Anesthesia, Resuscitation, and ICU: Q&A

1. Last year, I had my entire thyroid removed. That was actually what I wanted; I know most chest surgeons here in the States prefer to leave at least some part of the gland behind. Based on what I've heard from others, people often complain that it wasn't fully removed because their symptoms keep resurfacing even after surgery.
I was first diagnosed 33 years ago when I was just 12. The final diagnosis was toxic goiter. For the first time since being sick all these years, my recent lab results finally show my hormone levels are in the normal range.
2. My theory is that my memory loss—both long-term and short-term—is tied to the illness. However, my doctor insists there’s no connection between my thyroid and my hormonal status regarding cognitive issues.
3. That’s why I think this theory about anesthesia impact might actually hold water.
4. My previous surgery was a long one, and things definitely went off the rails. I mentioned before that I could hear everything happening in the OR and painfully endured every stage of a massive abdominal incision. No one ever admitted they realized I was conscious, but I vividly remember hearing panicked voices as they struggled to wake me up after the procedure. I suspect there might have been oxygen deprivation, which could have damaged certain brain centers—in this case, the ones responsible for memory...
Do you have any more specific theories now? 🙄
P.S.: I hope that clears things up for electricpanther82

Quick question for the group. Is it normal for your urine to have a really intense, strange smell after general anesthesia and then getting a painkiller injection? I could almost swear it smells exactly like medication. I just had my tonsils out, so I’m wondering if I should be worried or if this is just what happens when you're dehydrated from the procedure.

I've got a procedure scheduled for tomorrow, and I might be under general anesthesia or just local. The doctor hasn't really decided which way we're going yet.

Since I had surgery under general anesthesia about a year ago—where they actually intubated me—I was wondering, do they always go through with intubation if you're under general?

The thing is, I woke up today with this super sore throat that's honestly getting worse as the day goes on, and now I'm starting to cough. I guess I'm wondering if that could be an issue during intubation? 🤷 I really don't want them to push back the whole thing because of this. 😢

Sam Hall15 said:There’s a distinct possibility that patients might take a little longer to wake up from anesthesia—essentially, the neuromuscular blockade lingers. That said, muscle relaxant antagonists work quite effectively for patients dealing with myasthenia, so there really isn't much to fear. Depending on the specific procedure, an anesthesiologist can simply opt for anesthesia without any relaxation at all, which effectively brings the risk down to zero. At least, that's my take regarding the direct negative impact on myasthenia.

hm... honestly, for someone with myasthenia, the smartest move would be to ditch non-depolarizing relaxants entirely... you know, induce with just enough to get the tube in, then transition to high-dose Sevoflurane, and you’ll achieve adequate relaxation for pretty much any surgery.
If we're talking about something intense like a Whipple procedure or major neurosurgery, you could probably toss in 2 milligrams of Neostigmine and call it a day—it's not like it matters much when the patient is heading straight into shock anyway, right? (relatively speaking, of course).

Well, obviously... it all hinges on how severe the myasthenia actually is. If someone is living a perfectly fine life on just Mestinon, then maybe under-dosing Norcuron is an option. But if they're stuck taking steroids or even undergoing plasma exchange? Then you should stay far away from non-depolarizing agents—run the other way, if you will.

Mark Rogers4 said:Just a quick question—is it normal for my urine to have this intense, weird smell after being put under general anesthesia and then getting a painkiller injection? I could almost swear it smells like some kind of medication. (I just had tonsil surgery, so I’m wondering if I should be worried, or if it’s just because I haven't been drinking enough water?)

There are probably several factors at play here... they might have used Propofol during induction... I know that can sometimes tint urine green, though I can't say much about the scent—not that I make a habit of sniffing patients' urine—(certainly wouldn't do that for my current salary 🙂
. It's also possible the analgesic used was Tramadol, which occasionally leaves a yeast-like scent in the urine—though there isn't any hard scientific data on that, just things I've heard passed down from older colleagues)

But... the most likely culprit is the simple fact that almost every patient heading into surgery arrives completely dehydrated. Often, even after the procedure, they aren't getting enough fluids to compensate—post-op nurses in the recovery rooms aren't always quite as proactive as the staff in the ICU—so the urine ends up concentrated, darker, and carries that sharp, intense ammonia smell

copperraven53 said:I have a procedure scheduled for tomorrow—it could be done under local or short general anesthesia, though my doctor hasn't actually decided which route we're taking yet.

Since I had surgery a year ago under general anesthesia where they had to intubate me, I'm wondering—is intubation always a requirement when you're going under general?

The thing is, I woke up today with a sore throat that’s been getting progressively worse throughout the day, and now I've started coughing. I’m worried—could this interfere with the intubation process? 🤷 I really wouldn't want them to postpone the whole thing just because of this. 😢

1. Intubation isn't a given with every general anesthesia case... for quite a few minor procedures—think cosmetic work or smaller orthopedic surgeries—a laryngeal mask or an i-gel is often perfectly sufficient.

2. An upper respiratory infection shouldn't necessarily prevent intubation unless it's particularly severe; however, if I were tasked with anesthetizing a patient dealing with an upper airway inflammation, I would absolutely opt for intubation to ensure secretions don't migrate down into the lower airways.

3. Personally, if a patient shows up with a respiratory infection for an elective procedure, I am definitely pushing for a postponement... it’s nothing urgent, so the surgery can wait. My priority is patient safety first, and their convenience comes second.

Alexander Wright said:khm... for a myasthenia patient, the best bet would be to ditch non-depolarizing relaxants entirely... you could induce with succinylcholine for intubation, then switch to high-dose Sevoflurane, and you'd likely hit adequate relaxation for pretty much any surgery.
If you're dealing with a Whipple procedure or some neurosurgery, maybe throw in 2 milligrams of Pavulon and you'll be fine... besides, they're heading into shock anyway, so it doesn't really matter when their strength returns.

Of course... it all depends on how severe the myasthenia is. If someone has a decent quality of life just on Mestinon monotherapy, then underdosing Norcuron might work, but if they need steroids or even plasma exchange, stay far away from non-depolarizing agents like the plague.

I'm curious about your personal experience, or anyone else's who has worked with patients like this. Why avoid relaxants if they respond well to antagonists? There isn't any actual long-term risk of worsening the disease itself by using them.
They get Neostigmine, spend a little time in the PACU, and if everything looks good, they head back to the floor.

Question for urbanscout50 or Anthony Dubledore.

My five-year-old son is scheduled to have his third wisdom tooth removed this Tuesday. He’s been complaining about headaches for two days now, and frankly, I'm getting nervous about the anesthesia since we don't know what's causing the pain. What should my next move be?
Thanks in advance for any insight.

Sam Hall15 said:I’m curious about your personal experience—or anyone else who has dealt with patients like this. Why avoid relaxants if they respond well to antagonists? There isn't any real long-term risk of worsening the underlying disease by using them, either.
They get neostigmine, spend a little time in the PACU, and if everything looks fine, they head back to the ward.

Well... my own experience (which matters less) and the experience of more seasoned colleagues (which matters more) suggests that deep anesthesia with sevoflurane is usually enough to achieve adequate relaxation.

About a month and a half ago, we had a patient with myasthenia gravis who was on a regimen of Decortin and Mestinon. She was scheduled for a laparoscopic cholecystectomy, so we went with a standard induction—etomidate, fentanyl, and leptopantrol—followed by a bit more fentanyl and inhalation (MAC around 1.5). The relaxation was perfectly adequate (and let's be honest, our surgeons are constantly complaining... we’ve spoiled them 🙂
The emergence was absolutely seamless.

Do you think waking up would feel any different if we didn't use Lepto during induction? I'd say yes. While deep inhalation anesthesia alone can provide enough relaxation, you'd have to hit a significantly higher MAC to achieve that same level of muscle relaxation provided by a relaxant—which, let's face it, isn't usually necessary. It would likely be lower than what's required during an inhalation-based induction, but certainly higher than maintenance levels (though I haven't actually tried that myself yet).

crimsonnomad61 said:A question for Dr. Pella or Anthony Dubledore.

My five-year-old son is scheduled to have his third wisdom tooth removed this Tuesday. For the last two days, he’s been complaining of headaches, and I'm getting nervous about the anesthesia since we aren't sure what's causing the pain. What should I do?
Thanks in advance for any advice.

If these headaches have been going on for a little while, you really ought to run some basic tests. It could just be a simple upper respiratory infection, but it might also be psychosomatic—essentially him projecting his fear of the surgery through physical symptoms. Either way, take him to see his pediatrician first. Once you have those results, bring them to the anesthesiologist. If the pediatrician doesn't find anything major, the anesthesiologist will make the final call based on the labs and their own exam. I know that sounds a bit vague, but without more info, there isn't much else I can say. If you have more details, let us know and we'll try to be more specific. Good luck!

Alexander Wright said:1. You don't always need an intubation for general anesthesia... for a ton of minor stuff (like plastic surgery, small ortho jobs, etc.), a laryngeal mask or an i-gel works just fine.

2. Upper airway inflammation shouldn't really mess with the ability to intubate unless it's super intense. Honestly, if I had to anesthetize someone with upper airway inflammation, I'd definitely intubate them just to make sure secretions don't slide down into the lower airways.

3. If a patient has a respiratory infection, I’d absolutely push back an elective procedure... it's not an emergency, so the surgery can wait. Patient safety comes first, comfort comes second.

Thanks for the advice. 🙂

Just wanted to give a quick update. The doctor decided my cold wasn't bad enough, so they went ahead with the procedure anyway. It was a cyst puncture with sclerotherapy. The whole thing took about 25 minutes. They gave me anesthesia through a mask (not sure what the technical term is 😁) instead of intubating me, and before that, they gave me some injection that made me feel incredibly dizzy. Everything turned out okay, though I was pretty worried.

copperraven53 said:Thanks for the advice. 🙂

Just wanted to give a quick update. The doctor decided my cold wasn't severe enough to delay things, so they went ahead with the procedure. It was a cyst puncture with sclerotherapy. The whole thing took about 25 minutes; they gave me anesthesia through a mask (I can't recall the technical term 😁) instead of intubation, though I did get an injection beforehand that made me feel incredibly dizzy. Everything went fine, even though I was pretty anxious about it.

That lovely Propofol.....

neontrucker39 said:I am asking anyone who has personally experienced, or even just heard stories about, people feeling pain while being fully conscious during surgery despite being under anesthesia. I went through this myself, and for a long time afterward, I would wake up in the middle of the night gripped by the fear that it might all happen again...

During a cardiac electrophysiology procedure I underwent, they used local anesthesia via injection in my right groin area, but honestly, it did absolutely nothing for the pain. I felt everything—from the scalpel incision to the insertion of the catheters and the probe moving closer to my heart, all the way down to the removal from the groin. It was anything but pleasant.

As for the surgeries I’ve had under general anesthesia, fortunately, I haven't had any stories of waking up mid-procedure or having out-of-body experiences. 🙂

Man, I don't get it. How is it even possible to have heart surgery at a local clinic?? As much of a layman as I am, I'm pretty sure that's supposed to be done at a major general hospital. Like, couldn't you have just looked for a general facility instead?😲

electricpanther82 Asks:
Good grief, how on earth is it even possible to have heart surgery at a local clinic? No matter how much of a layman I am, I’m pretty sure that needs to be done at a major general hospital. Couldn't you have searched for a general facility instead?😲

It isn't some massive chest surgery where they saw through your ribs with a saw or grind them down. No, they just make three small incisions with a scalpel, retracting the tissue and skin to make room for the introducers. But even then—especially when they're doing it "live" (in my case, since I didn't exactly feel the full strength of the anesthesia on my own skin)—it hurts like hell. It’s particularly brutal because that area is packed with muscle. And then, of course, there is the part where they have to thread the catheter through the vein. While the probe was traveling toward my heart and maneuvering around in there, it wasn't exactly painful, but it felt incredibly uncomfortable.

neontinker5 said:It’s not like some major chest surgery where they’re sawing through your ribs or anything, but they do make those three little incisions with a scalpel to stretch the skin back so they can get the sheaths in. Honestly, though, when you're doing it "live"—which was my case since I didn't really feel the local anesthesia kick in properly—it hurts like hell, especially since there's so much muscle in that area, and then they have to slide the catheter through the vein... while it was traveling up toward my heart and wiggling around in there, it didn't exactly hurt, but man, it felt super weird.

Speaking from the perspective of someone who’s actually been through a coronary angiogram, you pretty much nailed the experience...
Just a few quick thoughts:
- These interventions are done percutaneously. Basically, they puncture the blood vessel and thread a guidewire through it, followed by a dilator, then the sheath, and then everything else goes through there. Usually, there's no scalpel cutting involved unless they need to slightly widen the puncture site to make it easier for the dilator or sheath to slide in.
- That vessel isn't a vein; it's an artery, which they use to go "upstream" through the aorta to reach the openings of the coronary arteries.
- You couldn't feel the wire passing through the aorta. Like you said, it was probably just that unsettling sensation of knowing something is crawling around inside your body...
- The local anesthesia probably wasn't applied well enough or in quite a high enough dose.

As for general anesthesia, that's really not standard practice for PTCA procedures.

Scott Allen10 Asks:
From the perspective of a patient who has lived through this. Coronary angiography. You’ve described the experience fairly accurately...

Electrophysiology. 😉🙂 But it's close enough.

Scott Allen10 said:Generally speaking, scalpel incisions aren't necessary unless you specifically need to widen a small entry point to allow for easier passage of a dilator or a sheath.

An incision would definitely be necessary to make that kind of entry through the artery, wouldn't it? It seems like he'd have to dilate it slightly as well.

Scott Allen10 Asks:
You likely couldn't feel the wires passing through the aorta. It was probably just that unsettling sensation you mentioned—that realization that something is moving around inside your body.

I didn't feel any actual pain, but there was this growing sense of discomfort that seemed to tighten right against my chest as the catheter drew closer.

Scott Allen10 said:Perhaps the local anesthetic simply wasn't administered effectively, or maybe there just wasn't enough of it used?

Is it actually possible for a person to be immune to anesthesia, or perhaps for their nerve receptors to simply be more sensitive than average? When I talk about this "immunity," I'm referring to my own experience; I’ve already undergone three different procedures under local anesthesia, and I happen to be allergic to atropine. Furthermore, why is it that when you meet with the anesthesiologist before a procedure, they always have to go through those repetitive, ritualistic questioning sessions? 😁

Hey everyone, I’ve got a question for the group. For a septoplasty—you know, fixing that deviated septum—what kind of anesthesia do they usually throw at you? And how does the breathing part work—do they actually go in with an intubation tube and all that? I’m scheduled for this surgery soon, but honestly, I am absolutely terrified of the whole anesthesia process. 😢

casualcobra Asks:
Hello, I have a quick question regarding septoplasty surgery. What type of anesthesia is typically used, and how is ventilation handled—is endotracheal intubation required? I’m scheduled for this procedure soon, but I am honestly terrified of the anesthesia part... 😢

General endotracheal anesthesia will be used; the patient will be intubated orotracheally, just like 99% of other general anesthesia cases, meaning the nose remains clear. As for the anesthetic itself, the approach depends more on the individual patient than on the fact that it’s a septoplasty. They will almost certainly start with IV induction followed by balanced anesthesia—a combination of IV and inhalation agents. Don't worry, everything should go smoothly... Good luck.