in, they're hard to get out, and they had to redo parts of it because of a surgical error.
I honestly couldn't listen to him complain anymore—I felt a huge amount of guilt because I was one of the people pushing him to get the surgery in the first place.
Long story short, it's been a few months now, and the wound isn't healing properly, and the site where the device is located is still painful. Just more frustration.
A few days ago, we finally convinced him to go back for a follow-up with the surgeon who did the procedure.
He barely made it there, and the doctor told him the device was implanted too shallowly and that he needs to go back in for a corrective surgery immediately!
So, folks, I need some advice. Is it okay for someone in his condition to be given general anesthesia instead of just local? And can he actually demand that? The doctor isn't being very communicative, so I'm wondering what his rights are in this whole mess.
On top of that, he's clearly dealing with massive frustration, nerves, and a total aversion and fear toward hospitals.
Any insight would be much appreciated.

If there aren't any contraindications for general anesthesia, he should talk to the surgeon and insist on being put under. He absolutely needs to tell them about the nightmare experience he had with the local anesthesia and how the procedure was handled.

stormymaker24 said:Wait, what do you mean it worked so fast?

Honestly, your dentist might just be that good—maybe they hit a spot right near the nerve, which would explain why the numbness kicked in almost instantly. If their work is solid and they’re actually talented at fixing teeth as well as they are at numbing them, I wouldn't dream of switching dentists anytime soon. Just stick with the pro if they get the job done.
Best,

Kimberly Edwards38 said:Hey everyone. So, I’ve got a question for the group. I’m starting to wonder about the long-term effects of having frequent surgeries and, you know, dealing with all the different types of anesthesia. I actually just got home about a week ago from my eighth surgery—this one was done under spinal anesthesia. Looking back at the whole tally, I’ve been through general anesthesia twice, spinal twice, an axillary nerve block once, and I think I’ve had local anesthesia a couple of times too. Honestly, I haven’t really run into any major issues so far (aside from that annoying struggle with peeing right after the spinal, if you know what I mean), but I can't help feeling a little anxious about what this might be doing to my body in the long run. It’s especially weighing on me since I’ve already got at least two more procedures on the calendar. Any thoughts?

Look, I’m just saying—you really ought to sit down and have a heart-to-heart with your surgeon about all this. You need to get the full lowdown on the potential fallout, any weird complications that might pop up, and the actual risks involved. Every procedure is its own beast, you know? Don't just wing it based on some random internet thread; make sure you know exactly what to expect before you go under the knife.

When it comes to anesthesia, look—every single time you go under, there’s a unique set of risks involved. Honestly, every new round feels a bit like the first one when you consider the potential for acute, immediate complications. It's just how it works. Then you've got the chronic side of things, where long-term issues can stem from how the drugs actually function, how your body breaks them down, or how they eventually clear out of your system. But anyway, let's try to break this down logically:
Look, I’m no doctor, but when you start talking about IV setups, things can get a little dicey if they aren't handled perfectly. Even just the initial poke can go sideways—you might end up with a burst vein that needs a redo, or just those annoying bruises and inflamed spots where the needle went in. It's one of those "small thing, big headache" situations. Then there’s the whole issue of paravenous administration. Basically, if a vein pops during anesthesia, all that fluid and medication leaks out into the surrounding tissue instead of staying in the bloodstream. That can cause some nasty swelling, irritation, or inflammation. In really bad cases, it can even lead to necrosis, which is just a fancy way of saying the tissue starts dying off. And man, the absolute worst-case scenario? If a med accidentally gets injected into an artery instead of a vein, it can cut off circulation entirely. We're talking potential necrosis for the whole area that the artery feeds—like, your entire hand could be at risk. Definitely not something you want happening in an OR.
So, here’s the thing about that pre-medication phase—you know, when they give you those chill-out meds to help you relax before they wheel you off to the OR? There’s always this tiny, nagging chance of a nasty allergic reaction hitting right then. It’s one of those things you don't really think about until it's mentioned. And honestly, even once they start the actual anesthesia, things can get a little unpredictable. Since most of these drugs are stuff you’ve probably never encountered in your life, it’s super tough for doctors to predict how your body might react. Sometimes, your system just decides to throw a curveball with an unexpected reaction to a medication you've never even touched before. It's just one of those weird medical wildcards, I guess.
So, when you’re dealing with intubation—you know, sliding that breathing tube down into the trachea—things can get messy fast. Sometimes it’s just a "difficult airway" situation where you can't get the tube in, which isn't actually the end of the world if you can pivot. Like, if you can just switch over to bag-mask ventilation or pop in a laryngeal mask, everyone stays breathing and we move on with our lives. No biggie. BUT—and this is a massive *but*—if the patient has already been given a paralytic, and then you realize you can't intubate them, AND you can't get a mask on them, AND you can't ventilate them with the bag? Yeah, that is a nightmare scenario. If you can't quickly reverse that muscle block, you're looking at an emergency tracheotomy or a cricothyrotomy—basically having to go through the neck to create an airway right then and there. In a best-case scenario, if things go sideways, you're looking at severe brain damage or even a permanent vegetative state. It’s heavy stuff. And don't even get me started on trying to intubate someone with a full stomach. I mean, obviously, I'm talking about the patient's stomach, not the anesthesiologist's! That whole situation is its own special kind of disaster. You risk them vomiting and inhaling all that acidic stomach contents straight into the lungs, which leads to aspiration pneumonia. And that can be just as fatal as the airway issues themselves. Just one of those high-stakes parts of the job that keeps you on your toes.
You know, I was reading up on some medical stuff earlier, and it’s kind of wild how much can go wrong with something as standard as intubation. Like, it's not just about getting the breathing right; you could actually end up causing damage to the lips, teeth, or even the tongue. They can even mess with your vocal cords or cause issues down in the trachea. It's definitely one of those things where you realize how delicate everything really is.
So, here’s the thing about anesthesia—it’s definitely not always a smooth ride. Sometimes things just don't go exactly according to plan, and you can end up with some pretty unpredictable reactions to the meds. Like, you might deal with "light" anesthesia where you aren't quite under enough and start drifting back toward consciousness, which is super weird. Or, on the flip side, you could go too deep, and that's when things get a bit dicey with your vitals—usually resulting in your blood pressure taking a sudden dive. It's one of those "anything can happen" situations, even when everything seems totally fine.
Waking someone up from anesthesia is honestly one of those high-stakes moments where you really have to trust your gut. You’re basically playing a game of timing—trying to figure out exactly when the drugs have worn off enough that it's safe to pull the breathing tube and move them over to a recovery room or a PACU. It's all about finding that sweet spot where they're stable enough to handle it.
You could also end up throwing up here, too. Honestly, it’s definitely something to keep in mind if you're planning on heading that way.
So, look, even if everything seems totally fine in the OR or the recovery room right after you wake up, things can get a little dicey later on. It’s all that weird biology stuff—metabolism, how your body breaks down meds, how it flushes them out, and those active metabolites that hang around longer than they should. Basically, the drug might have a "delayed reaction." The most common way this hits is with extreme drowsiness, shallow breathing, or even worse, someone accidentally stopping breathing altogether. Now, honestly? Not a huge deal if you're still right next to the anesthesia crew where they can jump on you instantly. But if you've been moved away and you're flying solo? Yeah, that's when things get pretty sketchy. We've already chatted about the whole situation with pain management and stuff not quite hitting the mark, but this side of things is just as important to keep in mind.

Look, what I just laid out can happen with pretty much any anesthesia, whether it’s your first time under or your fiftieth. Even if someone says they have decades of "anesthesia experience," there's honestly no guarantee that things won't go sideways.

I could go on about the long-term effects of anesthesia, but let me try to keep this brief.
Basically, anesthetics are drugs that mostly get processed by your liver and then cleared out through your liver or kidneys. Just like any medication, when you're dealing with massive amounts, it can put a real strain on the liver and kidneys. To make matters worse, during anesthesia, blood flow to those organs can drop, leaving them struggling with a lack of oxygen while they're working overtime to break down the drugs. This can lead to cellular damage. Now, if those organs are already dealing with other issues—say, if you're regularly taking stuff like Advil, Aleve, or Motrin, which we know can be tough on the kidneys—they might not be able to handle the extra load from the anesthesia. They end up accumulating tiny bits of damage that can eventually snowball into something permanent. Plus, some of the metabolic byproducts created when the body breaks down these drugs are known to be toxic to the liver and kidneys.
This risk is higher with frequent, back-to-back procedures that last a long time, or if someone is undergoing surgery while their vitals are already unstable (like a young patient dealing with major trauma).
If things take a turn—like a sudden drop in blood pressure from bleeding or acute heart failure—doctors might have to use vasopressors to bring the pressure up. These drugs constrict blood vessels quite aggressively, which can cause ischemia (basically, a lack of blood flow) in parts of the body supplied by smaller vessels. That can lead to tissue death (necrosis) in areas like the intestines or limbs.
Then there's the brain. Because of how anesthetics affect the central nervous system, you can run into cognitive dysfunction—essentially, issues with mental processing. This ranges from being barely noticeable to serious personality changes, especially in older patients or after heavy-duty surgeries like cardiac, neurosurgery, or organ transplants.

Alright, all that was regarding general anesthesia.

Regional anesthesia—things like a spinal block or a nerve block (like in the armpit)—has its own set of potential headaches too.
With both techniques, there's always a small chance of accidentally hitting a nerve, which can cause paresthesia (weird sensations in the area controlled by that nerve) that usually fades away pretty quickly. However, if the anesthetic actually gets injected directly into the nerve, it can cause permanent damage.
There's also the risk of accidentally nicking a blood vessel. If a large amount of local anesthetic gets into the bloodstream, it can trigger neurological issues or even heart arrhythmias and cardiac arrest.
With spinal anesthesia, you might deal with temporary urinary retention (not being able to pee) while the drug is active, which usually just requires a quick catheterization to fix. You might also get those nasty post-puncture headaches. To help prevent those, doctors often suggest lying flat for 24 hours after the procedure and staying super hydrated. Drinking things with caffeine, like coffee or tea, has also been shown to help reduce the frequency of those headaches.
The most serious complication would be an epidural or spinal hematoma—where a blood vessel is accidentally nicked near the spinal cord. If that blood builds up and starts pressing on the spinal cord or nerves, and it isn't caught and treated surgically right away, it can lead to paralysis or permanent disability.

So, yeah, that's the short version of regional anesthesia.

As for that whole theory about losing five years of your life after general anesthesia... honestly, I don't know anything about that. If it were true, I guess we'd have to tack on another three years just for reading all this stuff I just wrote! Seriously though, I'm not sure that "five-year rule" holds any water. It reminds me of the late Michael Jackson—by that logic, he should have lost decades of his life, but in the end, it wasn't the anesthesia that got him, it was the poor choice of medical oversight.👎

I hope this helps answer your question at least a little bit. Wishing you the best of luck with your treatment—hopefully, you can avoid any more surgeries or anesthesia altogether. Good luck.

Sam Hall15 said:Mechanical ventilation—I mean, who doesn't love that? 😁

Patients on ventilators 🙂

electricpanther82 said:Thanks, urbanscout50! Yeah, she’s a friend of mine, but she’s just terrified of the whole procedure. She honestly figured she’d rather just sleep through it if possible. She was a smoker for years and now at 35, she's dealing with some issues that mean she really needs to get this done, but she doesn't want to deal with a major hospital setting. I think it's mostly just people being scared of the discomfort and the pain, you know? Especially when it's your first time going in for something like this—people get so worked up. I actually panicked like a total wreck during my own gastroscopy, so I ended up driving all the way out to a different clinic just to get sedated. It's kind of hilarious looking back because I've actually had much worse experiences (like having a permanent tooth pulled without any numbing 😢😢😢). Anyway, she’ll definitely check out that Jordan clinic or some other private facilities in Washington, D.C.—though finding places like that in Miami isn't always easy.

Maybe have her ask around at the hospital in Miami; they might be able to or willing to do a bronchoscopy under anesthesia. It shouldn't cost much, and maybe they can point her in the right direction regarding where else it's offered here in the States.
Best,

Man, this discussion is getting deep into some serious territory. Honestly, the most important rule is that there’s no single rule for which anesthetic to use. You pick the drug (type and dose) and the whole technique based on how the patient is doing overall, what kind of surgery it is, the surgeon's skill level, and—let's be real—the anesthesiologist's own experience, knowledge, and personal preferences. All this talk about "I love this drug" or "I hate that one" is pretty pointless; forcing a specific choice just limits our toolkit, which can actually be dangerous depending on the situation.
Take succinylcholine, for instance. Everyone loves to harp on its life-threatening side effects—things like arrhythmias, malignant hyperthermia, or severe bradycardia that's a nightmare to fix in patients on beta-blockers. But nobody ever mentions the one "harmless" side effect that is absolutely miserable for the patient, especially after quick, minor procedures: intense muscle soreness. Every single muscle you didn't even know you had starts aching (trust me, I've been there). So, I have to ask, why put a patient through that? Especially if the procedure is long enough to allow for induction with a different relaxant. And don't even get me started on drug interactions. Why give something if it isn't strictly necessary?

Esmeron. It’s a solid relaxant, and if you go with a higher dose, it gets you intubated within a minute, much like lepto. The catch with Esmeron is that allergic reactions are pretty common. Then there's Norcuron, which is another good relaxant that people seem to ignore. It definitely has its place, particularly for inducing patients with asthma or allergies (assuming Pavulon isn't available), and it actually wears off faster than Esmeron.

Etomidate is a decent drug, but it tends to make patients nauseous more often. It’s usually my go-to for patients with allergies, asthma, or unstable hemodynamics. However, Etomidate can cause such intense tremors that it's almost like they had lepto, which can raise intra-abdominal pressure and trigger vomiting. So, performing an induction on a full stomach becomes a real question mark, doesn't it?

Thiopental—the big pharma industry basically pushed this one out of the market. Still, compared to Propofol, the wake-up period after Thiopental is longer. So, why bother using it for minor cases where you want the patient to head home quickly?

Propofol. Now we're talking. It's a fantastic anesthetic—fast-acting, and patients wake up quickly and lucid (unless, of course, they were also given some Dormicum, Thiopental, or Fentanyl). It shuts down the gag reflex nicely, making it great for intubation without relaxation or using a laryngeal mask. Plus, if they're lucky, they have some pretty pleasant dreams. One huge plus: it doesn't cause nausea. In fact, giving small doses of Propofol toward the end of anesthesia is actually recommended to prevent post-op nausea and vomiting.
Of course, it's not perfect, and you have to keep its downsides in mind. The biggest issue is how it hits the hemodynamics. Propofol drops blood pressure more than almost any other anesthetic, especially if you push it fast. In my book, giving Propofol to a polytrauma patient who's bleeding out, in shock, or severely dehydrated from an ileus is just plain reckless. In those cases, I think Ketalar is the way to go, even though nobody seems to mention it here.

Ketalar. In my opinion, this is the gold standard for patients in shock, hypovolemic, or heavily traumatized. It helps bump up blood pressure and heart rate, which helps prevent a total cardiovascular crash. Another huge perk is the analgesic component. Basically, with one drug, the patient is asleep and pain-free. Once they're hemodynamically stable—whether that's because they recovered or the anesthesiologist and surgeon stabilized them—you can switch to something else or just supplement the Ketalar with smaller doses of other drugs. Just keep in mind that for "cold" procedures, you should probably add something like Norcuron or Dormicum to avoid or dampen those post-Ketalar hallucinations (which are usually more annoying for the people around the patient than the patient themselves).

We could go on forever like this about every single drug. When it comes to other medications or specific maneuvers, you really should follow the established protocols in every situation where they are prescribed, regardless of what the "house style" is or what the old-timers say. Because if everything goes smoothly, great. But if things go south, everyone—including those veteran doctors who set the "house style"—is going to ask, "Why didn't you do this? It was right there in the protocol." At that point, neither the house rules, nor the advice of your seniors, nor your own opinion on a drug's efficacy will save you. You'll be in a massive bind, facing potential lawsuits and a career that's on the line.
In my book, preoxygenation is a must for those cold procedures where you aren't expecting any intubation nightmares. It’s especially vital for the younger, less experienced anesthesiologists out there—I mean, it’s happened more than once where solid preoxygenation basically saved someone's neck with patients who seemed totally routine. You don't have to be all intense about it, jamming the mask onto their face and forcing them to breathe oxygen for several minutes until they feel like they're suffocating. Honestly, you can just run the bypass on the anesthesia machine, hold the mask a few inches away from their face, and tell them to take a couple of deep breaths. That's plenty. You can even just ride those few deep breaths right after you induce them with Thiopental.
Anyway, that's the gist of it.

electricpanther82 said:Just one question for a loved one who needs a bronchoscopy. Where in the US is anesthesia typically given for this? Money isn't an issue, but I'm curious about how they handle the anesthesia—is it light sedation or deep anesthesia?

Honestly, if you’re near Washington, D.C., your best bet is probably Jordan. It’s a specialized hospital focused on pulmonary issues, so their pulmonologists and anesthesiologists are basically pros at handling patients specifically for these kinds of procedures. They see this stuff all day long.
Usually, bronchoscopies fall into two categories:
1) Rigid bronchoscopy (using a metal tube to look at the larger airways), which almost always requires general anesthesia. To be totally honest, this is a massive headache for the anesthesiologist. It’s high-stress, and frankly, nobody loves doing it. You often have to relax the patient, but then they struggle to breathe, or the anesthesiologist can't ventilate properly because the scope is in the way, and then the pulmonologist is fighting the anesthesiologist just to get a clear view. In the middle of all that chaos, the patient often ends up looking more blue than pink! While things usually turn out fine, I wanted to give you a realistic picture of what's happening behind the scenes. The teams over at Jordan are definitely the most experienced with this specific setup.
2) Fiberoptic (flexible) bronchoscopy, which is the much more common version. This is typically done without full general anesthesia. If they put someone completely under, they have to intubate them to protect the airway, which makes the whole thing take way longer, keeps the patient in the hospital longer, and requires a full anesthesia team. Instead, they usually use local anesthesia. Basically, the pulmonologist sprays the nose, mouth, and throat with a local anesthetic before sliding the scope in, and then numbs the vocal cords as they move deeper, adding more local anesthetic as they go down into the lungs. Sometimes, they might give the patient some light sedation to take the edge off. In my opinion, pulmonologists actually prefer a cooperative patient because things like whether or not a patient coughs can actually help with the diagnosis. If they *do* decide to go with general anesthesia for a flexible scope, it has to be deep enough to keep the patient perfectly still so they don't make sudden movements that could cause injury during the procedure. Personally, I think doing a flexible bronchoscopy under general anesthesia should really only be reserved for small children, patients who are extremely uncooperative, or those with severe heart conditions where even minimal stress is a huge risk (in those cases, you really have to weigh the benefits against the risks of any "medical heroics").
As for whether you can pay extra somewhere to get it done under general anesthesia? I honestly don't know. Your best move is to call specific clinics directly and ask.
Wishing you and your loved one the very best. I'm rooting for a negative result.

Look, guys, most of these cases are pretty much cut from the same cloth. If you've got a healthy patient and the surgery isn't overly intense, you could jokingly say you could run the anesthesia on autopilot. We're talking about 80-90% of our patients right there. In my book, the absolute best anesthetic technique is simply the one you've mastered, and the best drug is the one you actually have experience with. Once things get complicated, everyone starts overthinking which drug is "better" than the other. Honestly, every single agent has its pros and cons, and they all still have their specific niche and timing in the OR (well, obviously excluding the ones that aren't even on the market anymore).
The reason we see anesthesiologists being stingy with heavy-duty opioids for pain management usually boils down to one frustrating thing: freshly operated patients get sent to surgical wards where they just don't get the level of monitoring they need. Most of our big-shot surgeons have already headed home or moved on to the next case, and frankly, some just don't care—they've done their cuts and stitches, and as far as they're concerned, their job is done. That leaves poor patients at the mercy of the nurses, who are mostly wonderful people, but there just aren't enough of them to keep up with everyone physically. (In our hospitals, it’s often the nurses doing the heavy lifting while doctors just write the orders and check if they worked. It’s a sad reality, but true. Doctors prescribe the meds, but anesthesiologists are the only ones who seem to have that innate "caregiver gene" baked into their DNA from day one!) So, you end up with someone screaming in pain, yet somehow breathing fine—but if that pain relief doesn't kick in, they could stop breathing because of the lingering effects of the anesthesia. It's a well-known fact that people rarely die from pain, but they definitely die from respiratory failure. Why is it like this in our hospitals?!
Will it ever get better? "We'll see!" shouted the blind!

Hey there!
I'm not entirely sure what the standard protocol is where you guys are, but here in the States, our cardiac surgeons are pretty relentless about getting a full picture of the carotid arteries. If they have even a shadow of a doubt about a scan or aren't 100% sold on the initial diagnosis, they’ll push for a re-test or a CT angiography just to be safe. And if those results show any stenosis that actually impacts blood flow, they’re going to insist on fixing the carotids before they even touch the heart—especially if the cardiac procedure involves using the bypass machine.
Honestly, it’s tough for me to weigh in on your specific situation because I’d basically just be guessing at this point.
If you didn't get an MRI of your brain before the heart surgery, there's no way to tell if these changes were already there or if they happened after the fact. If they showed up post-op, then logically, it’s likely a consequence of the surgery. Any procedure involving the bypass machine carries a risk of neurological issues—things like reduced blood flow due to low pressure or tiny air microemboli from the machine itself or the heart being opened—but it’s much more likely to hit someone who already has underlying issues like atherosclerosis or high blood pressure.
From what you've described, it sounds like that might be what happened in your case. Since your symptoms aren't constant but seem to shift around, it’s possible that whatever is happening in your carotids is hemodynamically significant right now. That means even a tiny dip in blood pressure or a small piece of plaque breaking loose could be sending microemboli straight to your brain, which lines up with what your neurologists told you. It’s also possible the heart surgery and the bypass machine just tipped the scales, leaving your neurological stability a bit shaky so that you’re reacting to minor fluctuations that wouldn't have bothered you before.
Of course, there's also the possibility of little clots forming on the artificial valves, which can break off and cause embolisms. You'd probably want to check that out with an echocardiogram.
As you can see from my rambling here, my whole explanation is basically built on "maybe" and "probably."
My best advice? Take that MRI result and sit down with a neurologist. Ask them the exact same questions you've been asking here on the forum. Then, take those answers to a vascular surgeon and ask them the same thing. Finally, loop in the anesthesiologist at whichever hospital you'll be having the surgery in.
If the carotid surgery is indicated—meaning they think it’ll actually improve your condition or at least stop things from getting worse—then you should probably go through with it. With good coordination between the surgeon and the anesthesiologist, everything should go smoothly (well, it *should*—we can never be 100% certain with this stuff). During the procedure, they usually use a shunt (basically a little tube to keep blood flowing to the brain) to keep ischemia, or lack of blood flow, to an absolute minimum. Plus, the anesthesiologist will carefully manage your blood pressure with meds to keep that risk low. Even the anesthetic agents themselves help protect the brain from ischemic damage.
There is an option to do it under local or regional anesthesia, but personally, I wouldn't recommend it—especially if the surgeon thinks the surgical site might be tricky to reach.
It’s a bit of a catch-22: if you don't go through with the surgery, you'll never truly know if it was the right call or not. 😕.
Wishing you the best of luck with your decision and whatever steps you take next. Please keep us posted on how it goes! Best,

Arthur Martinez9 said:Is it normal that they didn't send an internist or an anesthesiologist to check me out before my surgery? It wasn't an emergency, though it was for an ectopic pregnancy. I'm 25.

Look, if this wasn't an emergency situation, you really should have been sent for a pre-anesthesia screening. Since you're young—and I'm assuming you're healthy—they probably figured just chatting with the anesthesiologist right before the procedure would be enough. Honestly, though, it also depends on the hospital's specific policies and how much the anesthesia and OBGYN departments actually coordinate with one another.

[QUOTE=electricpanther82;25188852]I'm also wondering how I should handle having three wisdom teeth to pull. What would an anesthesiologist recommend—doing them one by one under local anesthesia, or maybe just knocking all three out at once with general anesthesia? To be honest, I really don't feel like going under general anesthesia, and it feels like the recovery might be pretty rough, but my dentist said doing it all at once would get it over with faster.....[/QUOTE

Deciding whether to go under general anesthesia for tooth extractions is really something you need to hammer out with the dentist or oral surgeon who’s actually performing the procedure. If you don't have any underlying health issues that make general anesthesia a no-go, then yeah, it's true that one session under anesthesia could knock out that triple threat all at once. But honestly, there’s no real reason you can't just do them one by one with local anesthesia, unless the way those teeth are stuck in there means the surgeon needs to make a bigger incision, shave down some bone, or do other heavy-duty stuff (which, again, you’ll have to clear with your surgeon). If that's the case, I'd definitely lean toward general anesthesia. You also have to think about what your dentist prefers. If they feel more confident and can do a cleaner job when the patient is fully under, the results will likely be better and the risk of complications stays minimal.
As for using analgo-sedation for stuff like this, if I'm being totally real, I'm not a fan and think it's best to steer clear.
The pain management part isn't usually the big issue because if the analgesia isn't quite enough, it's super easy to just top it off with a little more local anesthetic (we only use tiny amounts anyway).
The real headache comes from the sedation side of things, because you can never truly predict how someone is going to react to the meds. Some people relax perfectly fine, everything goes smoothly, and everyone walks away happy.
But then you get others who, instead of chilling out, get all excited and restless. They start talking non-stop, they can't stop fidgeting, or they even get a bit aggressive. In those cases, throwing more sedative at them just makes the whole situation worse, so you usually just have to call the whole thing off.
The third scenario is when a standard dose of sedative knocks someone out so deeply that you can't cooperate with them at all. Operating on a patient in that state is a massive risk because they lose those vital protective airway reflexes, which makes it way too easy for them to choke on saliva or blood and stuff.
So, bottom line: talk it over with your dentist and see what they say.[/QUOTE]

northernpanther12 said:Why shouldn't you just crash back to sleep right after waking up from general anesthesia? Why is it better to stay awake for a bit?

It’s all about monitoring alertness and making sure the recovery process is actually going smoothly. See, some of the drugs we use have this weird secondary effect caused by redistribution. For example, certain anesthetics get processed through the liver and dumped into the gut to be cleared out. At that moment, the concentration in the blood drops, and the patient feels wide awake. But then, maybe 30 minutes to an hour later, those same drugs get reabsorbed from the gut back into the bloodstream. Suddenly, you get this spike in concentration, and—boom—they're under again. This leads to exactly what Sam Hall15 mentioned: respiratory depression. That’s the big scary one, the most dangerous complication. If there isn't a trained team right there to jump in and handle it properly, well, you can probably imagine how bad things could go 🙂.
That’s also why patients often complain about being in pain once they get back to the ward. Since there isn't always enough staff to provide constant, hands-on supervision, we end up relying on what I call "vocal monitoring." 😱 Basically, if a patient is screaming in pain, it means they are awake and breathing perfectly fine—because, let's face it, you can't scream if you aren't breathing! I won't even get into the whole mess of side effects related to pain right now.