Anesthesia, Resuscitation, and ICU: Q&A

A quick question for the anesthesiologists on call from a med student
So, I’m currently in my fourth year—which basically means I haven't even sniffed anesthesia yet, unless you count one brief visit to the ICU, sedating a patient who was in a coma (she had a GCS of 7, was actually all over the local news for a bit because a massive storm blew her down, suffered a brain contusion, and had to rush into emergency surgery to get a drain placed for ICP monitoring), and witnessing one resuscitation. Honestly, that resuscitation was probably one of the most pivotal moments of my entire medical school career! It happened totally out of nowhere during our internal medicine rotation; a patient just collapsed, and this senior doctor stepped in and immediately started barking orders at us to coordinate who was doing what. Usually, students just stand there and watch the code happen—they don't really let us jump in to do the compressions or the bagging ourselves
Anyway, I wanted to ask: how many years does residency actually take? What’s the deal with the on-call shifts and all those little details? I’m asking because I am genuinely considering this as a career path—it really appeals to me! But whenever I mention it to any of the faculty assistants at the university, I just get these looks like, "Are you insane?" or "Oh man, don't even bother," or "Nobody wants that because it's way too intense"...

Nora, you've been in anesthesia for five years now, which means you're essentially in the middle of standardizing your specialization across the entire US. Your shifts during residency, and even after you're finished, will depend entirely on the needs of whichever hospital system you join. In major medical centers, people can really steer their careers toward specific interests—and if they have the drive, they can tackle just about anything. However, in smaller facilities or places facing an anesthesiologist shortage, you won't have much choice; you'll end up doing a little bit of everything. Naturally, that brings the question of job quality into play. During your training, you'll rotate through various branches of anesthesia and intensive care. If that's your goal, you can certainly push yourself to cover all those bases, including resuscitation, which touches upon almost everything. You’ll also rotate through several internal medicine specialties and neurology, though I'm not entirely sure about pediatrics. In practice, it becomes quite an individual journey based on your own goals, as you'll likely dedicate more time to certain areas.
I hope this helps at least a little.

Help me out here!
My mom was just taken off the table today after undergoing full anesthesia for heart surgery because an emergency popped up mid-procedure.
Now they’re planning to put her back under for more anesthesia this coming Monday.
Is it actually safe to dose someone with anesthesia that quickly, especially when we're talking about a weak heart?
What kind of fallout should I be looking out for?
thanks

They say there's no such thing as a stupid question, right?..😁

So, am I actually allowed to go into surgery with a fixed dental appliance if I'm going under general anesthesia?

I know you have to strip off all the metal—rings, earrings, piercings, and all that, probably because of the risk with electroshock equipment during the procedure, right?🤷
It’s for a potential eye surgery that would probably run about three or four hours on average..

Thanks for the help🙂

Robert Campbell63 said:Help!
My mom was taken off the table today right after full anesthesia following heart surgery because of an emergency.
They are planning to redo the anesthesia this coming Monday.
Is it actually safe to administer them so close together—especially considering her heart isn't exactly in top shape?
Any potential consequences?
thanks

It's fine... by Monday, her body will have metabolized those drugs entirely. Honestly, if yesterday's induction went smoothly without causing any major hemodynamic issues, there’s really no reason to expect anything different on Monday.

Amanda Sanders44 said:They say there’s no such thing as a stupid question...😁

Is it okay to go into surgery—specifically under general anesthesia—if I have a fixed dental appliance?

I know you have to take off all the metal—rings, earrings, piercings (probably just in case they need to use defibrillators🤷).
We're looking at a potential eye surgery that would likely run about 3 or 4 hours...

Thanks for any insight.🙂

It shouldn't be an issue, provided it doesn't interfere with your ability to open your mouth properly. The real headache comes with loose teeth or removable dentures, since those can pose a serious risk to a patient's airway during the procedure.

Amanda Sanders44 said:They say there’s no such thing as a stupid question...😁

Can you go under general anesthesia if you're using a fixed medical device?

I know you have to take off all the metal—rings, earrings, piercings (especially if there’s any chance of electric shock).🤷)
We're looking at a potential eye surgery that would likely run about 3.4 hours on average.

Thanks for the reply!🙂

I know a woman who had an appendicitis flare-up and ended up needing surgery to have it removed... unfortunately. Look, if you have a hangnail on your finger, you just clip it off, right? You can probably figure this one out on your own too... but seriously, go talk to your doctors first.

😢
I don't know, man, it just seems totally logical to take the device off if you're going under with inhaled anesthesia... but if we're talking about an IV device, then it doesn't bother anyone at all....🤷

Laura Hernandez49 said:I know a woman who had an appendectomy and had to have it removed... unfortunately... listen... when you have to take off nail polish if you're wearing it... well, regarding the aparatic... you can probably figure that part out yourself... though maybe check with the doctors first.

The nail polish thing is mandatory because of pulse oximetry—it filters certain light frequencies, which can feed the oximeter some seriously fake data, lol.

As for the aparatic, that’s a different story. In theory, you might run into an issue if the surgeon uses a monopolar cautery without a grounding pad (you know, that thing they stick under your shoulder or hip before surgery) while the aparatic is wired directly to the ground—which, let's be honest, is basically impossible in a real clinical setting.

If the aparatic is fixed in place and isn't going anywhere, there's really no reason to strip it off. Removing it right before an elective procedure is more about following established routine than any actual physiological necessity.
It’s similar to wearing masks in the OR—technically, only the lead surgeon, the assistants, and the scrub nurse need them; everyone else could get by with just a surgical cap (assuming they aren't nursing a cold)—but everyone wears a mask anyway just to avoid the lecture from the cranky scrub nurses who won't stop nagging.

Regarding inhalation versus IV... for the aparatic, it doesn't make much difference.

Hi 🙂
I've got an endoscopic ultrasound scheduled. After the first attempt was a total bust, I'm opting for full anesthesia this time—honestly, I don't think I could handle it any other way. Can anyone walk me through what the actual process looks like? Also, if the whole thing takes about 45 minutes, how long am I going to be out for afterward? Thanks 🙂

Eric Moore8 Asks:
Hey there. Just checking in. 🙂
So, I’ve got an endoscopic ultrasound on the horizon. After that first attempt went south—and let's just say it wasn't exactly a walk in the park—I've decided to go under full anesthesia this time around. Honestly, I don't think I could handle it any other way. Could anyone walk me through what the actual process looks like? Also, if the whole procedure takes about 45 minutes, how long am I realistically going to be out cold afterward? Thanks in advance. 🙂

Look, let's be real—for those elective procedures, patients usually get handed at least a little something to take the edge off—anxiolytics like Xanax or Ativan, for instance—so it’s no wonder they end up drifting off for a few extra hours afterward.
Honestly, you’re probably better off just asking the anesthesiologist who'll be handling your sedation whether they plan on giving you any premedication beforehand. It's worth a quick word—better to know what's coming.
At my hospital, it isn't really the standard practice to give premedication to outpatients coming in for things like gastroscopies or colonoscopies—though, honestly, that seems to vary quite a bit from one medical center to another.

Alexander Wright said:Look, for elective procedures, they usually give you at least a little something to take the edge off—some kind of anxiolytic like Xanax or Valium—which often leaves you feeling drowsy for a few hours afterward.
Your best bet is just asking the anesthesiologist who’s handling you whether you'll be getting any premedication.
At my hospital, it's not really standard practice to premedicate outpatient patients coming in for things like gastroscopies or colonoscopies, though that definitely varies from one medical center to another.

I'm aware of that. When I had my first endoscopy, they did give me a bit of an anxiolytic, but I ended up passing on it anyway. That specific procedure takes way longer than a standard gastroscopy (which I've done before, obviously, without anesthesia). For this one, they’re doing full-on anesthesia right from the start, so I really wanted to hear what your experiences have been like.

Does anyone know if someone with circulation issues is allowed to go under general anesthesia?

Sam Hall15 said:Hey Nora—so you’ve been in anesthesia for five years now! Just so you know, that basically lines up perfectly with how they’re standardizing specialties across the entire US and the EU right now. As for your shifts during residency—and honestly, even after you're fully certified—it really all boils down to the specific hospital system you land in and how much they need you. In those massive medical centers, people actually get to pick their lane and specialize in what they love—though, let's be real, if you have the drive, you can technically do a bit of everything. But in smaller facilities, or places where there's a serious shortage of anesthesiologists? Well, you don't really get a choice there; you just jump in wherever the fire is. Of course, that always brings up the big question of job quality and how much focus you can actually give each case. During your training, you'll rotate through all the different branches of anesthesia. You’ll hit intensive care, and if you really put in the work—which I totally think you should if that's your end goal—you can probably touch every single sub-specialty. And then there’s resuscitation, which kind of acts as the glue holding all those pieces together. You’ll also rotate through several internal medicine departments and neurology—I'm not 100% sure about pediatrics, though! At the end of the day, it’s a super individual journey. It really comes down to what you're passionate about—you'll naturally find yourself gravitating toward the stuff you actually enjoy doing.
I really hope I was able to help out even just a little bit!

Thanks a million! 😍

I was hoping someone could help me clear a few things up:
A couple of days ago, I had a minor gynecological procedure at a private clinic over in Chicago (not sure if I should name names here).
Basically, they originally told me it would just be local anesthesia, but when I showed up for my exam on the day of the surgery, they switched it up and said it would be general anesthesia—and that I might even need to stay overnight. All in all, everything went really smoothly, especially since this whole thing was pretty traumatic for me and I was super anxious about it.
The anesthesia lasted exactly thirty minutes. I was conscious almost immediately after waking up, and within about 7 or 8 hours, I was already cleared to head home.
Now that the dust has settled, I’ve got this sudden wave of curiosity, so I was wondering if anyone could explain what actually happened during the process. Between the intense nerves and just feeling uneasy, I wasn't exactly following along closely.
First, they put one of those plastic IV lines in my left arm—I'm guessing that's how they gave me the intravenous anesthesia. From what I've read on this thread, it was probably Propofol.
They asked me twice if I was feeling dizzy right before I actually started feeling lightheaded, and they also stuck this huge patch on my right leg... I am dying to know what that was for!
And it feels like—though I can't say for certain because my brain was a fog—that once my head started spinning, they placed a mask over my face... does that sound right?
I woke up exactly 30 minutes later. I remember seeing the clock in the room showing 11:45, and the very first thing obsessing me when I came to was: "What time is it?"
I don't want people to think I'm implying the gynecologist, the anesthesiologist, or the nurses were being unfair or withholding info; it's just that I was way too freaked out at the time to ask anything. They did give me a quick rundown of the plan and asked me a few questions... but yeah, now that I'm back home and feeling okay, I'm finally getting curious.

rowdyraven23 said:She’s asking for a little clarification:
A few days ago, I underwent a relatively minor gynecological procedure at a private clinic here in the States (not sure if I should name them).
Basically, even though they originally scheduled it under local anesthesia, during the exam on the day of the surgery, they told me they were going to switch to general anesthesia and that I might need to stay overnight. All in all, everything went quite smoothly—especially considering this was something that caused me significant trauma, so I was incredibly anxious.
The anesthesia lasted exactly thirty minutes; I was conscious immediately upon waking up, and after about 7 or 8 hours, I was actually cleared to go home.
Now that the dust has settled, curiosity has kicked in, so I was wondering if anyone could explain what exactly happened—given that I was too overwhelmed by nerves and discomfort to really follow along properly.
They first inserted a plastic catheter into my left arm—I assume that’s how I received intravenous anesthesia, and from what I’ve read on this thread, it was likely Propofol.
They asked me twice if I was feeling dizzy right before I actually started feeling lightheaded, and they also stuck some kind of large patch/sticker on my right leg... I'm dying to know what that was and what its purpose was?
And it seems to me—though I can't say for certain—that once my head started spinning, they placed a mask over my face... is that possible?
I woke up exactly after 30 minutes; I remember the clock in the OR showing 11:45, and the very first question haunting me when I came to was: "What time is it?"
I don't want my questions to come across as though the gynecologist, the anesthesiologist, and the nurses weren't being fair or didn't tell me anything about the procedure—it’s just that I was far too nervous to ask anything... they gave me brief explanations of what they would do and what would happen, they asked me a few things... but yeah, it's only now that I'm back home and feeling okay that I've become curious....

They most likely administered a short IV anesthesia using Propofol (which is essentially the gold standard anesthetic for procedures like the one you described).

If that "patch" had a wire attached to it, it was almost certainly a grounding pad for an electrosurgical unit (electrocautery). These tools use electrical current to cut tissue and cauterize vessels to stop bleeding (they are significantly more efficient than the standard scalpels used just for skin incisions), but when using a monopolar setup, you need a wide electrode adhered somewhere to complete the circuit. In abdominal surgeries, it’s usually placed on the right shoulder blade, while for cardiac procedures, it might be on the lower back or similar, because the current travels from the surgical tool to that electrode to close the loop.

As for the mask, they applied it because Propofol, in that initial induction dose, tends to suppress respiration (what foreign medical literature refers to as suppressing the "hypoxic drive"), so they had to ventilate you (meaning the anesthesiologist was essentially breathing for you using a manual bag) until your spontaneous breathing returned. Later on, they likely just held the mask in place and lifted your chin to open the airway, allowing you to breathe in either pure oxygen or perhaps a mixture of oxygen and nitrous oxide (an IV Propofol plus N2O/O2 mask combo is a pretty solid setup for short-term IV anesthesia).

One of the major perks of Propofol for these kinds of outpatient procedures is its antiemetic properties (it helps prevent nausea), the fact that patients wake up feeling quite lucid, and the way it metabolizes rapidly in the body, which is why people can often head home the very same day.

Kate Taylor59 said:Does anyone know if someone with circulation issues can go under general anesthesia?

Of course they can... you just need to make sure you end up in the hands of an anesthesiologist who actually knows their stuff. 🙂

You'll have to define "circulation issues" for me first...

Alexander Wright Asks:
Of course it's possible... you just have to make sure it ends up in the hands of an anesthesiologist who actually knows what they're doing. 🙂

So, what exactly constitutes "impaired circulation"? It’s one of those medical terms people throw around like they know what it means, but it's actually quite broad. Basically, you're looking at any situation where the blood isn't flowing through your vessels quite the way it should be—whether that's because of a blockage, some structural issue with the veins or arteries, or just general inefficiency in how the system moves oxygen and nutrients to your tissues. It's not just one thing; it can range from minor issues to something much more serious.

My left leg keeps going numb on me quite often, and my feet feel like they're perpetually stuck in ice.
I used to deal with these constant, nagging headaches, and looking back, it was all down to circulation issues—it felt like oxygen just wasn't making its way up to my brain properly. I'd also get this persistent ringing in my ears quite often. 🤷 They told me I should probably get into some kind of sport... as if that's just going to solve everything.

Kate Taylor59 said:My left leg goes numb all the time, and my hands and feet just feel like ice blocks...
I used to get these killer headaches because of circulation issues—apparently, oxygen wasn't quite making it to the brain... I get this ringing in my ears quite often too.🤷They told me I really ought to start getting some exercise in my life..

It's possible; it isn't actually that scary... how old are you anyway?

Alexander Wright said:It’s possible, it isn't really that bad... how old are you anyway?

18