Anesthesia, Resuscitation, and ICU: Q&A

I would appreciate some advice on a specific question:

What should I do if my local anesthesia takes an unusually long time—like one or two hours—to actually kick in, especially when I am preparing for a CT Myelogram?

To give you a little context—years ago, I had to undergo a minor surgical procedure without much warning. In that instance, the local anesthetic didn't start working until about an hour or two after the procedure was already finished. Honestly, I can't even recall how long the whole thing lasted... it was quite a blur. To make matters worse, the doctor didn't believe me when I said I was in pain. They basically treated me like I was just being dramatic.

I am looking for a response as soon as possible so I know how to handle this—it’s a bit nerve-wracking. Since I have to travel all the way to Washington, D.C. for this myelogram, and I live quite a distance away, I really want to be prepared.

I believe you. It’s totally possible for local anesthesia to just miss the mark or fail entirely sometimes. My mom had her tonsils out under local back in the 70s and it didn't even touch the pain. Now, just imagine someone digging around in your throat with big surgical scissors... brrr👎👎👎. Then, at the end of the procedure, the doctor is just standing there surprised that it didn't work. I don't know if it's an issue of how long it takes to kick in, but if it's taking two hours for you, maybe look into a different type of anesthesia? If that's even an option for this kind of thing. Though, honestly, I don't think local is suitable for everything. Three of my friends ended up having a D&C done under local, and there's no way all three of them are just being dramatic crybabies—they were all in absolute agony...😕 anyway, can you swap that procedure out for an MRI instead?

electricpanther82 said:I believe you—honestly, local anesthesia can be hit or miss; sometimes it just doesn't kick in properly, or at all. It’s actually quite scary—my mom had her tonsils out under local back in the 70s and it didn't work for her either. Just imagine someone using large surgical scissors to tear at the tissue in your throat... brrr! 👎👎👎. To top it off, the doctor was reportedly surprised that the numbing didn't hold. I'm not sure if it's just a matter of waiting long enough for it to take effect, but if it takes two hours for you, maybe you could look into a different type of anesthesia—if that's even an option for this specific procedure. Though, I suspect local isn't suitable for everything; three of my friends ended up having a D&C done under local, and there is no way all three of them were just being overly dramatic or sensitive—they all went through excruciating pain... 😕 anyway, is there any way you could swap that procedure out for an MRI instead?

I already had the MRI. This is just an extra step they want to do to get a clearer picture of what's going on.

cosmicowl92 said:Please help me with this question:

What should I do if local anesthesia takes a full hour or two to kick in right before a CT myelogram?

Just for context—years ago, I had a minor surgical procedure done without enough numbing. The local stuff didn't even start working until maybe an hour or two after they finished. I can't even remember how long the whole thing lasted. To make matters worse, the doctor wouldn't believe I was actually in pain. They basically treated me like I was being dramatic.

I really need some quick advice on how to handle this. Since I have to travel all the way to Washington, D.C. for the scan, I live pretty far away.

Look, I’m definitely not an expert here, but I honestly don't know how effective the anesthesia protocols usually are in these clinics. A lumbar puncture involving contrast injection isn't really comparable to a full-on surgery... the discomfort and pain should be significantly lower than what you went through back then.

Still, when it comes to your specific situation, there's no better move than just being upfront with the technician about your past experience with local anesthesia. What you can do is simply ask them to wait a bit longer between the injection and the actual puncture—just give it plenty of time until you're sure the anesthetic has fully kicked in.

I have a question regarding general anesthesia.
Last year, I underwent two procedures under general anesthesia using only Propofol (a gastroscopy and a colonoscopy); following those, I was given oxygen and saline, and I recovered quite smoothly and quickly, feeling perfectly fine for the rest of the day.
On another occasion, I had to undergo a bronchoscopy (I am one of those mentally unstable types who refuses to cooperate, so I had a pre-arranged arrangement) via a fiberoptic scope.
To my confusion, they administered both Dormicum and Propofol. I should emphasize that I was completely relaxed and not nervous at all, as I wasn't afraid, knowing full well I wouldn't feel the procedure itself.
Unlike the gastroenterology procedures where I received oxygen and saline for about half an hour afterward, I didn't get that here; furthermore, waking up was an absolute nightmare—my husband noted that the difference was night and day. I spent the entire day feeling dizzy and profoundly drugged.
The night was wretched; I slept for twelve hours, yet I was plagued by nightmares in which I desperately wanted to wake up but found myself unable to, physically feeling as though someone were pulling my arm, or as if there were something heavy on my pillow, or as if I were struggling to force my eyes open with my fingers just to regain consciousness...
My dreams were truly horrific.
And the day following that anesthesia (which was actually yesterday) I experienced this strange memory loss, as if everything happening to me vanished instantly; I simply couldn't replay the previous day in my mind. However, I can recall everything perfectly well from before the Dormicum; the days and events leading up to it remain entirely intact.
It is my suspicion that this is due to the Dormicum, and frankly, I cannot fathom why it was even administered to me.
If I ever find myself needing general anesthesia again—which I will, as I have an upcoming surgery scheduled—is there any way to avoid a repeat of this ordeal? (Specifically, I mean avoiding the Dormicum)
I hold that drug responsible, because I am aware that some people who take it orally later have no recollection of anything they did during the day if they stayed awake, and there are certainly people like that.
This was my first encounter with Dormicum in my entire life, and I am beginning to believe it is not the right solution for me, particularly when paired with Propofol.
To reiterate, Propofol alone, followed by being on oxygen and saline, was a much more pleasant experience compared to this disaster.

It is quite likely that the Dormicum caused those "disturbances," though it might not be the sole deciding factor. Simply providing rehydration won't do much to help someone wake up from anesthesia, nor will oxygen, so there isn't a specific reason to administer them. As for premedication with Dormicum, it isn't strictly necessary if the patient feels fine and isn't experiencing excessive anxiety about the procedure. However, it can often be a very good thing. And honestly, you shouldn't worry about feeling sleepy after the anesthesia... for heaven's sake, just get some sleep! There is no need to be overly alert on a day when you have undergone general anesthesia. 😁The dreaming is likely not a direct consequence of the midazolam, but rather a result of the entire anesthesia and bronchoscopy process itself.

I am immensely grateful, though I must admit my primary source of anxiety was the memory loss and those rather peculiar sensations experienced during that half-asleep state; nevertheless, I hold onto the hope that my cognitive faculties might eventually return to their former condition (however questionable that state may have been in the first place).
Regarding the anesthesia itself, I felt no trepidation whatsoever—quite the opposite, actually—largely because I have never had any unpleasant encounters with it in the past.

Amnesia is one of the main reasons why Dormicum is used during premedication or during the induction phase of anesthesia; it effectively wipes away any unpleasant memories. That gap in your memory is perfectly normal, so there is no need to worry.
In a day or two, you will feel like a whole new person!

🙂 much appreciated, doctor!

So, I was scrolling through some random forum online and stumbled upon this story about a woman who was absolutely terrified of waking up mid-surgery. Apparently, she actually struck a deal with her anesthesiologist to keep one hand from being fully paralyzed by the relaxants. Her logic was that if everything else goes sideways—like the machines failing or whatever—she could at least wiggle that one hand to signal she’s conscious. It’s like that one limb stays "awake" while the rest of her body is out cold. Is there any actual truth to that, or am I just reading some total nonsense?🤷?

It isn't complete nonsense, since it is technically feasible... but otherwise.....

Just one question here...

I recently underwent general anesthesia, and I noticed that my skin was absolutely flawless for the following two days
And I mean literally perfect.
My pores were tightened, there wasn't a hint of redness... just top-tier results.
But get this—the day before, because of all the stress, my entire face was inflamed and looked like a total disaster.

Could there be any connection to the anesthesia, and what on earth is the secret behind this? 😬

but still.......I guess doctors probably don't find this whole situation very comfortable? Or maybe they do? Sam Hall15, I know I’m being a total pain, honestly, I wish I hadn't even heard about this stuff. At this rate, I’m going to develop a phobia of surgery for no reason and start panicking that one day I'll end up needing an operation when I don't even need one, though it seems like things like this aren't actually that rare😢is it possible for just anyone to sign a waiver saying they want one hand to remain un-numbed and that the patient is specifically requesting it? And another thing—if my finances or my credit score allow for it in the next two or three years, I might actually work up the nerve to go for, uh, a breast augmentation😍😍😍 do you get given a relaxant for that kind of procedure so they don't have to crack open your ribcage or abdominal cavity, but instead they just make a small incision in the breast, insert it, and stitch it back up... I think?

That really depends on several different factors. If you are young and healthy, they might attempt deep anesthesia without using a paralytic, though if they decide to go the intubation route, most teams will likely opt for a relaxant. Many of these drugs wear off quite quickly—some are used strictly during induction because their effects fade in less than ten minutes. However, there is virtually no chance of you being awake while under relaxation; any anesthesiologist would have to be completely incompetent or intoxicated to fail at keeping you under... Don't worry.

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

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

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

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

Sam Hall15 said:It’s not complete nonsense since you could actually pull it off... but still.....

I don't quite get what you mean there....🤔...like, how do you even relax someone while leaving one of their hands totally tense?😕...or am I just totally missing the point here...🙂

It’s possible; I actually saw 😁
once. The circulation gets restricted in the arm, but in my experience, it seems to recover after about 10 minutes... and you rarely reach a concentration of relaxant in that limb high enough to cause a neuromuscular blockade. I have a link here if anyone is interested 😁

Sam Hall15 said:It’s totally doable, I actually saw it happen myself once. 😁
So, the blood flow in my hand gets totally cut off for a bit, though I think it starts easing up after maybe ten minutes or so, and honestly, I don't think the relaxant ever actually hits a high enough concentration in that specific arm to trigger a full-on neuromuscular block anyway. I actually have a link handy if anyone's curious about the details. 😁

😕Wait, I think you might have things a little mixed up there. There’s actually a type of regional anesthesia where they use what people call a "white track" on the arm—basically, you apply compression starting from the fingertips all the way up to the upper arm to help drain the blood out of that limb first. Then, they wrap a sort of "double cuff" around the upper arm and inflate it just enough to cut off the arterial circulation to that extremity. After that, they use a tourniquet to apply the anesthetic that only affects that specific arm.

I just can't wrap my head around this one... I mean, what exactly is the point of having some relaxed patient sitting there while their arm is totally tense? It just doesn't add up to me.

Hey, if you happen to track down that link, toss it my way so I can take a look and see what the deal is...🙂

haha, it isn't a Bier block 😁
I'll find the link and send it over to you... the whole point was just an experiment, to see what it feels like to be relaxed without any anesthesia or analgesia.

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

Both Eva and I are definitely down for that link.