Anesthesia, Resuscitation, and ICU: Q&A

How do you even decide on an anesthesia plan for patients who haven't had a pre-op? You know, those emergency cases where they're rushed straight to the OR—like a major car accident or an emergency C-section and stuff like that.

I’m not sure if this topic has been brought up yet, but I couldn't find it anywhere while searching!!

Has anyone here ever experienced being awake under general anesthesia—meaning you could hear and feel everything—but you were completely paralyzed and unable to move or speak at all?

I’ve been reading about people who have gone through this, and they describe it as an absolute living nightmare, like something out of a horror movie.😲😱😱😱😱..
It sounds like many of them struggled with insomnia for quite a while afterward, too.
Some even said they found themselves praying for it to just end because the pain became so overwhelming and intense.
Just thinking about that level of pain... it honestly sounds terrifying.
Now, I’m feeling pretty anxious about my upcoming surgery under general anesthesia.

I would really appreciate hearing from anyone who has actually lived through this or can share their own experiences.

Oh, well, I actually just stumbled upon the right thread... oops!!!

I felt a little discouraged after skimming through that other thread, mostly because it didn't really have the kind of firsthand experiences I was hoping to find...
So, if anyone here has gone through something similar, I’d really love for you to jump in and share what happened for you! It would be so helpful to hear your stories.

Thanks so much!!

Don't go buying into all those stupid rumors 😉

It could happen, sure, but we're talking about something that is incredibly, incredibly, incredibly rare—usually only popping up in those outlier cases where you're forced to use non-standard anesthesia techniques because of one reason or another...

That’s exactly what this thread is for, isn't it? I actually started this whole thing because I hadn't heard a word about it myself until I saw those "real victims" 😢 on Oprah—you know, people talking about having six-hour heart surgeries and all that. Kevin Garcia12, it’s incredibly, incredibly rare, but it happens. I guess the odds probably come down to a few things... like if the pre-op exams were thorough enough, if the patient actually follows the instructions, or if the anesthesiologist isn't just some resident who accidentally misses the dosage 🙂 and so on. silenteagle47, these people are genuinely dealing with PTSD. They can't sleep, they get hit with waves of anxiety... and honestly, how could they not? I used to be terrified of local anesthesia myself. There was just something creepy about watching the instruments and hearing everything. Even my mom had a bad experience with local anesthesia when she had her tonsils out. I always figured it was better to just sleep through the whole thing. Then I watched that movie *Awake*, where the guy is conscious and in pain but totally paralyzed... gave me the chills. Absolute chills. I don't exactly want to go under that easily either, but if you find yourself in that situation, you don't really have a choice. You just have to trust the doctor. They know what they're doing.

The likelihood of intraoperative awareness occurring alongside paralysis without adequate analgesia is extremely low, not to mention the fact that physiological markers would reveal such distress almost immediately. These scenarios predominantly occur in the USA, though I wouldn't attribute it to superior clinical insight. Rather, it seems to be a byproduct of their healthcare system. In an effort to cut costs and extend anesthetic services to rural areas, there is a heavy reliance on mid-level providers, specifically CRNAs and AAs. These are advanced practice nurses who operate either under an anesthesiologist's supervision or independently. They are quite politically active in lobbying for more autonomy—driven by financial incentives, of course—which ultimately places patient safety at risk.

Haha, so you're telling me those nurses can just hand out anesthesia whenever they want?????? That’s wild. Their advanced training sounds worlds apart from what actual anesthesiology residency entails... at this rate, I feel like I could probably learn to drive a freight train by myself. Sam Hall15, what’s the actual breakdown between an anesthesiologist and an anesthesia tech? Like, what does a tech need to know, and what are they actually doing in there? They aren't supposed to make the calls on the anesthesia itself, right? It's more like they're just there to assist during the surgery?

In our neck of the woods, an anesthesia technician—often just called an anesthetist—is essentially a medical technician working alongside the anesthesiologist, much like how a scrub nurse assists a surgeon. While seasoned technicians possess immense knowledge and are invaluable because they anticipate exactly what needs to happen during a crisis, they don't have the authority to make clinical decisions for the patient. Their role involves prepping medications, placing peripheral IV lines, monitoring vitals, and assisting with manual maneuvers. Generally speaking, they are highly skilled in resuscitation procedures.
Now, things work quite differently in the USA. They’ve developed this system involving CRNAs and AAs who can administer anesthesia either independently or under the supervision of a physician (in this context, the surgeon). It is worth noting that the surgeons there aren't necessarily more knowledgeable about anesthesia than we are; in fact, they often stumble and have to call an anesthesiologist to bail them out. This doesn't usually happen during low-risk cases where everything goes according to plan. Lately, however, anesthesiologists in the States are starting to realize the dangers of such practices and are attempting to bring them back within realistic boundaries.

I've got an anesthesiologist in the family. From what I can gather, they basically get summoned every time someone else screws up... colleagues from other departments are constantly dumping their patients into the ICU on them, usually right when things get messy and complicated. I guess that says plenty about the actual quality, importance, and sheer weight of responsibility that comes with one of the toughest specialties in medicine...👍

urbanscout50 said:Most of the time, we’re looking at an anesthesiologist totally miscalculating the dose of the hypnotic needed to keep someone under properly. If they throw in a muscle relaxant—you know, the stuff that paralyzes everything except your heart and your gut muscles—you end up with a patient who’s completely paralyzed, can't move a single muscle, but they're wide awake and hearing every damn thing. It's a nightmare for the patient. Now, if they got enough analgesics (heavy-duty opioids), they won't feel pain. But if the opioid dose is too low? Then they feel the pain, which is just horrific for the patient... and honestly, pretty traumatic for the anesthesiologist afterward, too. Why does this happen? 1) You've got "cheapskate" anesthesiologists who try to skimp on the drugs, failing to monitor the anesthesia or the surgery closely enough, or they just forget to top up the dose (look, just avoid those types of doctors at all costs). 2) Some people just metabolize drugs incredibly fast, so you can't seem to get them to stay under—especially alcoholics or patients on chronic meds where their livers chew through the drugs way faster than average. 3) The patient's baseline health before going under... say, someone with massive blood loss, trauma, or elderly, frail patients. They actually need much *lower* doses just to keep things stable without crashing their vitals. Or, things shift mid-surgery—like a huge hemorrhage requiring massive blood and fluid replacement, which basically "washes" the anesthetic out of the system. You have to adjust on the fly, and it's never a sure thing. 4) Equipment failure or technical glitches...
As it turns out, being an anesthesiologist is high-stakes, dynamic work. You have to watch the patient constantly and react instantly. Most people think it doesn't matter who's handling the anesthesia as long as the surgeon is good, but they don't realize they're handing their life over to a stranger... literally. They are trusting this person with their consciousness and, more importantly, their actual BREATHING... and yet they act like it's secondary.
Bottom line: 1) For general anesthesia: usually, a woman gets one shot of the hypnotic and the relaxant, and then they deepen the anesthesia by adding analgesics only after the baby is out. If the OBGYN can't get the baby out quickly enough, anything can happen... usually waking up and feeling pain.
2) For regional anesthesia (spinal or epidural): the patient is awake, but the lower abdomen and legs are numb, so they can't move and they don't feel pain. This lets the surgery happen while Mom gets to see the baby and do skin-to-skin immediately. When the local anesthetic is administered and before it fully "takes," people feel warmth, tingling, or pins and needles in their legs and lower body. That isn't a bad dose; it's just a normal reaction as the drug spreads. Of course, sometimes the block doesn't "take," or it doesn't spread right, or for some reason regional isn't even possible—in those cases, they switch to general.
Choosing between general or regional depends on how urgent things are, the health of the mom and baby, the anesthesiologist's experience, and what the mother, the anesthesiologist, and the OBGYN all agree on.
That's the gist of it, anyway... 🙂

Basically, it’s all about making sure those surgeons get to walk away with all the glory.
And one more thing... if you ever find yourself dealing with the anesthesiologists over at the Mayo Clinic... watch your back...👎

St. Jude Children's Research Hospital.
So, I had my nose surgery all lined up.
I’d already gone through the whole drill with all the required tests and stuff.
They start wheeling me into the OR, getting ready to put me under...
And then, out of nowhere, they ask if I have any health issues.👎
It turns out neither the surgeon nor the anesthesiologist even glanced at my charts.
I just tell them, "Look, I don't have a thyroid."
They give me this look like I'm speaking a foreign language, even though they have my files right there. It's pretty obvious nobody bothered to read them.👎
Suddenly, they actually take a peek at the results and realize I'm in constant hyperthyroidism.
At that point, nobody wants to sign off on me.
The whole awkward mess drags on for maybe 45 minutes.
Just... wow. Unbelievable.
In the end, they discharge me, and the anesthesiologist ends up prescribing a new hormone replacement therapy—which is usually my endocrinologist's job—and tells me to come back in six weeks with updated labs.
Seriously, guys, I was on medical leave, I stayed in the hospital, they were poking me with needles, and they even gave me those nasty pills the night before to try and relax—which honestly made me feel terrible, by the way, since the anesthesiologist prescribed them—and yet still, absolutely nobody checked my records????????
I basically bolted out of there.
Total disaster, just a complete mess...
How am I supposed to trust these people now???🤷

Hmm, that’s certainly an unfortunate situation, especially since they wasted so much of your time on nothing...
By the way, what you were writing about with all those abbreviations is called an anesthesiologist 😁

I hope your next experience is much better, though there is a silver lining here. They didn't take unnecessary risks; rather, it seems the anesthesiologist assessed the situation and adjusted the medication to meet your body's new requirements during surgery

Best of luck

Amy Richardson74 said:I had a pretty similar experience—specifically during my C-section—where they paralyze your lower half, legs, stomach, and all that, and honestly, it’s a terrifying sensation. I’m convinced my anesthesiologist missed the mark on the dosage because the feeling in my legs was just awful; they were tingling and twitching, yet I couldn't move them at all. You want to shift, you want to react, but you're stuck—and it isn't even like you've lost sensation entirely... you can hear the doctors talking and everything, but you just feel physically ill...

Look, nobody just randomly injected you with anything—that’s called spinal or epidural anesthesia, administered in your lower back, and I'm certain they wouldn't have done it without consulting you first. I actually had a C-section done that way once, and honestly, the sensation is fantastic because you stay fully conscious without any pain, so you get to see your baby immediately—plus, the recovery is much easier than dealing with general anesthesia after a C-section.

Ah... a real anesthesiologist just sticks to thiopental, succinylcholine, and pavulon—pulling the tube out with that final stitch, being as stingy with fentanyl as a budget shopper at Walmart, and honestly, two vials of orange Braunol is more than enough for a liver transplant 🙂

😁 Aside from Pavulon and succinylcholine, there isn't much here to save on costs... 😁 😁 😁

Alexander Wright said:Man... a real old-school anesthesiologist just sticks to thiopental, succinylcholine, and pavulon, pulls the tube out with one smooth motion, and hoards fentanyl like a miser hoarding gold coins—honestly, they could probably pull off a whole liver transplant with just two shots of those orange Brownies. 🙂

I actually know a couple of those guys... the only thing that really gets under their skin is that nobody uses succinylcholine anymore and you can barely find it anywhere. 🙂

It’s still available and in use, though perhaps not frequently since we don't have many American anesthesiologists here, but it is there; succinylcholine is quite good, truly... 😁
but all jokes aside, it would be absolutely insane to think an anesthesiologist would cut corners on medication, especially when it comes to fentanyl, or really anything else at all.

Sam Hall15 said:We still have some in stock, and people use it—maybe not all the time since we don't really have American anesthesiologists here, but it's available, and Succamel is actually pretty solid. 😁
But honestly, jokes aside, it would be absolutely insane to think an anesthesiologist would cut corners on meds, especially when it comes to Fentanyl, though really, they wouldn't skimp on anything else either.

Yeah, totally... it's so effective that in malpractice suits, lawyers actually grill anesthesiologists about why they’d even bother using Lystenon/Lepotosukcin/Succamel when those drugs aren't even covered by Medicare because of those scary side effects. I mean, time has moved on, and other similar paralytics have basically overtaken it...🙂...just like Halothane was phased out about ten years ago...

I definitely agree that you generally don't see people pinching pennies on anesthesia drugs (though there's always that one outlier, right?). It's not even a choice, really; you just can't provide high-quality care without them.