Anesthesia, Resuscitation, and ICU: Q&A

Regarding birth control pills before surgery—can I just stay on them as usual? Since you aren't supposed to miss even a single dose, I'm a bit stuck there. Also, about those side effects from general anesthesia... honestly, the idea of waking up during surgery really creeps me out. Even if the chance is just 0.01%, it’s terrifying because you have no way of knowing if you'll be that unlucky person. Is being afraid of this actually rational? And what are the statistics here in the US regarding this? Are there actual cases, and what kind of percentage are we looking at??... urbanscout50, thanks for all the detailed answers😍

Well, I’m back after my surgery—I broke my ankle, you see. About eight months ago, they put in some plates, and now they’ve finally taken them out. Everything went smoothly, thank God. While I'm at it, I want to extend my gratitude to all the doctors in this community who help us by selflessly sharing their expertise with those of us in entirely different professions.
My anesthesiologist also sends her thanks. 🙂 During the pre-medication phase in the OR, we had a little chat, and I mentioned to her that I'd read online that the surgeon isn't the only vital player in the room. I told her I was grateful she'd be looking out for me to ensure everything goes according to plan and, more importantly, that I stay pain-free. It caught her off guard; it’s quite rare for a patient to offer thanks to the anesthesiologist, as everyone seems hyper-focused solely on the surgeon. 😉
That’s why I think it’s genuinely beneficial to do a little digging online—at least so you aren't flying blind when your anesthesiologist starts explaining things. They did chuckle a bit during our discussion about anesthesia options the day before surgery; I told them that, as an electrical engineer, I certainly didn't feel qualified to dictate which type of anesthesia I should receive. I noted that they are the expert, and they are undoubtedly better equipped to weigh the risks against the benefits. We talked through the various types and subtypes (most of my knowledge comes from this forum), my specific fears, and my past experiences. Ultimately, she made the call, and I placed my full trust in her decision because it was her specialty, not mine. She understands the granular details while I just know the generalities. The doctor makes the decisions, and having this gathered intelligence helps a patient build confidence in their physician, preventing that frantic feeling of uncertainty about what is actually happening to your body.
They opted for a spinal block, though it seemed to affect one leg more than the other. 😕 It felt a bit strange compared to my first surgery, where both legs were completely numb for quite a while (even for several hours afterward); this time, I could actually wiggle my toes a little even during the procedure. While they were using the saw, I had this sensation like someone was occasionally touching me. My anesthesiologist had warned me beforehand that I might feel something like that, but that there wouldn't be any actual pain, and she was spot on. The person really knows their craft!

Naturally, one must follow all the protocols laid out by urbanscout50. These aren't just "rules meant to be broken"; if you ignore them, you're only doing yourself a disservice, and at that point, even the most brilliant anesthesiologist won't be able to perform their job effectively.

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.

Scott Allen10 said:silverridge36, your post feels a bit inconsistent. You correctly state that one should follow the preoperative advice listed above... but then conclude by saying we should "research online instead of just listening to doctors."😕...
how does that work?...🤷...is some random snippet from the internet regarding anesthesia really more relevant than, say, advice from urbanscout50?...hm...let's stay focused on the topic at hand....don't let this drift into a triage session....that last point sounds too much like those fringe alternative medicine claims that make my skin crawl...🙂

I don't intend to intrude on your discussion, but I believe silverridge36 meant that it isn't a bad thing to educate oneself using professional and relevant sources before a procedure. In this digital age, it is quite easy to gain knowledge in any field, which can be of vital importance.

In my own experience, I had a difficult case following gallbladder surgery, where I developed intense back pain just hours after the operation. Had I been better educated on general anesthesia, I likely could have assisted the resident in the abdominal surgery ward with the diagnosis (which they were struggling to reach), rather than staying awake all night. Doctors aren't infallible—people are.

Regards.

So, why shouldn't you just crash out and go right back to sleep immediately after waking up from general anesthesia? Why is it actually better to hang out and stay awake for a little bit first?

That rule generally applies to facilities lacking dedicated recovery rooms, where you might feel tempted to sleep whenever you please. It's essentially about airway protection; anesthesia suppresses your cough and swallow reflexes, potentially leaving your upper airway obstructed by your tongue or soft palate. That is why staying awake is recommended until the effects wear off... however, in specialized recovery units, anesthesiologists and CRNAs monitor your airway closely, which allows you to sleep safely

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.

What actually causes that nasty nausea you sometimes get when you're waking up from anesthesia? I've been under general anesthesia three times now—twice everything went perfectly smooth, but that one single time... man, the nausea was just brutal, like I couldn't stop feeling like I was going to throw up.

Brenda Sanders46 said:What actually causes that nausea you get when waking up from anesthesia? I've been under general anesthesia three times now—two of those were totally fine, but that one other time was just awful, with constant nausea and feeling like I was going to throw up...

The simplest way to look at it is that even when you feel pretty much awake and your breathing is steady, there’s still a good amount of anesthetic and all those other drugs used during the procedure circulating through your system. Until your body fully flushes everything out—which can take anywhere from a few hours to a day or two—those lingering meds can mess with your brain and trigger that exact nausea you're talking about.

urbanscout50 said:.... they call it "monitoring by screaming"😱. while ....

😂...

So, I was catching up with my uncle's buddy the other day—we were chatting about some hospital stuff—and he mentioned this wild thing that happened during a hip surgery he had a while back. He said he experienced this weird kind of awareness; like, he could actually hear people talking and felt totally awake, yet he didn't feel any pain at all. But here’s the kicker: he said it was actually a great experience. Like watching a really good movie playing in his head. No panic, no anxiety, nothing, just... chill. 🤣Since anesthesia is basically a cocktail of different drugs, is it actually possible for someone to have a "positive" awareness experience like that? Also, random question about animal anesthesia—my cat just had his neutering done recently, and he was throwing up while he was drifting off under the meds. Do they actually use the same types of anesthesia on animals as we do on humans? Not necessarily the same dosage, obviously, but I mean the actual types and chemical makeup? If these questions seem a bit morbid or just plain silly, I swear I'm being serious, I'm genuinely curious, hm. It's been sweltering here in Phoenix for days, so maybe that explains why I'm feeling so sluggish and asking such random things. 🤣

I’m also wondering about my three wisdom teeth... since I've got three of them waiting to come out, what would an anesthesiologist actually suggest? Should I just knock them out one by one under local anesthesia, or maybe just go for all three at once under general? Honestly, the thought of going under general anesthesia just for dental work sounds exhausting, and I feel like the recovery might be a total drag, but my dentist mentioned that doing it all at once would get it over with much faster...

I also have three wisdom teeth that need to come out.

I actually tried going the local anesthesia route once, but it was a complete disaster. I had a full-blown panic attack—first I started hyperventilating, then I actually passed out. By the time I came to, I was basically lecturing them about the operating room.😂🤣

All in all, it was a pretty hilarious experience.

So, my dentist suggested analgosedation. I did a little digging into it and the idea really appealed to me because you’re supposedly totally relaxed, there’s no pain, and you don't remember any of it afterward. Of course, they still have to use local anesthesia alongside the sedatives.

Finally, I worked up the courage to schedule this wonderful procedure. As luck would have it, while I was getting my nails done, I met a woman who works as an anesthesiologist at our local clinic, so I asked her what she thought.
She told me absolutely not. She said she’s had some really bad experiences with analgosedation because apparently, sometimes the sedative doesn't react well with the local anesthetic, leaving you in a state where you're drowsy but can still feel the pain.😲😲 😲😲😲😲
She also mentioned that pulling three wisdom teeth is just too long of a procedure to do under that kind of sedation. Her final verdict? "If you were my child, I wouldn't let you do this."

And just like that, all my hopes were crushed.

Her advice was to find a place that offers general anesthesia instead, since that’s the safest bet. Now I’m on the hunt for a surgeon willing to perform the procedure that way. I heard about a professor from our university who rents out an operating room at a hospital to perform these kinds of surgeries; as soon as I finish my finals, I’m going to reach out and see if we can work something out.☕

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 procedure or anything, it was for an ectopic pregnancy. I'm 25.

[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]

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.

urbanscout50, thank you so much. It’s been a long time since anyone has truly impressed me like this—finally, an explanation that actually makes sense.🙏🙏🙏

It’s pretty much exactly what that lady I happened to meet told me as well. Thanks again; you really helped me feel confident in my decision.👍👍 👍

I’ve had experience with general anesthesia before and handled it perfectly fine, so I’m not going to overthink this anymore. I’m going to get everything coordinated and scheduled right away. I want to get this settled as soon as possible; I really don't want to be caught off guard by a pregnancy. My friend went through such a hard time with her wisdom teeth while she was pregnant, and I honestly don't need that kind of stress in my life. Thanks one more time.😁

I’m hanging out here because the cardiology section is a bit of a mess, and I was thinking maybe urbanscout50 or Scott Allen10 might have some insight to offer.
Back in July, I had heart surgery—they fixed my valves and put in a ring (St. Jude No 30)—and right after that, these vision issues started hitting me. Sometimes it's total blindness, other times the whole world just feels like it's spinning in a centrifuge... usually lasts about 20 minutes. A color Doppler pointed toward issues with my carotids, and an MSCT confirmed it. I was all set for surgery, but then—of course—I run a fever and everything gets pushed back. To be safe, since the neurologists suspect microemboli, they want me to get an MR. So, I went back under the knife to have them remove the wires used to close my sternum (we use wires here too), pull out the pacemaker wire that was accidentally left behind, and clear out some tissue buildup near the incision. Now, look—I’ve never really had issues with anesthesia before, and this was my third heart surgery in less than two years, but once they pulled the tube out this time, I could barely breathe. And God, the waking up part... the shouting and the frantic calling... it’s a pretty horrific memory, honestly.
The MR results came back saying: A solitary punctate lesion with high signal intensity on T2W and FLAIR sequences is visible at the left parietal corticomedullary junction. The subarachnoid space at the base and convexity of the brain appears widened. There is coiling of the distal segment of the left extracranial ICA and kinking of the distal segment of the right extracranial ICA, with lumen dilation (pseudoaneurysm) present immediately following the first kink. The vertebral arteries are elongated and tortuous without stenosis or aneurysmal dilation.
CONCLUSION: The MR scan of the endocranium shows a solitary microangiopathic change in the left parietal region, cortical reductive changes in the brain, and the aforementioned coiling and kinking.
So, here are my questions: Would things have played out differently if we’d had a solid carotid scan before the heart surgery? I’m not trying to point fingers or blame anyone, I just need some peace of mind. Would the extracorporeal circulation or the surgery itself have been handled differently if they knew what the carotids looked like? It would help me process everything if I have to accept that the surgery went sideways, because it feels insane that all these eye issues showed up only after the operation—before that, I was perfectly fine.
Second question: Should I go through with carotid surgery given these brain findings and where the carotid issues are located? I’m terrified the surgery might do more harm than good. The vascular surgeon saw the kinking and said it’s positioned too high to easily reach, basically saying, "We can try, but if we can't get to it, we stop." But what about the brain stuff on the MR? What does that actually mean? Am I allowed to risk leaving my brain without normal circulation just to take a shot at fixing the carotids?
What am I looking at regarding the surgery and anesthesia? And what happens if I just... don't do anything?
Thanks in advance, everyone! 😘

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,

Thanks a ton, urbanscout50. Even if there's a healthy dose of "maybe" and "probably" in your answer, it’s enough to help me keep moving forward.
"Probably" nobody paid much attention to my carotid arteries before the surgery. I mean, the coronary angiogram showed totally clear vessels, and the carotid color Doppler didn't show any plaque either—so there just wasn't any reason to track their path all the way up to the brain. It was only after the procedure that everything actually surfaced. Between the kinking and the coiling happening right at the base of the brain, surgery would be pretty damn complicated. We're talking about a maxillofacial surgeon having to remove jawbone—I think that's how it sounds in Latin—and dealing with a massive amount of nerve fibers while they're at it... Anyway, opinions are split down the middle; some say it's a hard "no" on surgery, others say it's absolutely mandatory, and I'm just over here trying not to lose my mind. Personally, what matters to me is that before the surgery, I didn't have any heart issues, aside from the heart itself suddenly giving out. Everything started spiraling after that, so I'm pretty convinced it's all a consequence of the operation. Those vision gaps aren't happening every single day anymore—whether that's because the EKC emboli are clearing out or because I'm trying to keep my anticoagulant at 2.5 or higher, I honestly have no clue. My neurologist appointment isn't until late May, and I'll get a follow-up color Doppler at the end of this month. If the pressure in that pseudoaneurysm between the two bends starts climbing, I guess I won't have much choice but to go under the knife. In the meantime... keep your fingers crossed for me.
In any case, I'll check back in as soon as there's news—maybe we can all learn something from it.👍