Anesthesia, Resuscitation, and ICU: Q&A

I suspect that really comes down to the specific type of procedure being performed.

Now I’m starting to get concerned myself... my mom’s relative had a leg amputated under spinal anesthesia.

Why couldn't they just perform my abdominal surgery without using the classic method?

Kenneth Hernandez67 said:Can someone help me make sense of this?

Everyone here keeps talking about intubation like it’s some huge, terrifying nightmare 😱 when it comes to 'standard' anesthesia.

I actually went through it last year—they just tube you once you're drifting off and pull it out before you even wake up, so ~ you honestly HAVE NO CLUE they even did it, let alone deal with any fallout from it.

So, what’s the big scary deal 😕

By the way, I specifically ASKED for a spinal or an epidural because I WANTED to be awake while they were working inside my abdomen, but they wouldn't let me.

The reason given was that I’d probably end up arguing with them during the surgery.🙂

There are really two ways to measure how "scary" intubation is. One is for the patient, and the other is for the medical staff.
For patients, it’s mostly just the throat pain and discomfort you feel when you start coming around under anesthesia, or even after the tube is pulled out. If you happened to get nasal intubated, you might have some stuff going on in your nose too. As for dental issues, it's a bit of a toss-up. Honestly, these annoyances are pretty minor and don't mean much to the doctors.

The second kind—which is way more important to anesthesiologists—is when you simply can't get the tube in. See, intubation isn't done while someone is wide awake. We have to administer a barbiturate (like Thiopental) and a muscle relaxant (like Succinylcholine) intravenously. These drugs knock the person out (the barbiturate) and, more importantly, relax the muscles (the relaxant). That second drug causes total paralysis, which means the patient can't move a single muscle, including their ability to breathe. This is the CRITICAL moment. Now, THE PATIENT MUST BE INTUBATED. This is always done using a laryngoscope (which is why, in rare cases, teeth get damaged—if a clumsy anesthesiologist uses the patient's teeth as leverage for the laryngoscope blade instead of using proper technique). If we can't get that tube into the trachea after two or three tries for whatever reason... man, it turns into pure chaos. Because the person can't breathe on their own and hasn't been intubated to be mechanically ventilated... You're frantically calling for another anesthesiologist... they try... nothing... grab the mask and Ambu bag... try again... nothing... grab the fiberoptic intubator... still nothing... the patient's heart rate slows, blood pressure drops... give Atropine, give Alupent... go back to the Ambu bag and mask, trying to ventilate them manually—sometimes it works, sometimes it doesn't... you're already thinking about an emergency tracheotomy or a cricothyrotomy... try the tube one more time... finally, it's in, connect to the ventilator, 100% oxygen... pulse stabilizes, saturation looks good... whew, damn, I almost had a heart attack myself... you're standing there trying to light a cigarette with hands that are slightly shaking. All of this happens in maybe a minute or two at most.
That’s the real scary part you have to be prepared for with EVERY intubation. But like I said, once the patient is out, they usually won't even remember their head was in a bag.

Another slightly less intense issue is when a patient struggles to clear secretions after surgery involving a tube. There are several reasons for that, but it's definitely less dramatic.

👋

So, am I allowed to guess that you're an anesthesiologist?

Scott Allen10, fine then, help me wrap my head around why I couldn't go with the spinal option.

Perhaps Scott Allen10 could shed some light on the specific criteria for choosing between an epidural or spinal block versus when general anesthesia becomes a necessity. It seems pretty obvious that the decision hinges on the type of surgery being performed, though I suspect certain hospital protocols or local traditions might play a role in that too.

Jose Miller3 said:So, can I just assume you're an anesthesiologist?

You're welcome to guess, but that's not quite my job—I'm just hanging out in the same neighborhood, if you know what I mean.

Kenneth Hernandez67 said:Scott Allen10, could you maybe help me wrap my head around why I wasn't even given the option for spinal anesthesia?

It’s honestly pretty tough to say for sure since there are so many factors involved, ranging from specific medical needs to just general surgical protocols, but usually, when it comes to abdominal surgery here in the States, doctors almost always opt for general anesthesia.

Why 😕

Should we be afraid of our own gut instincts 😉?

Scott Allen10 said:You can make your guesses, but I’m not saying anything—just kind of hovering around the truth...

A cleaning lady in an operating room? 😉

verica said:Hey, maybe Scott Allen10 can break down when they go with an epidural or spinal versus when they have to use general anesthesia? It seems like it really depends on the type of surgery being performed (and maybe even just the 'tradition' at a specific hospital?)

Man, it’s definitely not that simple. Technically, you could perform almost any procedure—even some cardiac surgeries—using a regional block (like spinal or epidural). It's pretty standard to use regional blocks for surgeries on the legs, hips, and even parts of the pelvic area. You've got the old-school, straightforward way with a spinal, or the slightly more sophisticated approach using an epidural.
But honestly, there are so many moving parts. It could be anything from local hospital customs or just how the staff feels that day, to a literal shortage of meds or specific needles, or even actual medical necessity.
Usually, those regional blocks are targeted around the L1 - L2 vertebrae level because if you go any higher, you're messing with the spinal cord, and honestly, not many doctors are brave enough to play experimenter with that. Plus, if you aim too high, you risk causing paraparesis, which is a nightmare nobody wants to deal with.

The big distinction between spinal and epidural is that with an epidural, you aren't actually entering the cerebrospinal fluid space. Epidurals—where they almost always place a catheter between the spine and the dura mater—are way better for the patient because you can fine-tune the level of pain relief and sedation. With a spinal, you inject the anesthetic and that's basically it. You also see more hemodynamic issues with spinals, like vasodilation causing blood pressure or pulse to drop, and respiratory depression happens more often there too. A classic example is a painless labor; using an epidural catheter allows doctors to carefully titrate the medication so the mother gets relief while still maintaining the sensation and muscle strength needed to actually finish the delivery. Lately, we've also seen much more use of epidural catheters for managing pain, usually in cancer patients, to give them a bit of a normal life through effective pain management.
Another difference is speed; a spinal kicks in within a minute or two so you can get straight to work, whereas an epidural takes about 20 to 30 minutes to really start "hitting." From a hospital management perspective, that matters—you can move through more patients in a day and get them home faster, which keeps costs down.

On the flip side, general anesthesia is the go-to for abdominal, chest, or brain surgeries. It gives the anesthesiologist total control over the depth of sedation, and the patient's airway is fully managed...
It all comes down to the specifics of the case. For instance, take a patient with myasthenia gravis who needs abdominal surgery—something normally done under general anesthesia. There's a massive risk of triggering a myasthenic crisis, which would turn a routine thing into a total disaster. In a case like that, doing it via a regional block is a much smarter move than going with general anesthesia.
So, I’d say I agree with the initial thought: the choice of anesthesia mostly boils down to the type of surgery, the individual patient's unique medical profile, and the clinical preferences of the staff. The patient's personal preference is usually way down at the bottom of that list.
👋

Jose Miller3 said:A janitor working in an operating room? 😉

😁 😁How'd you figure that out?

Kenneth Hernandez67 said:why not 😕

just face our own fears deep down inside 😉?

Maybe you had an extraterrestrial living in your gut, so they wouldn't let you watch!
😁 😁 😉

Scott Allen10 said:😁 😁 How can you be so sure?

But seriously though—can you actually prove you're a doctor or something? If you could... maybe we'd take you a little more seriously...

Scott Allen10 said:Maybe you just had an extraterrestrial in your stomach, so they wouldn't let you watch!
😁 😁 😉

Or maybe it's because I used a marker to draw a perfectly symmetrical incision before the surgery so they wouldn't mess anything up—they realized there might be issues if I were actually conscious.😁

Jose Miller3 said:Seriously though, can you actually prove you're a doctor? If so, maybe we'll start taking you a little more seriously.

Look, I’m not a doctor, but like I mentioned before, I spend basically all my time living and breathing this stuff every single day.
I mean, does that really make me some kind of clown? 😢

Go ahead and get all worked up if you want, but you write with this super authoritative vibe—which honestly made me assume you were a doctor.
And man, people here are just way too quick to hand out unsolicited advice (I mean, look at me...) so it’s probably worth being picky about whose input you actually take to heart.
I mean, sure, you could have just told me straight up if you were a physician or whatever, but I really respect that you just stuck to the truth. I still trust what you put out there in your posts, and I'll definitely keep reading them...

Scott Allen10 really knows his stuff and gives some killer advice. Plus, she’s putting in the work too.

Kenneth Hernandez67 said:I had surgery last year under those conditions. They intubate you while you're out and pull it before you wake up. You have absolutely no idea it even happened, let alone any lingering effects.

So, what exactly is the problem? 😕

I wonder the same thing. I’ve been under general anesthesia three times now, and I’ve never had an issue waking up—aside from that brutal thirst everyone gets after being put under.

On the other hand, I had sinus surgery last year using what they call "twilight" sedation. They pumped me full of something through my IV first, so I didn't feel a thing when they did the local injections around my nose. I was conscious the whole time, yet felt zero pain; in fact, I felt incredibly euphoric. I don't have much experience with drugs, but if that's how it feels for addicts, I can somewhat empathize. 😁

Scott Allen10, excellent post!

Beyond what you’ve noted—mortality rates under general anesthesia remain a critical factor. They haven't dropped significantly below one percent.

Abdominal surgeries carry a high risk of respiratory failure. Given the proximity to the diaphragm and the substantial fluid shifts—both loss and replacement—cardiopulmonary failure is a real threat; thus, general anesthesia with intubation is the safer bet.

There is also the issue of aspiration—especially in emergency cases rather than elective ones—where an empty stomach isn't guaranteed. This can lead to pulmonary aspiration and subsequent pneumonia. Recently, clinicians have been utilizing supraglottic devices for these scenarios. Instead of a tube entering the trachea, the device features a mask-like component that sits over the glottis, effectively protecting the airway while still allowing ventilation.