Anesthesia, Resuscitation, and ICU: Q&A

Joshua Ramos14 said:Hey everyone,

I wanted to pick your brains on something.

I've got surgery scheduled for a hernia repair on September 18th, and I have a few questions:

1. Which is better—going under general anesthesia or getting a spinal block?
2. I was chatting with a nurse who mentioned she personally thinks spinal is always the way to go, though obviously, I should just follow whatever my anesthesiologist recommends (which is what I figured anyway).
3. Does a spinal hurt? Honestly, the idea of getting an injection in my back doesn't exactly scream "painless" to me.🙂
4. Is there a chance I could get back into sports by early December or January? Something low-key like paintball.

1. They're both "equally good," really... it just comes down to which one works best for your specific situation. It all depends on your medical history, any contraindications, and honestly, just what you're most comfortable with.
2. A spinal is usually easier on your system... it basically just blocks the pain signals (and everything else) from traveling from your body up to your brain. General anesthesia affects pretty much every organ system in your body... so refer back to point one for that.
3. Most patients describe it more as a weird discomfort rather than actual pain... so don't sweat it too much. Just make sure you don't try to be a hero and stand up too soon after a spinal; if you try to act tough and get up prematurely, those post-procedure headaches will hit you, and then you'll *really* know what pain feels like.
4. Yeah... most likely... definitely check in with your surgeon about that.

neonowl67 said:So, over the last couple of months, I’ve actually had to go under general anesthesia twice now. The first time was for a dislocated shoulder where they knocked me out to pop it back in, and then just yesterday I had to have some manual manipulation done on the same shoulder. The thing is, both times I’ve ended up with this insane muscle soreness all over my body. It hits everything—my groin, abs, neck, back, biceps, triceps... basically everywhere except my calves. Last time, the ache cleared up in about two days, but man, it still sucks having to deal with it again because it honestly makes it hard to move around normally.

Anyone else get a weird reaction to anesthesia?

I’ve heard similar stories from patients who were given muscle relaxants during their anesthesia (especially if they used succinylcholine during induction)... you should probably ask them exactly what they administered... but honestly, it's usually nothing to worry about...

Scott Allen10 said:1. Both options are "equally effective," so the real question is which one suits you better personally. It all comes down to your specific medical profile, any potential contraindications, and ultimately, what you feel most comfortable with.
2. A spinal block tends to be much gentler on the body because it specifically targets and blocks pain signals—and other sensory impulses—from the periphery before they ever reach the brain. General anesthesia, on the other hand, impacts multiple organ systems simultaneously. For more detail, see point one.
3. Most patients describe the sensation as a bit of discomfort rather than actual pain, so there’s really nothing to worry about. Just a small piece of advice: make sure you don't try to get up too quickly after a spinal block. If you try to act tough and stand up prematurely, you might end up with a nasty post-procedure headache, and trust me, you definitely don't want to experience that kind of pain.
4. Yes, that is very likely... I would suggest having a quick chat with your surgeon to confirm everything.

I really appreciate the insights, thank you. I'm currently counting down the days until September 18th when I head into the hospital (I plan on taking care of some grooming beforehand!), and then on the 19th, I'll be undergoing the surgery at the local General Hospital. I'll be sure to check back in here to share my experience once I find out whether they went with the spinal or general anesthesia. 🙂

Drew Ruiz7 said:I find anesthesiologists incredibly attractive 😍......just like surgeons......... in those green scrubs, wearing their masks 😍😍😍

Me too!!!🙂)

Dr. Dre

I was wondering about the exact timing for removing the intubation tube... is it typically pulled right when the surgery wraps up while we just wait for the patient to fully wake up? Also, is it possible for someone to start breathing on their own without the tube if the anesthesia is still lingering quite strongly?...

And my other question is, how many hours after the procedure does the anesthetic actually last to ensure there's no pain?
ACL reconstruction surgery

Linda Martinez60 said:I’m wondering when exactly they pull the intubation tube out? Like, once the surgery wraps up, do they just take it out and wait for the patient to wake up? And can you breathe on your own (without the tube) if the anesthesia is still really kicking in?

Also, how many hours after the surgery does the anesthetic stay in your system so there isn't any pain?
ACL surgery

An intubation tube is basically a tube placed into the trachea (windpipe) through the mouth or nose via orotracheal or nasotracheal intubation for patients undergoing general endotracheal anesthesia (GEA).
The tube has three main jobs:
to ensure a secure airway during the period of anesthesia,
to allow for normal lung ventilation (whether the patient is breathing on their own or being assisted by the anesthesia machine),
and to protect the airway from aspirating stomach contents (which is super important).

During a procedure under GEA, the anesthesiologist keeps the patient asleep while ventilating them using the anesthesia machine, where a specific mix of gases is set. So, during this type of anesthesia, the patient isn't actually inhaling air, but rather a combo of oxygen, nitrous oxide, and inhaled anesthetics (usually something like isoflurane or sevoflurane these days). If needed, they’ll also add muscle relaxants, narcotics, analgesics, and so on...

Toward the end of the surgery, the anesthesiologist adjusts the settings on the machine, stops the flow of anesthetic agents, and starts ventilating the patient with pure oxygen. At roughly the same time, they give the patient an IV combination of meds to reverse the effects of the muscle relaxants (decurarization). By watching the ventilation parameters on the monitor and observing the patient clinically, they look for signs of spontaneous breathing and the first signs of waking up. The patient still has the tube in and is connected to the machine at this point. Once it’s determined that the patient is achieving enough tidal volume through spontaneous breathing, their level of alertness is good, and there aren't any other red flags, the anesthesiologist decides to perform extubation (pulling the tube). The patient stays under the watchful eye of the anesthesia team for a bit, usually in the Post-Anesthesia Care Unit (PACU), which most American hospitals have. Here, their breathing and overall status are closely monitored, and they get help if they need it. After a while, the patient is re-evaluated, and if the anesthesiologist thinks everything looks solid, they move the patient back to a regular hospital room.

It is actually possible to do the whole anesthesia process without a tube (using a mask instead). This method requires more focus and skill from the anesthesia team and is typically used for shorter procedures. Basically, by adjusting the dosage of the anesthetic and avoiding muscle relaxants (which always require a tube), they reach the necessary depth of anesthesia while the patient continues to breathe on their own. So, the anesthesia "holds" as long as the patient can breathe independently.😁

Pain is a super individual thing, so there’s no one-size-fits-all answer here. If it starts hurting, don't feel bad about speaking up and asking for pain meds. An ACL repair will most likely be done using regional anesthesia rather than general. You should definitely chat with your anesthesiologist about those options before the big day.

Thanks so much, Scott Allen10

It’s likely going to be general anesthesia since that's just how the doctor prefers to operate... which is why I wanted to check...
I'm really hoping for a smooth recovery and a great outcome so that I can look back on this surgery with nothing but positive memories...😉

I’ve actually had a few🙄breast augmentation surgeries...
The first one was a nightmare. I was under Dr. Dre and ended up in a coma; I was out for 24 hours. It was terrifying. I had this sensation like I was falling somewhere—like I could actually see myself plummeting—but I couldn't move a muscle. Pure horror. My subsequent surgeries were at General Hospital, and I have to give them credit; their anesthesiologists are top-tier!!!!!👍👍
There was just this one instance where, right before surgery, I got stuck with this female anesthesiologist who looked like she was more interested in her bank account than my health. She kept grilling me with question after question until I was practically sobbing. Even waking up from that one felt off; honestly, I wouldn't be surprised if she intentionally gave me a "heavy" dose. Other times, though, the anesthesia was so smooth I was ready to head home almost immediately after the procedure.
Even my most recent surgery with Gomez went incredibly well. They really have a great anesthesia team there!🙂

Hi everyone 🙂

Honestly, this thread caught me off guard. Due to a string of bad luck over the last few years, I’ve spent—and I’m not even exaggerating—thousands of hours digging through medical journals and patient stories on various forums. But I don't recall ever finding this much high-quality, free, and competent medical insight as I have right here. Kudos 👍

I have a question I haven't been able to answer, so I’m hoping any anesthesiologists hanging out here might be able to help. What are the actual risks associated with local anesthesia (specifically genitofemoral and ilioinguinal blocks) during a bilateral inguinal hernia repair? I have a procedure coming up soon at a clinic outside the US where they're insisting this type of anesthesia is the lowest risk option, but I'm still not entirely convinced the dangers are negligible. How much of a risk is there for permanent nerve damage (chronic pain) from this kind of thing, and are there other potential long-term complications?...

Thanks in advance. 🙂

Thanks for the kind words! Honestly, I’m just happy if our little chats can actually help someone out. If the FBI ever gave us a shoutout, we’d probably be the most popular group on the whole health forum...😁....But look, we definitely have to keep in mind that this is all just internet talk—it’s never going to replace the actual advice you get from a real doctor sitting right in front of you at the clinic.

As for your specific question, I don't really have much hands-on experience with those types of nerve blocks myself, so I'm not about to start throwing around guesses or random advice. I know Prince is planning to swing by the thread later, so he might weigh in with some insight... But if you want my two cents on anesthesia blocks in general, my best advice is to check in with the absolute pros in the field—the guys over at the Mayo Clinic. Those people live and breathe regional anesthesia... honestly, they're so good at it, you'd think they'd try to perform brain surgery using nothing but a local block at this rate...😁...they're total experts at using ultrasound to pinpoint exactly where the nerves are for the injection, and they do it routinely, so when it comes to regional stuff, you really can't go wrong with them.

Scott Allen10 said:Thanks for the kind words. Glad this thread might actually help someone out. If only the FBI would give us a shoutout, she’d be our favorite person on Healthline...😁Obviously, you have to remember this is just an online forum... it’s definitely no substitute for talking to a real doctor in person.

Explain the acronym or just drop a link where we're supposed to be singing your praises... 😁
Haven't been around here in years. Just dropping in occasionally... I'm an outsider at this point, so I don't really get what's going on anymore...

In my case, finding a competent doctor in person is basically like an atheist waiting for a vision of the Virgin Mary in a water heater... so I really value any kind of expert advice I can get from a distance... 🙂

Scott Allen10 said:If you want actual advice on nerve blocks, just go talk to the residents at the Mayo Clinic. They live for nothing else but regional anesthesia... eventually they'll probably try performing brain surgery through a block too...😁They rely heavily on ultrasound to pinpoint nerves and infiltration sites. It's just routine for them now... as far as regional anesthesia advice goes, you really can't go wrong there...

Thanks. 👍

Hey there!
What exactly is a pen service in anesthesia, and what’s the point of doing it?
Thanks!

It’s not going to be some "pen service," it’s actually called a "pain service." Basically, the anesthesia department would set up a dedicated unit to manage pain relief, mostly for patients who just came out of surgery and are struggling with intense discomfort that standard protocols aren't quite hitting... Calling it a "pain service" sounds super fancy and high-end when you talk about it, but if we're being real, a systematic, professional service like that doesn't really exist in the US yet, at least not the way it should.

I don't really have a specific question—not that I actually expect anyone here to be competent enough to give me a real answer these days—but I just need to vent about this surgery I've got coming up tomorrow.
Since I'm allergic to local anesthetics, and since most stuff out there is probably based on lidocaine anyway, I’ve basically just let my teeth go to hell. I mean, I can't exactly run to the dentist for every little thing, so we decided to just go big or go home. We're focusing on everything critical that needs to be PULLED. So, yeah.
Under general anesthesia, I'm getting about 12 teeth pulled and a few fillings done. 🙂🙂 ,,
I'm a little shaky about it, but once it's over, I'll come back and let you guys know how it went. 😍

crimsongull20 said:Maybe break down the acronym for us or just drop a link if you're looking for a pat on the back😁
(I haven't really hung out here in years, I just pop in once in a blue moon and I'm totally out of the loop, so I have no clue what's going on.)

😁...The FBI section—you know, where all the messages, complaints, and random comments live. It's just a section on the main page tucked away near the bottom... just scroll down a bit... look around... aha... click... and there you go...😍...or honestly, you can just do it this way...hey there...

Scott Allen10 said:😍...Sure, I can do that too...Hey...

Sure, you can too... 🙂 I can't say I'm surprised... Just more of the same.

I’m not entirely sure if this belongs in this thread, but I have a question. If someone is awake and conscious, yet they're hooked up to a ventilator—meaning there's a tube down their throat—does that actually hurt? What is that experience even like for them?

crimsongull20 said:Hey everyone 🙂

I'm wondering about the risks of local anesthesia (specifically genitofemoral and ilioinguinal nerve blocks) for a bilateral inguinal hernia repair? I'm getting ready for a procedure soon (outside of the US) where they're trying to convince me that this type of anesthesia is the lowest risk option for the patient, but I'm not totally sold that the dangers are negligible. What's the actual risk of permanent nerve damage (chronic pain) with this kind of thing, and are there any other possible complications with lasting effects?

Thanks in advance. 🙂

Look, in anesthesia, there’s no such thing as "negligible" risk! Things always seem to happen right when you least expect them.
The main risks associated with those specific blocks would be:
1) An allergic reaction to the local anesthetic (have you ever had local stuff before? If yes, no biggie—if not, you'll find out),
2) Accidentally injecting the anesthetic into a blood vessel (since they use a fair amount of it, you could have serious reactions like heart arrhythmias, loss of consciousness, dizziness, tingling in your hands, or even seizures depending on the drug used. Most of these can be managed or calmed down with medication, but they are incredibly unpleasant for the patient, especially since you still have to endure the surgery itself),
3) Accidental nerve injury from the needle (this can leave some lasting issues like paresthesia or numbness—basically weird tingling or losing sensation in the area covered by that nerve. This is usually avoided by performing the block under ultrasound guidance and using a nerve stimulator, though it also depends somewhat on your unique anatomy and, honestly, how skilled and experienced your anesthesiologist is),
4) A partial or failed block (meaning the surgery goes ahead, everything looks fine, and then suddenly it starts hurting because the block didn't take or only worked partially. You've got two options there: either go full general anesthesia and get to experience all the "joys" of being knocked out, which isn't exactly fun, or the surgeons just add more anesthetic as needed while you're still awake and praying it won't hurt—which, spoiler alert, usually means it will, making things even less pleasant),
5) The chance of infection during the injection, which is super rare and usually only happens if someone is being sloppy or using non-sterile techniques.

And since it sounds like you have to deal with bilateral hernias, all of this basically doubles because they have to perform the block on both sides.

Sorry, that was a bit heavy on the worry side. :-(

Let me lighten the mood a little. :-)
Peripheral blocks might actually be the best choice for a patient because they only numb the specific part of the body being operated on, and the numbing lasts for a good while after the surgery.
You aren't pumping drugs into your system that beat up your liver, lungs, brain, or kidneys (which is what happens with general anesthesia). You don't wake up feeling like a zombie, either. Plus, you don't deal with that post-op nausea and vomiting, which hernia surgeries can sometimes trigger. When people wake up from general anesthesia, they often tense up or try to cough against the breathing tube; they strain their abs, which can actually jeopardize the surgery if the stitches pop. It doesn't happen constantly, but it's a real thing, and it means the hernia could come back and you'd be heading back into surgery.
You could also go the route of regional anesthesia like a spinal or epidural block, which would essentially numb your legs and lower abdomen for a few hours. If it's a spinal, they usually tell you not to get up for 24 hours. With an epidural, you wouldn't necessarily need to stay bedridden for a whole day unless they accidentally hit the spinal space. You'd use a smaller amount of anesthetic compared to the blocks mentioned above, and they could handle both sides. I think the potential complications for those are listed somewhere else on this forum.

I think I’ve covered just about everything you asked me:

But honestly, the big thing is this—during your pre-op screening and when you actually sit down with the anesthesiologist right before the surgery, just lay it all out there. Talk through every single fear, every "what if," and even your hopes. Make them explain exactly why they believe a specific type of anesthesia is the best call for your body.
At the end of the day, it really boils down to how much experience the anesthesiology team has and how often they perform that specific technique. If you're at a major medical center where they do this kind of procedure routinely—especially if they're using ultrasound guidance—you can probably feel pretty confident following their lead.
Since we're talking about a bilateral hernia, though, don't be afraid to ask their opinion on spinal or epidural options too.

Anyway, that’s my two cents. Phew.
Best of luck with the anesthesia and the whole surgery!

Emily Sanchez90 said:I'm not sure if this is the right spot for this question, but what happens when a patient is awake and conscious but hooked up to a ventilator? You know, with that breathing tube down their throat. Does it actually hurt them, and what does it feel like?

It’s pretty standard practice to give patients with an endotracheal tube varying doses of sedatives just to help them deal with the tube itself and the whole mechanical ventilation process more comfortably.

The answer isn't exactly black and white, either. It’s a given that having that "tube" in your mouth is going to be irritating and uncomfortable, which is why we lean on those meds. The tube can also cause sores or irritation on the lips and tongue, so when you're caring for someone like that, you really have to stay on top of it by repositioning the tube in their mouth and keeping their oral hygiene spotless. What makes things even tougher is how dry their mouths get. Since the tube prevents them from closing their mouth all the way, the mucous membranes in the mouth and on the tongue end up drying out and cracking. Honestly, just try keeping your mouth open for ten minutes straight—you'll see how quickly everything dries out all the way back to your tonsils.
That said, some patients handle the tube just fine without much trouble, especially if they're lucid enough to understand what's happening and can be talked through why it's necessary.
Also, keep in mind that a tube like that shouldn't be in there for more than about ten days. Nowadays, in places like major ICU units, it's routine to perform a percutaneous tracheostomy for patients who need long-term ventilation; they'll set up a tracheal cannula so the breathing happens through that instead, allowing them to pull the oral tube out. Good luck.

Scott Allen10 said:It’s pretty standard practice to give a patient some sedative—more or less depending on the case—just to help them tolerate the endotracheal tube and the overall mechanical ventilation process.

The answer here isn't exactly black and white. It’s a given that having a "tube" in your mouth is irritating and just plain uncomfortable. That’s why those medications are added beforehand. The tube can also cause sores and irritation on the oral mucosa and tongue, so when you're treating these patients, you really have to be proactive about repositioning the tube within the mouth and maintaining proper oral hygiene. To make matters worse, these patients deal with intense dry mouth. Think about it: having a tube in means you can't fully close your mouth, which inevitably leads to dryness and cracking of the oral lining and tongue to some degree. Just try keeping your mouth open for ten minutes straight. You'll see how fast everything dries out all the way back to your tonsils.
That said, some patients handle the tube without any issues at all, especially if they are conscious enough to understand what’s happening and have the reason explained to them.
Also, keep in mind that a tube shouldn't stay in the mouth for more than about ten days. Nowadays, it's common in major US hospitals to routinely perform a percutaneous tracheostomy for patients who need prolonged intubation and mechanical ventilation. A tracheal cannula is placed, ventilation continues through that, and the oral tube is removed. Good luck.

Thanks for such a thorough breakdown. The discomfort is manageable, but my main concern is making sure there isn't any significant pain involved. Since patients in this state can't speak, they can't even tell you how much it hurts.

By the way, wouldn't it be fascinating if anesthesiologists kept a running log of what patients say right when they wake up and are asked for their names?🤣
One of my friends blurted out that he was Madonna.😁