Anesthesia, Resuscitation, and ICU: Q&A

Brenda Foster said:When I was a little girl, I had my appendix removed. Out of three different anesthetics used, they confirmed an allergic reaction to two of them (fentanyl and nesdonal). The side effects from all that ended up causing extrasystoles, which I spent six years being treated for.
The real issue I deal with now is that as soon as I mention I'm allergic to those two specific drugs, people start panicking. It basically means I can't get any numbing injections at the dentist, so I’ve had to endure root canals while feeling everything "live." Even my eye surgery could only proceed because they used adrenaline... I don't even want to describe how intense that pain was.
I always carry around a formal medical certificate signed by my doctors stating my allergies, just in case some emergency situation pops up.
Is there actually a test out there that could pinpoint exactly what I'm allergic to? I'd love to avoid a repeat of everything I've been through and hopefully make these "everyday" medical situations a lot easier to manage.
Thanks.

In my case, doctors mentioned that as a result of a general anesthesia session that went pretty poorly, I've developed this long-term hyperthyroidism along with extrasystoles that haven't cleared up even after all these years—and I'm only 24.

No one has ever actually referred me for allergy testing...

But I am 100% certain that something went sideways during the anesthesia.🙄

Nicholas Alvarez60 said:In what way (how exactly) was the allergy to fentanyl and Nesonal (I think you mean thiopental) actually proven?
Are we talking about six years of extrasystoles?
Honestly, if someone is allergic to fentanyl, thiopental, AND all local anesthetics, they basically hit the jackpot in the worst way possible...
You might be allergic to a specific drug, or maybe just a preservative within a certain formulation, etc.
Just because you're allergic to one anesthetic doesn't mean you'll react to another, and thank God, there are more than just a few ways to manage pain during procedures.
You should find a competent specialist who can give you a straight answer on this, especially considering how these various "what-if" scenarios might play out in the future...

The allergy was confirmed when my blood was sent off for analysis in NYC immediately after the surgery.
The extrasystoles were attributed to an allergic reaction to those anesthetics mentioned above (I spent quite a while being treated at a hospital in Cleveland).
I know there's a huge variety of anesthetics out there, which is why I'm curious if there's any kind of testing available that could pinpoint exactly what I'm reacting to.
I’ve done the "standard" allergy tests before, which showed reactions to certain preservatives, metals, and so on.
Sometimes I break out in hives, but most of the time it passes without a visible rash.
Right now, I'm mostly struggling with the issues mentioned earlier and the stress of trying to navigate even the simplest situations.

urbanscout50 said:Best regards!
Regardless of how your allergy to those specific anesthetics was "proven," I really think you should sit down with your doctor and lay everything out. Ask them to refer you for more specialized allergy testing so you can definitively confirm or rule out reactions to certain drugs or anesthetics. If needed, you might want to re-test for thiopental (though an allergy there isn't a huge deal since there are plenty of alternatives) and fentanyl—plus other drugs in that same class, like sufentanil, pethidine, morphine, alfentanil, or tramadol. These are used as opioid analgesics in almost every general anesthesia case or for post-op pain management, so an allergy to that group could actually be a pretty significant hurdle.
good luck.

Thank you so much!

What does anesthesia actually look like for a 3-year-old having their third set of tonsils removed?

Hey everyone.

So, I've got my tonsillectomy scheduled for this coming Monday (under general anesthesia), and I was just sitting here wondering if there’s any actual issue with my period starting the day after the surgery? Or, on the off chance that my cycle starts on the exact same day as the operation, is it true that they won't let me go under? Usually, though, it looks like I'll be getting it the very next day.

I’m definitely going to run this by my doctor, but I figured I'd check in and see what you all think first.

wanderingdriver26 said:Hey everyone.

I’ve got my tonsillectomy scheduled for this coming Monday under general anesthesia. What I’m wondering is—is it actually an issue if my period starts the day after the surgery? Or, if it happens on the actual day of the procedure, is it true that they won't let me go through with it? Usually, I expect it to arrive just one day after the operation.

I’ll be asking my doctor as well, but I wanted to see what you all think first.

I’m also scheduled for a hospital stay for a tonsillectomy on April 27th, with the surgery itself on the 28th... and that's exactly when I'm due to start mine. It's been on my mind too. 😕

Hi there.
I need to head in for surgery to deal with a 7cm endometriotic cyst. What’s really weighing on my mind—naturally—is the whole general anesthesia thing. As far as I know, I don't have any major underlying health issues... well, none that I'm aware of. About 3 or 4 years ago, I had some episodes of heart palpitations and was on beta-blockers, but that seems to be settled now—I haven't taken them in 2 or 3 years.
Honestly, my biggest worry right now is my weight. I'm about 5'5" and 196 lbs. I'm trying to lose some weight in the time I have left before the procedure. On top of that, I've started worrying about my teeth lately—they aren't exactly rotting or anything, they just seem more brittle, like they're wearing down faster...
Is there anything at all I could do to lower the risks associated with anesthesia, or am I kind of stuck? I don't smoke, I don't drink alcohol, and I'm not on any medications. I guess I'm just feeling pretty overwhelmed by the anxiety of it all.

urbanscout50 said:Don't wear contact lenses while you're under anesthesia!

Does this rule also apply to spinal anesthesia—and what about someone wearing two-week contacts, the kind you basically sleep in?
Thanks in advance for the help. 🙂

Laura Kelly7 said:Does this apply to spinal anesthesia too? And what about someone who wears two-week contact lenses—the kind you actually sleep in?
Thanks in advance for the help 🙂

Seriously, does nobody here have an answer? 😢

Laura Kelly7 said:Does nobody have any info? 😢

It would be safer to just take those lenses out, since there is always a risk of complications...

Sarah Garcia84 said:You’re better off taking your contacts out—there’s always a risk of complications if you don't.

Thanks for the input, but I'm actually curious—what kind of complications are we talking about here?
I've been doing some digging online, and honestly, I'm coming up empty.

I also noticed that they recommend taking contacts out before an epidural, yet I know plenty of people who went through with an epidural while wearing them and nothing happened at all.🤷

Laura Kelly7 said:Thanks for getting back to me, I'm just really curious about what kind of complications could actually pop up if you don't?
I've been doing a bit of Googling, but honestly, I'm coming up totally empty

I also noticed that they usually recommend taking out contact lenses before an epidural, but I know plenty of people who went through with their epidurals while wearing them and nothing ever happened 🤷

🤷....I mean, when you go to bed, you probably take your contacts out....when you head in for surgery, you strip off your clothes and shoes....you take out your dentures....you wipe off the makeup and nail polish.....

Basically, stripping off all those extras, including your contacts, falls squarely into the category of precautionary measures! It's just about making sure there aren't any hurdles if things suddenly get chaotic in the OR.

Think about it this way: say you're getting an epidural, and right after they insert the catheter and the block starts working, you suddenly have a cardiac arrest and the doctors have to jump on you for resuscitation....it's total chaos....grab this, do that, move fast, check the vitals....check pupil reactivity quickly....beeping everywhere....and then it's like, sorry doc, I can't see anything because of these contacts, and even if I could, there's no way I'm messing with them while you're performing CPR or whatever else is going down....

So yeah, just strip everything off and don't overthink it.....there’s definitely a reason behind the rules....🙂

Scott Allen10 said:🤷....I mean, when you go to bed, you probably take out your contact lenses....when you go in for surgery, you strip off your clothes and shoes....you pull out your dentures....you wipe off the makeup, the nail polish.....

Generally speaking, stripping all that stuff off—including contacts, if we’re looking strictly at the medical side—falls under the category of precaution!....It basically means there shouldn't be any hurdles if things suddenly turn into a total mess in the OR.

Look, say you’re getting an epidural, and right after the catheter is inserted and the block starts, you suffer a cardiac arrest and they have to resuscitate you....it's chaos—push this, move that....do this quickly, grab that....check the pupil reactivity immediately......beeeeep-beeeeep....sorry, dear colleague, I can't see a thing because this girl has contacts in, and even if you'll forgive me, I can't exactly pop them out while they're performing CPR or whatever else is happening....

Bottom line: get everything off yourself and out of your way and don't overthink it.....there's definitely a reason for it....🙂

Scott Allen10, thanks for the answer...as far as that "don't overthink it" part goes, that's a little hard for me—I'm a naturally curious woman...😁

That was a really vivid description, especially the beeeeep-beeeeep part (now it's stuck in my head like something out of an episode of *House*)—I know it's a precaution, but I'm not exactly "planning" on having a cardiac arrest (God forbid)—black humor aside, I realize there's always a chance of complications...😢

And honestly, it's a bit embarrassing—I'll be stripped down to nothing, then "out of it" from the spinal, and on top of that, acting like a blind chicken....🙂 so I thought I'd at least maintain a shred of human dignity and actually see what they're doing to me... (though maybe it would be better if I couldn't hear or see anything at all)🤣

And besides, how could they not check pupil reactivity? Contacts are transparent and you can see the eyes and pupils perfectly fine... alright, okay, I won't make a big deal out of it anymore; I'll just see what the anesthesiologist says...

It's a good thing I don't have dentures and I don't wear much makeup or nail polish, otherwise I'd have to worry about all that too...😛

Thanks everyone for the answers 😉

Scott Allen10 said:If that’s the opinion of a cardiothoracic surgeon—which, frankly, is quite reasonable and logical—then at least you can find some peace of mind knowing you’ve explored that avenue, especially since the illness wasn't caught early enough to be treated properly from the jump. Regarding methods that might actually help a heart this fragile stabilize, or what happens if things take a turn for the worse... well, there's the Intra-Aortic Balloon Pump (IABP), or eventually something like a Ventricular Assist Device (VAD). That first option is invasive, sure, but it's a real possibility; the second one? That would mean heading to New York City for open-chest surgery, which is a much heavier lift. Just stay focused on those cardiology channels in the coming days. Don't be afraid to keep pressing the cardiologists, surgeons, and anesthesiologists about diagnostic options, potential interventions, or surgery. Be... how should I put this... "persistent." Ask them until they get annoyed; who cares if they lose their cool? They are there for you and the patient, not the other way around. I know, I know, that sounds a bit dramatic, but it truly irritates me when medical staff act impatient with people who are clearly in shock because of a loved one's condition. Sometimes the intake and information protocols feel more like a concentration camp than a hospital. If you feel any friction or tension in your communication with them... just push through! Things often change for the better once you make your presence felt.
I’ve mentioned before that, in my experience, a tracheotomy is often the best way to help a patient gradually transition off the ventilator. Since the man has been in the ICU for days now, you can see certain things happening around him, and even without being a specialist, you'll likely realize that patience is the only way forward. Don't obsess over "what if" scenarios... just take it one day at a time. Don't get too carried away by tiny improvements, but please, don't lose hope even if things get complicated. There is comfort in the simple fact that he is still alive after more than two weeks in this state.
Two weeks in an intensive care unit under mechanical ventilation and in a state of shock carries a massive risk of complications... it’s just the reality of it. Pneumonia, hospital-acquired infections, urinary tract infections—if you haven't seen them yet, you should expect them. No one in the world has eradicated infections entirely, so we certainly haven't, and most of them aren't even caused by the staff (though, of course, that happens sometimes); they usually happen because bacteria migrate from the digestive tract into the blood, or due to prolonged ventilation through tubes and cannulas, or simply because the body's immune system is so depleted...
Good urine output, getting enteral nutrition via a feeding tube or orally if possible, solid physical therapy (turning him, repositioning in bed, massage, percussion), maintaining strict hygiene, excellent oral care (this is absolutely critical), keeping fluids balanced, managing hemodynamics (blood pressure, CVP, pulse, cardiac output), using antibiotics as needed, and keeping the airway clear (using closed suction systems for lung secretions, gentle ventilation modes like pressure support... etc... I’m just throwing out everything that's standard practice for critical patients in the ICU. I trust that's what's happening in your case too).

The Boeing 747 is a reliable but older model of ventilator that doesn't feature the most advanced ventilation modes. Honestly, my advice is not to stress over the specific numbers scrolling across that screen. If it shows he’s participating in breathing with 2L, it doesn't mean much, because everything can shift in five minutes. You won't be able to put those numbers into any real context, and they'll only serve to confuse you. CMV and SIMV are volume-controlled ventilation modes, and we used them for years. They aren't bad; they do the job, but they aren't necessarily the kindest thing for lungs that have been "wounded" by illness and long-term ventilation. At least, that's how it seems to me. But then again, that's a conversation for a specialized medical forum.
But, since you brought up the Boeing 747 and that whole situation regarding your father... well, if we are talking about signs of breathing, a good omen would be seeing the "flow by" and "pressure support" options enabled in the top row. And where it lists CMV and SIMV, you'd want to see that green light glowing next to the third option, CPAP... That would mean the patient is breathing under their own power, that every single breath they take is being supported by a more or less constant pressure assist, and that the air mix is somewhere around 30-50% O2.... And on the monitor display, you should see a minute volume of 5 - 6 - 7 L, even if the tidal volume is just 0.5L and the respiratory rate is 15 - 20.... On top of that, the patient monitor ought to show decent blood pressure, maybe 90 - 100, a steady pulse (under 100/110) without any major arrhythmias, and an SpO2 of at least 90%... all while the patient themselves doesn't look like they are struggling to breathe—no heavy labored breathing, no sweating, none of those frightening symptoms....
Anyway, my advice, just like I gave to your mom... just take it day by day and try to stay patient.... Good luck!🙂

God! I am the second daughter, and I just wanted to jump in and let you know that Dad actually pulled through. 🙂 You all have been such a huge help to us, and it truly meant the world to hear from someone who actually understands this stuff; it helped explain things during a time when everything was just such a massive unknown to us. Up until the moment he ended up in the hospital, we honestly thought he was "healthy," that nothing was wrong... in the end, they discovered first of all that he has a heart defect—mitral insufficiency (I actually have it too, though mine was caught a long time ago. And every single time the doctors asked if anyone in my family had it—not knowing—I’d always just say no). When they did his head CT, they also found some ischemic damage in the brain, about 1.5cm in the frontal lobe, but they can't pin down exactly when it happened. Whether it occurred during this hospital stay or before. Since the heart ultrasounds showed that the heart issue is an "old thing" and there are already several scars on the heart, it is entirely possible it happened much earlier. He’s just the type of person who won't talk about these things; he isn't exactly a fan of doctors or hospitals, so unfortunately, his condition had to get this complicated and lead to all of this.
Since you seem genuinely interested in this, I would gladly send you a photo of the discharge papers, but I really don't want to overwhelm you with too many details... Long story short, he is home now, recovering, taking it slow. 😉 I just wanted to let you know, in case you remember us, that we have a happy ending. 🙂 Thank God, the doctors, and everyone else that contributed to this! 🙂

Amy King said:God! I'm the second daughter, and I just wanted to jump in here and let everyone know that Dad pulled through. 🙂 You guys were such a massive help to us—it really meant everything to have someone who actually knows what they're talking about explaining things during such an uncertain time, because honestly, we were flying blind. Up until he ended up in the hospital, we thought he was perfectly fine... nothing wrong. As it turns out, the big issue was a heart defect—mitral regurgitation (I actually have it too, though mine was caught ages ago. Every time doctors asked if there was any family history—not knowing—I’d just say no). Then, when they did his head CT, they found some ischemic damage in the frontal lobe, about 1.5cm, though they couldn't pin down exactly when it happened. Whether it occurred during this recent hospital stay or much earlier is anyone's guess. Since the cardiac tests showed the heart issues are "old news" with several existing scars, it's entirely possible that brain damage happened way back. He's just not the type to talk about health stuff—he hates doctors and hospitals—so unfortunately, things had to get this complicated before we even realized how bad it was.
Since you all seem genuinely invested in this, I’d be more than happy to snap a photo of the discharge papers, but I don't want to overwhelm anyone with a wall of medical jargon... Long story short, he's home now and recovering, slowly but surely. 😉 I just wanted to check in and give you all an update—if you remember us—to let you know we got our happy ending. 🙂 Thank God, and thanks to the doctors and everyone else who helped make this happen! 🙂

Just wanted to say how glad I am for you all; that's fantastic news about your dad, and I hope he stays healthy moving forward. 😉

Wishing him the fastest recovery possible. 🙂

Amy King said:God! I’m the second daughter, and I just wanted to let you guys know that my dad actually made it through. 🙂 You all were such a huge help to us, and honestly, hearing from someone who actually knows what they're talking about meant the world during a time when we were totally flying blind. Up until he ended up in the hospital, we thought he was perfectly fine... but it turns out he has a heart defect—mitral insufficiency (I actually have it too, though mine was caught way back when; whenever doctors asked if there was any family history, I’d always just say no, not knowing). When they did his brain CT, they found a 1.5cm ischemic lesion in the frontal lobe, though they couldn't pin down exactly when it happened—whether it was during this hospital stay or something from before. Since the cardiac tests showed the heart issue is an old problem with some scarring already present, it's possible that happened a while ago. He’s just not the type to talk about health stuff; he’s never been a fan of doctors or hospitals, so unfortunately, things had to get this serious before we realized how bad it was.
Since you guys seem genuinely interested, I’d be happy to snap a photo of the discharge papers for you, but I don't want to overwhelm anyone with all the medical details... Anyway, he's home now and recovering slowly but surely. 😉 I just wanted to drop in and let you know—in case you remember us—that we got our happy ending. 🙂 Thank God, and thanks to the doctors and everyone else who helped make this happen! 🙂

🙂.....

I definitely remember you, and I am just so incredibly relieved to hear that things turned out okay for your family. And please, don't feel like you need to bother me with updates unless you want to. I'm just glad we could clear some things up and offer a little bit of guidance along the way. Honestly, what we do is nothing compared to the massive wave of chaos you guys are navigating right now as you try to find solid ground, and any family going through something like this deserves so much respect.
Wishing your dad nothing but the best moving forward, and please give my best to your mom and sister.

Regarding the ischemia... if I had to go by gut feeling, I’d guess it might be a result of everything that went down during this recent hospital stay. But, if I can be a little dark about it—if someone *has* to deal with an insult or ischemia, the frontal region is probably the "best" spot to land. It’s not exactly a win, but most other locations carry much higher risks for all sorts of complications...

Best of luck!🙂

Just wondering—is an amputation under epidural actually doable for someone on blood thinners?

Amy King said:God! I'm the second daughter, and I just wanted to let you guys know that my dad made it out. 🙂 You all were such a huge help to us. It really meant a lot to have someone who actually understands this stuff explain things to us during that time, because we were all pretty much in the dark. Up until he ended up in the hospital, we thought he was perfectly healthy and fine... turns out, they found he has a heart defect—mitral insufficiency (I actually have it too, though mine was caught ages ago. Every time doctors asked if there was any family history, I'd honestly say no, just not knowing!). When they did his head CT, they also found some ischemic damage about 1.5cm in the frontal lobe, but they can't tell exactly when it happened. Whether it occurred during this hospital stay or way before is anyone's guess. Since the heart scans showed the heart issues are an "old thing" and there's already some scarring, it's totally possible it happened earlier. He’s just not the type to talk about health stuff; he hates doctors and hospitals, so unfortunately, things got complicated and led to all of this.
Since you all seem genuinely interested, I'd be happy to snap a photo of his discharge papers, but I don't want to overwhelm you with details... Anyway, he's home now and recovering slowly but surely. 😉 I just wanted to check in and let you know—if you remember us—that we have a happy ending. 🙂 Thank God, and thanks to the doctors and everyone involved! 🙂

It honestly surprises me that mistake wasn't caught sooner. He really needs to see a cardiologist. With a heart defect like that, atrial fibrillation is a real risk. That kind of arrhythmia could definitely be what caused the ischemic stroke.

I was just reading somewhere that I shouldn't be taking pain relievers like Neogen about a week before anesthesia... which is a bit stressful because I rely on it quite a bit to manage some pretty intense pain. My pre-op appointment with the anesthesiologist isn't until three days before the actual surgery, so I won't really have a chance to ask them then. Does anyone know what else I might be able to use for pain relief leading up to the procedure? Thanks in advance...

redpuma26 said:I read somewhere that you shouldn't take pain relievers like Neogen about a week before anesthesia. I rely on it because my pain is just unbearable. My appointment with the anesthesiologist isn't until three days before the surgery, so I won't have a chance to ask them then. Is there anything else I can take for the pain leading up to the procedure? Thanks in advance!

Just stop taking NSAIDs three days before the surgery.