62 posts shown.
electricpanther82 said:So, about birth control pills before surgery—is it okay to just keep taking them like normal? I know you aren't supposed to miss a single dose, so I'm wondering how that works with everything else going on. And honestly, the whole thing about side effects from general anesthesia... the idea of actually waking up during surgery absolutely terrifies me. Even if there’s only a tiny, 0.01% chance, it still gets to me because you have no way of knowing if you're the one it'll happen to. Is that fear even rational? Does anyone know what the statistics look like here in the States regarding this kind of thing? Are there actual cases, and what kind of percentage are we talking about? urbanscout50, thanks so much for all the detailed answers!😍
You really ought to stop taking oral contraceptives about four weeks before any scheduled surgery. The main reason for this is basically just getting your coagulation system back to its "normal" baseline. See, those hormonal birth control pills actually mess with your blood clotting factors, making you way more prone to forming clots. In everyday life, it’s usually not a big deal, but things change once you’re under anesthesia. When your blood flow slows down—especially through your veins in your legs—and you combine that with the fact that you'll be lying still or immobilized after the procedure, you run a much higher risk of unwanted clotting. That can lead to some scary stuff like a pulmonary embolism or even thrombosis in the venous sinuses that drain blood from your brain. Honestly, the consequences can range from being totally minor to absolutely fatal. Better safe than sorry, right?
Stopping it just a few days before surgery doesn't really do much, honestly—besides the obvious risk of an unplanned pregnancy, there’s not much of a point to it.
Look, if you’re taking OK and you realize there just isn't enough time to pull a break, you absolutely have to give your anesthesiologist a heads-up. Let them know so they can stay extra sharp during the procedure and coordinate with the surgeon about what the post-op monitoring should look like—assuming, of course, the surgeon is actually cool with the suggestion.
Honestly, I really think they should make it a standard rule to ask women about their last period before any anesthesia or surgery. It’s just common sense, right? So, if you’re heading into a procedure and the staff forgets to bring it up, please—just speak up and let them know. And look, if your cycle is running late, do yourself a favor and take a pregnancy test first. If it turns out you are pregnant, you’ll definitely need to sit down with your doctors to figure out the best way to move forward safely. Better safe than sorry!
Has there ever been a case where someone stayed awake during anesthesia here in the States? Honestly, it’s a fair question. Ever since we started practicing anesthesia, awareness during surgery has been one of those things that can happen. I don't have any specific statistics on the exact frequency, though. To be perfectly honest, when it comes to side effects, there's always that lingering feeling that there's a fifty-fifty chance they might just pop up. 👎Or maybe not. 👍.
Honestly, don't overthink it. Just trust your anesthesiologist. From what I’ve seen, things almost always get complicated when it's someone close to you or even a colleague—someone who spends the whole time before surgery stressing out and imagining every single worst-case scenario they've ever read about online. It’s like they actually attract bad luck just by worrying about it so much.
I’d say a little bit of fear is totally normal—honestly, it might even be a good thing. But once that fear starts turning into a constant stream of negative thoughts? That’s where you hit the danger zone. That's bad, like, really bad.
So, how should you actually carry yourself before heading into surgery? It’s totally normal to feel a little jittery, but there's a right way to prep so everything goes smoothly once you're under.
So, once you’ve actually been told you need surgery, things start moving pretty fast. You’ll be chatting with your surgeon to nail down a date for the procedure, but here’s the thing: don't just sit around twiddling your thumbs while you wait. That window of time between the diagnosis and the actual operation is actually gold. It's your chance to get your body in peak condition—think of it like training for a big game. Whether it's tightening up your diet, getting more active, or tweaking how you manage other health issues, using that time to prep your system can make a massive difference in how you bounce back. Use it wisely!
So, let's talk about physical activity. Or, you know, actually moving your body instead of just being a permanent fixture on the couch. What's everyone's take on this?
There aren't really any strict rules here. Honestly, just stay as active as you feel up to doing based on how you're feeling physically. It’s all about that sweet spot—moving around helps boost your fitness, gives your immune system a much-needed kickstart, and basically primes your body to bounce back faster after surgery so you can get back to your regular routine without the long wait.
Body weight?
Honestly, if you're dealing with some extra weight, you really ought to try and drop as much as possible before heading into surgery. It just makes everything smoother.
When you're dealing with patients who have a high BMI, things get pretty complicated fast. You’ve got the heart working overtime, blood pressure climbing, and more often than not, blood sugar levels that are all over the place. On top of that, their breathing mechanics change completely, and you really have to consider the massive strain being put on their entire musculoskeletal system. It's a lot to manage.
So, I’ve been thinking lately about that stubborn fat buildup—you know, the kind that just settles in around the chest, neck, and face area. It’s one of those things that can really mess with your confidence, and honestly, it feels like no matter how much you tweak your diet or hit the gym, that specific kind of weight just wants to hang out right where you don't want it. It's frustrating, to say the least.
Sometimes, getting that endotracheal tube in place—you know, setting up the breathing tube to deliver all those anesthesia gases directly into the trachea—can get incredibly tricky, or even totally impossible. And honestly? When things go sideways like that, it can turn fatal fast.
When you're dealing with patients who have a higher body mass, you usually have to bump up the dosage of anesthesia. Since most of those drugs love to hang out in fat tissue, they tend to stick around much longer in those folks. It makes the whole recovery process a bit more drawn out—they just take a lot longer to wake up and fully shake off the effects.
People like that just need way more time to get their muscle strength back to where it needs to be—you know, enough to actually catch your breath properly. Plus, they’re much more prone to catching pneumonia, which, honestly, can turn fatal pretty quickly. On top of all that, their surgical wounds tend to take forever to heal and can be a real struggle to close up.
Teeth?
Seriously though, if you’ve got any busted or shaky teeth, you really need to get them fixed up before you head in for surgery!
Aside from the fact that decayed teeth can be a nasty little source of infection while someone's recovering from surgery, there's another headache we have to watch out for. It happens more often than you'd think—during intubation or some other procedure involving the mouth, a weak tooth might just snap. If a fragment ends up getting inhaled into the lungs, we're looking at some seriously life-threatening complications. Definitely not something you want on your hands.
Smoking?
Seriously, you guys need to quit smoking once and for all!!!
You know, when you look at what smoking actually does to the body, it’s pretty wild. It basically puts your cardiovascular system through a blender—your blood pressure spikes, those heart arteries start narrowing up, your heart rate goes into overdrive, and suddenly there's way less oxygen circulating in your blood. It's a lot for the body to handle.
When you smoke, your lungs basically turn into a swamp of excess mucus. It makes breathing a total chore, keeps you hacking away with that constant cough, and honestly, just leaves you wide open to nasty respiratory infections or even life-threatening pneumonia. Not exactly the way anyone wants to spend their time.
So, what's the deal with alcohol? Just a random thought popping into my head today.
Seriously, everyone, you really need to stop drinking alcohol!!!
Honestly, alcohol is just a total wrecking ball for the body. It doesn't just pick one target; it goes after everything—your liver, your brain, your blood vessels, your nerves, even your kidneys... it's basically a full-scale assault on your system. Just something to keep in mind, I guess.
Since most anesthetics get broken down in the liver and then cleared out through the kidneys, any damage to those organs totally messes with how they're processed. It makes it pretty tricky to predict exactly how they’ll behave in someone whose system has been hit hard by alcohol.
You also see this thing quite a bit where people struggling with alcohol dependency hit what’s basically "alcohol madness" right after anesthesia kicks in or even just a few days post-op. It can be a total nightmare—not just for the patient, but for their family and the nurses and doctors working the floor, too. Honestly, it’s pretty intense. And look, I hate to be the bearer of bad news, but we've actually seen fatal cases linked to this kind of post-op delirium. It's definitely something to keep on your radar.
So, what's the deal with the meds?
If you're on any regular meds, go ahead and keep taking them right up until the day of your surgery. Just make sure you take your usual morning dose early that day—and try to do it with little to no water at all.
When you're heading into the hospital, make sure you pack every single one of your medications with you. Seriously, don't leave anything behind at home. You never know—the hospital might not have exactly what you need on hand, and it’s way easier to have your own stash ready to go than to deal with the headache of tracking down a specific prescription mid-stay.
Exception:
Just a quick heads-up for anyone prepping for surgery: you’ll need to stop taking things like Advil, Aspirin, Voltaren, Aleve, or Motrin at least seven days before your procedure. Basically, these are all blood thinners or anti-inflammatories that can mess with how your blood clots. If you don't clear them out of your system, you run the risk of bleeding too much during or right after the operation, and nobody wants that kind of extra drama. Better safe than sorry!
So, here’s the deal regarding the meds: you need to stop taking Pelentan and Marivarin exactly four days before the surgery. But, you can't just quit them and leave things hanging—you have to start on low-molecular-weight heparin via subcutaneous injections at the same time. You definitely shouldn't try to DIY this, though; it all has to be done under a doctor's watchful eye. Also, don't forget that you'll need to check in with a hematology specialist before the actual procedure. They’ll review everything, give the final thumbs up on whether you're good to go, and map out exactly how we handle your treatment once you're in recovery.
Keep taking your blood sugar pills just like you normally do, but definitely skip that morning dose on the actual day of your surgery. If those pills aren't quite doing the trick to get your levels where they need to be, we might switch things over to Insulin therapy. Because of that possibility, it’s honestly a great idea to check into the hospital at least two or three days before the big day. Also, make sure you've had a sit-down with your diabetes specialist beforehand—they'll give us their expert take and lay out the game plan for managing your sugar once you're recovering.
What about herbal supplements or any other "alternative" remedies?
You really ought to cut all of that stuff out at least 7 days before your procedure.
Since these types of remedies haven't been studied nearly enough, nobody can say for sure how they'll react when mixed with anesthetics, and we don't want to risk any weird side effects or damage to your system.
The whole fasting and no-drinking thing before surgery?
If you're heading into the hospital in the morning, you’ll need to follow a specific fasting routine on the day of your surgery. This rule applies to everyone—whether you're already staying at the hospital or just driving in from home. And look, it’s not about being mean and making you hungry; it’s purely about keeping you safe during anesthesia. If your stomach is full when we induce anesthesia, there's a risk of vomiting, which can cause stomach contents to get into your lungs and lead to severe, sometimes fatal, pneumonia.
The standard routine for adults:
No eating anything starting 6 hours before surgery.
No drinking anything starting 4 hours before surgery.
The standard routine for kids:
No eating anything starting 6 hours before surgery.
No milk starting 4 hours before surgery.
No water starting 2 hours before surgery.
So, what actually *is* anesthesia? It sounds like one of those big, intimidating medical terms, but when you strip away all the fancy jargon, it’s basically just the science of making sure you don't feel a thing while someone works on you. Think of it as a master switch for your nervous system. Depending on what kind of procedure you're facing—whether it's something minor at a local clinic or a major surgery over at St. Jude Children's Research Hospital—the goal is always the same: managing pain and keeping you safe. Sometimes it’s just numbing a specific spot, and other times it’s more like hitting the "off" button on your consciousness entirely. It's pretty wild when you think about how we can basically pause your perception of reality just by using the right chemistry.
When we talk about anesthesia, what we're really talking about is losing sensation. It’s a broad term, honestly—it could mean you're just knocked out and unconscious, or maybe you're awake but can't feel any pain, or even both at the same time. It really just depends on what kind of procedure you're heading into.
So, what exactly are anesthetics? Honestly, it’s one of those things we all take for granted until we’re actually lying there staring at the ceiling in a hospital bed, wondering if everything is about to be okay. In the simplest terms, they’re the magic stuff that lets doctors perform surgery without you feeling a single thing. But it’s not just one "off switch." It’s more like a massive toolkit. You’ve got your local stuff—you know, like when a dentist numbs a tooth—and then you’ve got the heavy hitters used in places like St. Jude Children's Research Hospital where things get much more intense. Depending on what’s happening, an anesthesiologist might use a cocktail of different drugs to make sure you're totally out, or maybe just enough to dull the edge. We're talking about everything from basic numbing agents to complex intravenous meds or inhaled gases that basically tell your brain, "Hey, take a nap, we've got this." It’s pretty wild when you think about the science behind it—balancing everything perfectly so you stay safe while being completely unconscious. It’s a delicate dance, really. One minute you're chatting about the weather, the next, you're blinking and it's all over. Pretty crazy, right?
So, let's talk about anesthetics for a second. Basically, they're drugs that mess with your nervous system just enough to induce anesthesia. When you're looking at them, the big goal is to find something that does its job without causing a bunch of collateral damage to your other organs. You want them to hit the mark, then just fade away so your nervous system can get back to its usual, normal self once everything is over. Simple enough, right?
So, what are we looking at when it comes to types of anesthesia? It’s a big question, but I'll try to break it down without getting too bogged down in the weeds. Basically, it all depends on how much "gone" you need to be for whatever procedure is happening. First off, you've got local anesthesia. This is the most basic version—think like getting a couple of stitches at an urgent care clinic or getting a cavity filled at the dentist. They just numb the specific spot so you don't feel a thing right there, but you're wide awake and fully aware of everything else going on. Then there's regional anesthesia. This is a step up. Instead of just one tiny spot, they numb a whole chunk of you—like an entire arm or everything from the waist down. You might have heard people talk about an epidural during labor; that's a classic example of regional. You aren't unconscious, but that specific area is totally offline. If things get more serious, you move into sedation, often called "twilight sleep." This is common for things like colonoscopies. You aren't technically "out," but you're definitely in a dreamy, relaxed state where you won't care what's happening and probably won't even remember it. It's that middle ground between being awake and being under. Finally, there's general anesthesia. This is the heavy hitter. This is when the anesthesiologist has you completely unconscious. You aren't dreaming, you aren't feeling anything, and you aren't "there" at all until they bring you back. This is what happens for major surgeries at places like Mayo Clinic or St. Jude. It's a controlled state, but it's definitely the deepest level of "off." It really just boils down to what the surgeon needs and how much downtime you can handle afterward. Every case is different!
GENERAL ANESTHESIA:
inhalation
intravenous
rectal
Local anesthesia:
surface-level
infiltration technique
regional anesthesia
The main hub.
peripheral block
General anesthesia?
Think of general anesthesia as this gradual, reversible shutdown of your central nervous system. It’s not like flipping a light switch; it’s more of a slow fade. First, you lose consciousness, then you stop feeling any pain—that's the analgesia part—followed by that total memory wipe where you won't remember a thing about the surgery, and finally, everything relaxes out, including your muscles.
General anesthesia isn't usually just about one single drug; more often than not, we’re talking about a cocktail of different anesthetics all working together at once to get the job done.
When you look at how we actually get anesthetics into a patient's system, you can basically break general anesthesia down into three main ways: inhalation, IV, or rectal.
So, let's talk about general inhalation anesthesia for a sec. Basically, it’s this technique where we get you under and keep you asleep using anesthetic gases that you breathe in through your lungs. Most of the time, we’re working with a specific blend—think oxygen, nitrous oxide, maybe some Isoflurane or Sevoflurane—that travels through the anesthesia machine via a whole system of tubing. It’s all done under super strict control and, more importantly, under the constant, watchful eye of the anesthesia team to make sure everything stays smooth.
So, basically, we get those anesthetic gases right into the lungs by either sliding an endotracheal tube down into the trachea or just holding a mask over the patient's face. Simple enough, right?
To hit that sweet spot for surgery, you can't just rely on anesthetic gases alone. Usually, we’re layering in muscle relaxants to get everything still, along with some analgesics to make sure the patient doesn't feel a thing. It's all about finding that perfect balance.
General inhalation anesthesia is pretty much our bread and butter when it comes to what we do. It’s easily the go-to method most of the time. Honestly, the perks are hard to beat—you can hit that sweet spot of anesthetic depth super fast, keeping things steady and under control once you're there is a breeze, and the best part? Patients tend to wake up nice and snappy.
Look, nothing in medicine is ever 100% risk-free, so I always like to give people the heads-up on what could go sideways. You might deal with some minor airway irritation, a scratchy throat, or find yourself coughing a bit more than usual. There’s also a chance of some minor bruising or little nicks to your teeth, lips, or tongue just from the tube being placed in the trachea—nothing too crazy, but it happens. One big thing, though—and I really can't stress this enough—please, please follow the fasting instructions to the letter. If you eat or drink something when you aren't supposed to, there's a real risk of vomiting and inhaling stomach contents, which can lead to serious pneumonia. That’s the heavy stuff we try everything to avoid. You might also experience some nausea or vomiting once the anesthesia wears off, and while it's incredibly rare, there is a tiny possibility of awareness during the procedure. Just wanted to lay it all out there so you know exactly what we're looking at!
So, general IV anesthesia—basically, it’s just when we get someone under by injecting the anesthetic directly into a vein. Simple enough, right?
The best thing about this type of anesthesia is just how smooth and elegant the whole process is—it’s super straightforward to administer, and honestly, getting them under happens so fast.
We usually lean on this to get patients tucked in before we switch over to inhalation anesthesia—it’s just a smoother way to skip that awkward part where they're breathing in those anesthetic gases right off the bat. It’s also become my go-to move for quick little procedures where people need to head home pretty much immediately. Think minor surgeries, diagnostic tests, or even just setting a bone before they get put in a cast. It keeps things simple and efficient.
The biggest headache with this method is that you basically lose control over the anesthetic once it's in. Once you push it into the vein, its fate is entirely up to how well the patient's body can break it down and clear it out. You're pretty much just riding the wave and hoping their metabolism keeps up.
Look, nothing is ever 100% risk-free, so you’ve gotta be aware of what could go sideways. You might deal with some temporary stinging or soreness along the vein where they inject the meds, which is pretty common. There's also the possibility of an allergic reaction to the anesthetic—this can range from a minor little rash to something seriously life-threatening. This is why it is absolutely vital that you tell your anesthesiologist about every single allergy you've ever had, especially if you had a bad reaction during a previous surgery. Other things that can happen include waking up or being conscious during the procedure, feeling super confused, acting euphoric, losing your coordination, or just feeling really drowsy and nauseous once the anesthesia starts wearing off. Just something to keep in the back of your mind!
So, about rectal anesthesia—it's basically a technique where you deliver the anesthetic directly into the large intestine. Honestly, it’s pretty rare to see it used these days, and when it does pop up, it's usually just for little kiddos.
Local anesthesia? Any thoughts on that?
So, local anesthesia—basically, it’s just a way to numb a specific part of the body so you don't feel a thing, all while the patient stays wide awake or maybe just drifting in that light, sleepy kind of headspace.
When you look at how and where we actually apply anesthetics, you can basically break local anesthesia down into three main buckets: topical, infiltration, and regional.
So, let's talk about topical anesthesia for a sec. It’s basically just applying an anesthetic directly onto the surface of whatever part of the body is getting worked on. You usually see it used as a spray, some drops, or even a cream. And honestly? Most of the time, it's pretty much up to the surgeon to decide when and how to use it.
It’s usually the go-to for those little procedures involving the mouth, nose, or eyes.
So, let’s talk about infiltration anesthesia for a second. Basically, it’s this technique where you inject the anesthetic right at the site—and all around the area—where the surgery is actually happening. The whole goal is just to make sure that specific spot is completely numb and pain-free. It involves injecting the meds directly into the target tissue at just the right depth, and honestly, in most cases, it's pretty much up to the surgeon to handle that part of the process.
It’s perfect for those smaller, more straightforward procedures—you know, stuff like stitching up a wound, taking out minor skin lesions or subcutaneous growths, or even fixing small inguinal hernias. Just the little things.
Sometimes, if things really call for it, you can toss in a sedative or some sleep aid alongside the local anesthesia. If we go that route, just keep in mind the patient needs to be under constant watchful eyes from an anesthesiologist—basically, they’ll be under monitored anesthesia care or some kind of enhanced local anesthesia.
So, let's talk about regional anesthesia for a second. Basically, it’s this technique where you inject an anesthetic right near a nerve or the spinal cord to essentially "turn off" the pain signals for a specific, larger area of the body—kind of like flipping a master switch for a whole section. Depending on exactly where you're injecting that stuff, we usually split it into two main categories: central or peripheral. It's pretty straightforward once you get the hang of it!
Main block:
So, basically, we inject the anesthetic right around the spinal cord to block those pain signals from ever reaching the brain. Depending on exactly where we do the injection, we categorize that central block as either spinal or epidural.
So, once the anesthetic kicks in, you'll usually feel this weird tingling sensation or a wave of warmth hitting the area we've numbed up within just a few minutes. After that, the pain just fades away entirely, and eventually, you won't be able to move that part of your body at all. The whole thing typically lasts anywhere from two to four hours. Once it starts wearing off, everything slowly starts coming back online—you'll gradually get your feeling and movement back to normal.
If things don't go exactly according to plan with this type of anesthesia, we just pivot straight to general anesthesia. No biggie, we've got a backup ready to go.
Spinal anesthesia: basically, it’s that technique where we inject the anesthetic directly into the fluid that...
It wraps all the way around the spinal cord.
So, when we're looking at where we actually inject the anesthetic, we’re targeting the lower back area. It's pretty ideal because the risk of any spinal cord injury down there is basically negligible. The whole thing really comes down to where exactly you place the needle and just how much anesthetic you decide to push—that's what ultimately dictates how high up the numbing goes.
You can pretty much use spinal anesthesia for just about any procedure involving the legs, hips, pelvis, or even the lower abdomen—that includes C-sections too.
Honestly, complications from this type of anesthesia are super rare and usually just pass quickly.
You know, about 2% to 4% of the time, people end up dealing with those brutal, pounding headaches after getting spinal anesthesia. It’s a real pain, literally. To try and dodge that, doctors usually tell you that you need to stay lying completely flat for about 24 hours and just chug as much water as you can handle. Just gotta keep those fluids up!
So, let me break down epidurals for you real quick: it’s basically just a technique where we inject the anesthetic right into that little space between your spine and the outer covering of the spinal cord—what we call the epidural space.
So, with this type of anesthesia, we can basically target a specific area of the body and knock out the sensation there while leaving everything else feeling totally normal. It’s pretty cool because if we dial back the concentration of the anesthetic, we can actually block just the pain signals while keeping muscle strength intact—which is exactly how they manage painless births these days.
So, if you go ahead and thread a thin little plastic tube—you know, an epidural catheter—into that epidural space, you basically open up the door to continuous anesthesia. It’s pretty wild how it works; you can just keep pumping the anesthetic in steadily, which means you can maintain that pain relief for a long, long time.
So, when we're talking about epidurals, they’re basically the go-to move for anything happening down in the legs, the pelvis, or the lower abdomen—even reaching up toward the chest and lungs if needed. They also play a huge role in long-term pain management for patients dealing with cancer. It's a pretty versatile tool in the kit when you need to dial back the discomfort.
Peripheral block:
So, here's the deal with nerve blocks: basically, you're injecting the anesthetic right near a specific nerve or a whole bundle of them that services a certain part of the body. It’s a super targeted way to go. Instead of numbing out everything, you can just zero in on a much smaller area—like just the hand, the arm, the shoulder, or even just the foot or leg. It's pretty efficient when you want to be precise.
Regional intravenous anesthesia (RIVA) is basically a technique used to numb an arm or a leg. To pull this off, they first temporarily stop blood flow to that specific limb, then inject the anesthetic directly into the vein. From there, it flows into the tissue and reaches all those nerves.
SO, HOW DO WE PICK THE ANESTHESIA TYPE?
Once your surgeon decides you need the procedure and you’ve cleared all those pre-op tests and checkups, it's go-time.
You’ll meet your anesthesiologist for the first time in the premedication room. After a quick chat, they’ll walk you through which type of anesthesia they're planning to use. If there happens to be more than one way to do things, they usually give you a say in the decision-making process too.
The main factors your anesthesiologist weighs when deciding what's best are: your overall health, where the surgery is happening, the type and length of the operation, any underlying medical conditions you have, the meds you're currently taking, and—of course—your own preference at the end of the day.
electricpanther82 said:In previous posts, it was mentioned that this muscle relaxant isn't really used for short procedures, or if the abdominal cavity isn't being opened. But when we're talking about things like a hernia or an appendix removal—which are shorter surgeries—is that muscle relaxant actually given??? And why does someone have to be paralyzed for throat or sinus stuff🤷? Also, something that confuses me even more: it was said that the relaxant paralyzes everything except the heart muscle and the smooth muscles of the intestines. So, if all the muscles in the body are paralyzed and numbed, how is it theoretically possible for a patient to feel pain when they experience awareness during general anesthesia???? I get that they might be awake and hear talking, but that part about the pain😕
Look, the anesthesiologist is the one who calls the shots on whether to use a muscle relaxant before the whole thing kicks off. If they decide to go with general anesthesia using an endotracheal tube (that's the tube they slide down into your windpipe), they’ll usually give the relaxant right before intubation. The whole point is to chill out the muscles in the mouth and larynx so getting that tube in is way smoother. Sure, you *can* intubate without a relaxant, but you'd need to put the patient under much deeper, which means cranking up the doses of the sleep meds. If the anesthesia isn't deep enough and those laryngeal reflexes kick in, you risk damaging the vocal cords or the larynx.
As the surgery continues, we might use a muscle relaxant to make life easier for the surgeon working in the abdominal cavity (since things like an appendix or fixing a hernia require relaxed muscles so the surgeon can stitch up the abdominal wall properly), and it also helps the anesthesiologist manage mechanical ventilation.
For ENT (Ear, Nose, and Throat) surgeries, we need the patient relaxed to prevent those sudden, involuntary muscle twitches. Those spasms can mess with the surgeon's work and could cause some pretty serious injuries—like if there's a sudden jerk while they're working on the middle ear, where everything is incredibly tiny and delicate.
By balancing different anesthetic drugs, the anesthesiologist can hit that "sweet spot" of perfect anesthesia using the lowest possible doses, which helps dodge any nasty side effects from overdoing it.
So, think of it this way: a muscle relaxant ONLY affects the muscles. Painful stimuli are picked up and carried by nerve receptors and nerves. Imagine it like a railroad crossing. Lowering the gate stops the cars (muscle movements), but it doesn't do anything to stop the train (the pain signal) from moving along the tracks.
Local anesthetics act directly on the nerves to block the pain signal from traveling from the receptor to the brain (like putting barricades on the tracks).
Opioid analgesics and general anesthetics modulate that pain signal further up at the level of the spinal cord, brainstem, and the brain itself (think of them as maneuvers or switches at the main train station).
That's pretty much the gist of it.
electricpanther82 said:I’d also loop back to that question Hudson asked—what should someone actually do if they experience true anesthesia awareness? Who can they even turn to? I’ve seen so many articles mentioning how people just aren't believed when this happens, right?
In my book, the first step would be reaching out to the Chief of Anesthesia. They’d need to sit down with the patient and the anesthesiologist to review the anesthesia record, which gives a clear picture of what was happening during the procedure. Ideally, all three parties should sit down together and just talk through it. From there, the patient should notify the hospital administration and maybe even bring on a lawyer to negotiate a settlement for the pain and distress caused. If that doesn't work, well, then you look at filing a lawsuit.
Of course, you’ve got to have proof. It’s much easier if the patient has a crystal-clear memory of everything—the conversations, the specific people in the room—and those folks can back them up.
It gets way messier, though, if a patient claims they were awake but can’t remember a single thing, especially if the anesthesia chart and vitals don't show anything suggesting they were conscious. In those cases, it’s incredibly hard to prove the patient's word, and it’s easy for people to assume they’re just looking for a payout.
When we’re filling out an anesthesia record, we input precise vitals—blood pressure, pulse, breathing, oxygen saturation—and there’s absolutely no "massaging" the numbers. We can't afford to, because that record is our only defense if something goes sideways. Everything is documented in duplicate (one goes into the medical history, the other to the anesthesia archive), along with the patient's signed consent (signed before premedication, obviously), so the risk of tampering with the charts is kept to a minimum.
Looking at all that, you can see why it’s such a tough sell for staff to believe someone was awake. No one goes into general anesthesia intending for a patient to be conscious, and if the physiological parameters don't show signs of wakefulness, the team feels confident they followed protocol perfectly. If a patient can't recall the flow of surgery, the chatter in the OR, or the people present, it’s really hard to take their word for it. There’s been plenty of talk about depth-of-anesthesia monitoring, too. Unfortunately, most operating rooms in the US aren't equipped with that kind of tech, so I won't even go there (plus, even when you *do* have it, there’s still room for error).
On top of that, it's nearly impossible to predict how a patient will react to our meds. The human psyche is a weird thing. Some people get sleepy during premedication, others get relaxed and chatty, while some might become aggressive or even psychotic. Trying to figure out how much they actually remember versus how much their brain has scrambled is—honestly—nearly impossible. You see similar stuff during induction (before they hit deep enough anesthesia) or even more often during emergence. Waking up is a longer, slower, more dramatic process, and usually, the whole crew is there—surgeons, nurses, techs—everyone is talking, laughing, or moving around the patient.
When you pile all that up and try to make sense of it, I think you get a pretty clear picture of why proving awareness is such an uphill battle in most cases.
The question: "Why doesn't every single one of our ORs have objective depth-of-anesthesia monitoring?"
The answer: Money.
Sophia Thompson46 said:If I could just ask a quick question—it seems pretty straightforward—why do some people end up throwing up after surgery?
The question is simple enough, but man, the answer is actually pretty complicated.
Postoperative nausea and vomiting, or POMP, is a super common side effect of general anesthesia. It’s honestly one of those incredibly unpleasant, draining things that can really wear you down. I hear patients say all the time that the vomiting feels way worse than the actual pain from the procedure.
Whether it happens depends on the patient, what kind of surgery they’re having, and the specific anesthetic used.
1. People who are just more prone to it: folks who have dealt with nausea after previous anesthesias, women, people who get motion sickness easily, and non-smokers (and hey, I’m not out here telling anyone to start smoking!).
2. Types of surgeries where it’s more common: brain surgeries, ENT stuff (like middle ear procedures), major chest surgeries, big abdominal or laparoscopic surgeries (think gallbladder or gyno stuff), and even eye surgeries like correcting strabismus.
3. The drugs involved: the opioids used during or after surgery for pain management (for example, a lot of people feel sick after taking Tramadol, which is a common painkiller), and volatile anesthetics (those gases the patient breathes in).
So, what can we do about it?
1) During the pre-op checkup and chat with the anesthesiologist, we look at how many risk factors a patient has for developing POMP.
2) Once we weigh everything up, we estimate the risk and adjust our anesthesia technique accordingly, using different anti-nausea meds to help out.
For instance:
- If we can swing it, we use regional anesthesia instead.
- When general anesthesia is necessary, we try to avoid the specific drugs known to trigger POMP.
- We often use Propofol for general IV anesthesia.
- We give anti-nausea meds either right before or towards the end of the anesthesia.
- After the surgery, we want to stop the opioids as soon as possible and switch over to non-opioid painkillers.
- We keep the anti-nausea meds going once the patient is moved to the recovery ward.
So yeah, that’s the short version of the deal with POMP. In your case, the most likely culprit for the lingering nausea is probably the surgery itself, especially since your previous anesthesias went smoothly without any issues. Unless they stopped the anti-nausea treatment in the recovery unit—which I doubt, because nobody wants patients throwing up on their watch—then, well, that’s just bad luck.
P.S. Unfortunately, there are some people where nothing seems to work, and they keep throwing up despite all our medications and best efforts to help them feel better. In those cases, our hands are tied... or maybe their body is just giving us feedback on how it handled the anesthesia and the surgery. 🤷
Elizabeth Hill48 said:what happens if they give me general anesthesia and they don't realize I'm taking my meds? there's no way for them to know... how does Metoprolol actually react with those drugs?... if anyone knows😕
So, Metoprolol is a cardioselective beta-blocker. Basically, this group of drugs works on the heart by lowering both the heart rate and the strength of the contraction. By doing that, it reduces the workload on the heart and lowers its demand for oxygen, which helps prevent things like angina or even a heart attack. It’s kind of like giving your heart a little break. It's a super common class of medication, and tons of patients heading into surgery are on them.
The standard approach for anesthesiologists nowadays is to keep the beta-blocker therapy going right up until the day of the procedure (meaning you should definitely take your morning dose). They essentially act as a shield for your heart against the stress caused by the surgery itself—you know, before, during, and after the whole thing.
Now, interactions with anesthetics are definitely possible, and they do happen. See, anesthetics themselves can depress cardiac function, so if a patient is also on a beta-blocker, that effect can get amplified. This could lead to some significant hemodynamic issues, like a heart rate that's too slow or too weak, which then causes blood pressure to drop. That can lead to ischemia—which is just a fancy way of saying certain organs aren't getting enough blood. If that goes far enough, we're talking serious stuff like a stroke, kidney failure, liver failure, or even bowel necrosis.
Think about it this way: in certain situations where blood pressure drops suddenly—like during heavy bleeding—the body usually tries to fight back reflexively by ramping up the heart rate to compensate for the loss of blood. But if the patient is "blocked" by these meds, the heart can't speed up to respond, and boom, you're back to ischemia. It's a similar situation for patients with a pacemaker that's programmed to a fixed rate.
Man, I went on a bit of a tangent there, haha. But honestly, that absolute worst-case scenario is rare. It's possible, sure, but rare. In actual practice, what usually happens is just a slow pulse, and doctors typically only step in with medication if it's accompanied by a significant drop in blood pressure. Usually, they'll use drugs that work through different mechanisms to bump that heart rate back up. And if even that doesn't quite do the trick, they can always set up a temporary pacemaker to gently nudge the rate up to where it needs to be.
Just to hammer it home one more time: beta-blockers are taken right up to the day of surgery. Unlike some other heart meds, you don't skip them before anesthesia.
So, please don't worry. Stick to your prescribed routine and just leave the rest in the hands of your anesthesiologist.
If you’re looking into that regional block for cataract surgery, you really need to talk to the ophthalmologist over at St. Jude's. If they don't offer it or if they don't have someone on staff who actually knows how to pull it off, then you're kind of out of luck there.
Honestly, I’d strongly suggest scheduling a consultation with an anesthesiologist first. Just bring along all her most recent test results, take your mom in, walk them through how she handled things last time, and then hash out the details. If she’s still holding up reasonably well—meaning she can handle some moderate physical activity—and her angina is stable enough that it doesn't flare up constantly or require frequent Nitroglycerin, then a mix of general and local anesthesia might actually work. Basically, the anesthesiologist can sedate her using a cocktail that won't mess too much with her vitals (like her heart rate or blood pressure), while a local anesthetic injected right into the eye handles the actual pain. It’s a pretty solid combo because it gets the job done without needing massive doses of heavy drugs.
So yeah, first check in with the eye specialist, then get that meeting with the anesthesiologist on the books.
So, do you always need to use a muscle relaxant during general anesthesia? Like urbanscout50 mentioned earlier, the answer isn't a simple yes. It really all boils down to what kind of surgery we're talking about, how long it takes, the patient's overall health, and honestly, just the anesthesiologist's call on the matter.
For those quick little procedures—we're talking maybe thirty minutes or less where nothing major is being opened up inside the body—we usually don't bother with relaxants. We typically stick to IV sedatives or those volatile gases the patient breathes in. Ventilation (basically some form of assisted breathing) is handled with a good old-fashioned mask or a laryngeal mask. Of course, if things change mid-surgery—like if the procedure runs longer than expected or if the surgeon realizes they can't get the job done without it—then we'll bring in the relaxants.
Now, for the heavy lifting—surgeries lasting over an hour where cavities are being opened, or when the surgeon needs the patient to be absolutely still (think ear surgeries or neurosurgery)—that’s when relaxation comes into play. In those cases, we usually go with general endotracheal anesthesia. This involves placing a tube down the trachea (windpipe) to manage ventilation, through which we deliver oxygen and usually anesthetic gases to keep the patient at the right depth of sleep. The actual act of intubating requires a relaxant, and whether we keep adding more during the operation depends on everything I just mentioned. There's also the option of total IV anesthesia, where we maintain the sleep using IV meds (usually propofol) and just use the tube to provide a steady mix of oxygen and air. Again, relaxants follow the same rules.
When we're doing general endotracheal anesthesia, the patient is hooked up to the anesthesia machine, which handles the artificial ventilation and lets us keep a close eye on all their vital signs.
Regarding throat surgery (not entirely sure what specific case we're looking at here), it's performed under general endotracheal anesthesia, and a relaxant is used to help with the intubation. Whether more is needed later on just depends on those same factors I talked about before.
I should probably say a few words about propofol: it’s a beautiful IV anesthetic. It gets people to sleep fast and wakes them up just as quickly, often leaving them totally lucid (sometimes people even pick up right where they left off in a conversation before drifting off!). Plus, it doesn't cause that post-op nausea, making it the go-to choice for anyone prone to getting sick after anesthesia. And hey, if you're lucky, you might even have some pretty great dreams.
It wasn't that Michael Jackson was crazy for choosing propofol; he just made a bad call on who to trust. If he’d picked an anesthesiologist instead of a cardiologist, he’d probably still be with us today.
This can be done under general anesthesia. That means you'll have an anesthesiologist on hand, and you won't feel a single thing during the procedure.
Alternatively, it can be done using local anesthesia—what some call topical—where the ophthalmologist just drops some numbing agent into the eye before getting to work. In those cases, there isn't an anesthesiologist present, so if the numbing doesn't take properly and the patient ends up feeling pain or discomfort, that falls squarely on the surgeon's shoulders. Honestly, it breaks my heart when certain doctors (surgeons or anesthesiologists alike) deal with inadequate local or regional numbing by trying to convince the patient they aren't actually in pain or that they just have a "low pain tolerance." In my book, that’s just plain inhumane.
There's also the option of regional anesthesia, where they use a needle to inject the local anesthetic near the nerves behind the eye. It’s not super common, though, and you won't find it at every medical center.
Ms. fermina-daza, I’m guessing your mom had her last surgery done under local anesthesia. If her overall health allows for it—she’ll need to pass a pre-op screening at a specialized anesthesia clinic first—she can totally insist on going under general anesthesia. That way, she won't feel anything during the actual surgery, and once it's over, the hospital staff will handle her pain management with prescribed meds.
Good luck.
Generally speaking, any anesthesia should kick off with a pre-op consultation. If you’re looking at a scheduled, elective procedure—something you’ve already got on the books—you really want that check-up done at least a week beforehand. That way, if they need extra lab results, a second opinion, or if you need to tweak your medication, there’s actually time to make it happen without the stress. Most major hospitals, like the Mayo Clinic or big city medical centers, have dedicated outpatient clinics just for these consultations. In some places, the anesthesiologists working the clinic stay strictly in the office and rarely head into the OR, so the odds of seeing the same face on surgery day are pretty slim. But in other hospitals, the doctors rotate between the clinic and the operating room, so you might actually end up with the same person. Honestly, if you vibe with them and feel comfortable, you can always ask if they'll be the one handling your case.
Just a heads-up though: what the doctor says during that initial clinic visit isn't set in stone. Things change—health status fluctuates, meds get adjusted—so the final call always rests with the anesthesiologist who actually administers the anesthesia right before you go under.
Now, obviously, if we're talking about emergency surgeries, all that scheduling goes out the window and the assessment happens fast, right before the procedure starts.