Anesthesia, Resuscitation, and ICU: Q&A

@Taylor Anderson182/">@@Taylor Anderson182
When you're dealing with etomidate, telling the difference between actual seizures and myoclonus just by looking... well, it's tough. Myoclonus is actually pretty common with etomidate, which is why we usually toss in a benzodiazepine—like Valium or Ativan—or maybe some opioids before the etomidate hits, just to smooth out those muscle twitches. Now, etomidate, like most induction agents, inherently has anticonvulsant properties, but there have been documented cases of epi-attacks with it; plus, it’s often used specifically when we need to perform cortical stimulation because it keeps the brain signal quality much cleaner compared to other anesthetics... Basically, it's hard to say for sure, but one thing is certain: convulsions don't really have much to do with an allergy itself. I mean, you shouldn't even have to pay out of pocket for allergy testing unless you're looking at extra participation costs if you don't have supplemental insurance, and if a specialist recommends it, your primary care doctor should be able to handle it without a hitch. That said, a shellfish allergy isn't a dealbreaker unless they're using protamine to neutralize heparin, though the anesthesiologist will definitely keep that seizure info in mind when using etomidate so they can decide whether to pivot to something else instead...

@wiredpanther47/">@@wiredpanther47
Pediatric cases are handled differently than adults, and depending on how old the kid is, things vary quite a bit but what I wrote above ABSOLUTELY you have to emphasize to the anesthesiologist during the pre-op exam. Family history is something that frequently gets overlooked during these checkups, and besides, I highly doubt your wife was being "shocked" awake with electricity—that's just not how it works. It was more likely a TOF neurostimulator being used to monitor muscle function during emergence, which could point to two things: 1) less likely, a colleague administered a slightly higher dose of a relaxant, or 2) more likely, there's a (let's call it) compromised metabolism involved. I couldn't tell you definitively which one it was without seeing the exact drugs and dosages used over time, but some of the conditions that cause excessive or prolonged relaxation are genetic and can be passed down to children. You really need to mention this and make sure it's noted in the records so that whoever handles the child's anesthesia knows to exercise extra caution...

@neonwolf222/">@@neonwolf222
The question is framed incorrectly—to be precise, you're asking in the wrong place. Those kinds of fistulas are sites of chronic infection and bacterial colonization, and if you go through with a prosthesis placement (I assume that's what you mean by hip surgery), those bacteria can colonize the implant and cause massive problems. However, that's really a problem for the surgeon, the orthopedist, who knows way better than any anesthesiologist the risks involved in potentially ruining their work with the hardware they have on hand... So, to answer the question of whether you can undergo anesthesia for such a surgery with an active fistula—of course, the anesthesiologist will coordinate with you to choose the right technique, but as for whether it's actually *advisable* to do it while the fistula is still there... I'm afraid I can't give you a straight answer to that...

@Victoria0
No, there are medications and certain physiological conditions that can mess with your sense of balance, but generally speaking, I'm not aware of any drug currently used in anesthesia that would produce the kind of effects you're describing, certainly not under standard exposure and circumstances...

I have a question for the group; essentially, during a relatively minor surgery that lasted about forty minutes, I experienced something terrifying upon waking. I could see the lights in the operating room and was fully aware that I was coming around, yet I found myself completely unable to breathe. I tried to cry out, to signal for help, but neither my tongue nor my lips would respond—it was as if I were entirely paralyzed. I could hear the doctors telling me to breathe, but the air simply wouldn't come. In a moment of pure desperation, I began thrashing my head from side to side to signal to them that I was suffocating, and only after a few frantic movements did I finally catch my breath. Why on earth would this happen? It has left me profoundly traumatized.
Prior to this incident, I had undergone general anesthesia twice for procedures lasting about an hour each, and I never encountered anything even remotely like this.
Thank you.

There is simply no response🤷

Kevin Garcia12 said:@wiredpanther47
Pediatric protocols usually differ quite a bit from adult ones, and depending on how old the child is, those differences can vary significantly but regarding what was mentioned above ABSOLUTELY you have to make sure to emphasize this to the anesthesiologist during the pre-op consultation. Family medical history is something that often gets overlooked during checkups, but it's crucial. Otherwise, there's no way your spouse was being "woken up by electricity"—that isn't standard practice. It was most likely a TOF neurostimulator used to monitor muscle function during emergence. This could point to two things: 1) which is less likely—a colleague administered a slightly higher dose of the relaxant, or 2) which is more probable—there is a metabolic issue involved. I wouldn't want to jump to any definitive conclusions without seeing exactly what drugs were given, the dosages, and the timing, but some metabolic disorders that cause excessive intensity or prolonged relaxation are genetic. These can be passed down to children, so they really should be highlighted and noted in the medical records. That way, when an anesthesiologist works on the child, they know to exercise extra caution...

Oh man, reading that just made me even more anxious! Honestly, I'd prefer if she could just get it handled at our local clinic, ugh. As for the possibility of an overdose, that actually sounds plausible to me. My husband is an athlete—he's a big guy, about 250 lbs—so maybe they underestimated him and the dose was a bit too much? That’s what I’m really hoping is the case... ://///

Hey everyone, I’m looking for some advice from the group if anyone has a moment.
I'm scheduled for an abdominoplasty—basically a tummy tuck—in just under a month. However, I’ve been doing some reading, and I'm starting to get a bit spooked. Apparently, it can be a long, risky procedure because of the potential for blood clots. I know it's rare, but still, it's out there. For context, I'm generally healthy and don't take any daily meds, but I am a smoker (and I've read I should probably quit smoking and stop drinking herbal teas about two or three weeks before the surgery?).

So, I wanted to see if any doctors here, or even anyone who's gone through this themselves, could give me some perspective on the actual risks? I really started getting anxious once I began falling down the internet research rabbit hole...

says:
Hey everyone, I was hoping to pick some brains here if you don't mind. I'm scheduled for an abdominoplasty—a tummy tuck—in just under a month.
But honestly, I've been doing a deep dive online and now I'm spiraling a bit because everything says it's such a massive, risky procedure. Apparently, there's a chance of blood clots or DVT; I know it's rare, but seeing it written down makes it feel way more real. I'm generally healthy and don't take any meds, but I am a smoker (and I read that I should probably quit smoking and stop drinking herbal teas about two or three weeks before the surgery?).

So, I guess I'm wondering if any doctors in here or anyone who's actually gone through this can tell me what the actual risk level is? I started getting pretty anxious once I began Googling stuff...

Look, every single surgery comes with its own set of risks, plain and simple. Just try not to drive yourself crazy by falling down those internet rabbit holes...

amberpilot8 said:I have a question; basically, during a minor surgery that lasted about 40 minutes, I started waking up and saw the lights in the operating room, and I knew they were trying to wake me, but I just couldn't breathe. I tried to tell them, but my tongue and lips wouldn't work at all, almost like I was paralyzed. I could hear the doctors telling me to breathe, but I just couldn't... then I started shaking my head back and forth really hard to let them know I wasn't breathing, and after waving my head around a few times, I finally caught my breath. Why did this happen? It honestly left me pretty traumatized.
Before this, I’d been under general anesthesia twice for about an hour each time, and nothing like this ever happened.
Thanks!

Don't sweat it, there's really no need for the drama... You might have just struggled a bit with your breathing right after they gave you the muscle relaxant (that's just my guess anyway).

neonwolf222 said:I've been dealing with this fistula near my rectum for over 37 years now. It basically opens up every once in a while and leaks some discharge, which was left over from when I had an abscess cleaned out years ago—it looks like they didn't quite clear the tract completely back then. My doctors told me that trying to go in and clean it out after all this time doesn't have much of a chance of working. Honestly, it doesn't really bother me; it’s not painful, just a little bit of drainage occasionally, so I just stay on top of my hygiene.
The big question is, can I safely undergo hip surgery—like, both hips at once—with this condition hanging around? If Scott Allen10 has a moment, I'd love to hear his take on it, or if anyone else here has gone through something similar.

Kevin Garcia12 gave a killer response... I'm right there with him on that one.

Scott Allen10 said:Every procedure carries risk. Just don't lose your mind scrolling through all that online "info"...

Depends on if you can tell the difference between "information" and actual facts. If it wasn't for the internet, I probably would've ended up disabled despite having a small army of specialists on my side.

The thing is, they simply wouldn't let me access the highly publicized details they chose to ignore...

Scott Allen10 said:There was absolutely no cause for alarm, truly—nothing dramatic to report here. If I may venture a guess, you might have just experienced a bit of respiratory struggle following the reversal of the paralytics. It’s nothing to lose sleep over.

Scott Allen10, Scott Allen10... I honestly felt as though my very breath had been stolen from me; I was on the verge of suffocation.
"My sister didn't just scream, 'She isn't breathing!'" It wasn't some panicked outburst; it was a realization that cut through the sterile air of the room. And how exactly does an anesthesiologist react to a situation like that? To think that someone tasked with maintaining life can be caught off guard by such a visceral moment is truly exhausting.
Despite all that cutting-edge, high-tech equipment they have at their disposal, they still failed to realize I was gasping for air—that I wasn't even breathing.
I wasn't merely flirting around; quite the contrary—it was an exhaustive, drawn-out affair that seemed to persist indefinitely.
I previously navigated two general elections without any significant incident, and everything proceeded quite smoothly.

To build upon my previous point: fundamentally, the patient must remain unconscious.
Until he manages to catch his breath and find some semblance of stability, that's the end of the story. Period.

Look, I’m not gonna sit here and tell you your experience wasn't rough, because I'm sure it sucked... but honestly, I don't think anyone was actually trying to cause any unnecessary chaos. Those issues with waking up and breathing usually just come as a set, but let's be real—in anesthesia, sometimes 2 + 2 doesn't equal 4, and you just end up with a really rough wake-up call here and there. From an anesthesiologist's perspective, though, I'm pretty sure there wasn't any actual malpractice going on... so try not to sweat it too much.
It's kind of like how a pilot can land so smooth you don't even notice, but then a sudden crosswind hits and they slam onto the runway like a rock... hey, at least they landed, right? But yeah, the passengers... they aren't exactly thrilled about that part.

Of course I’m still breathing; there’s really no need for all this unnecessary theatrics.
I am currently grappling with a deficiency in my protein intake, which—if I am being entirely honest—is the solitary reason behind my current predicament; I have spent quite some time researching the matter online to confirm my suspicions.
And I won't even begin to mention the sheer volume of findings on this list. The numbers are simply grim. !!!!!!! Looking at this analysis, I have to wonder—what on earth is happening to the medical profession? It seems like today’s doctors can't even interpret basic findings anymore.

You think low protein intake is why you're waking up in the middle of the night? Honestly, I don't think that's it. There really shouldn't be any reason to go looking for a culprit there.🙂

Of course, we are talking about enzyme-protein interactions and protein-muscle connections; if muscle relaxants used during general anesthesia—which function by blocking muscle activity—fail to wear off once the patient awakens, it is likely due to a deficiency in specific enzymes... or, more realistically, a simple lapse in judgment by the anesthesiologist.

Scott Allen10, oh Scott Allen10... this is information you really ought to have mastered by now.

amberpilot8 said:I have a question; basically, I was undergoing this minor procedure that lasted about 40 minutes, and when I started waking up, I could see the lights in the operating room and knew they were trying to wake me, but I just couldn't breathe. I tried to tell them, but my tongue wouldn't move, my lips wouldn't work... it was like I was paralyzed. I could hear the doctors telling me to breathe, but I just couldn't... so I started frantically shaking my head from side to side to let them know I wasn't breathing, and after thrashing around a couple of times, I finally caught my breath. Why on earth did that happen? It left me totally traumatized... Before this, I’d been under general anesthesia twice for hour-long procedures and nothing like this ever happened. Thanks!div>

It’s likely because the surgery was so short, and they used a relaxant—stuff like rocuronium or vecuronium, which is what most hospitals here in the States use nowadays—where the window from the initial dose until muscle function returns is roughly 40 to 90 minutes... in much longer surgeries, there's plenty of time for the anesthesiologist to see how fast you're breaking down the drugs and adjust subsequent doses or infusion speeds to fit your needs, but with a super quick procedure, you don't really get that luxury...
To put it bluntly—you woke up before your muscle function had fully recovered. You aren't crazy, and honestly, it happens sometimes... while it's obviously better if it can be avoided, it doesn't always go perfectly every single time...
You also have to consider things like laryngospasm or other factors that can block your airway even if your muscles are working fine, but most likely, it was just that the muscle relaxant was still too heavy in your system...

amberpilot8 said:Of course I'm alive, no need for the drama. I'm low on protein, and that's the only reason (according to my Google searches).... not to mention that looking at my lab results, there's this massive red number !!!!!!! on the report, so for God's sake, what is going on with doctors these days? They can't even read their own charts.div>

Plasma protein levels might play a role, sure, but they aren't the smoking gun in a situation like this. It's quite simply that either too much medication was administered or there just wasn't enough time for your body to metabolize it... though, one could argue why the protein levels are low in the first place—whether it's an isolated issue or tied to broader organ dysfunction, since both the liver and kidneys are heavily involved in processing and clearing drugs from your system... 🙄

amberpilot8 said:Look, you’re talking about enzyme-proteins and muscle proteins, but if they’re using muscle relaxants to block movement during general anesthesia and the patient wakes up while the relaxant hasn't kicked in—or rather, isn't working anymore—it's likely because the relaxant wore off too soon due to a lack of enzymes... which basically points back to some oversight by the anesthesiologist.

Scott Allen10, oh man, Scott Allen10... you really should have known better than to think that...

This actually has nothing to do with muscle proteins and everything to do with albumin and alpha-acid glycoproteins, which act as carriers for drugs in the bloodstream; and as for the "overdose" theory—maybe, I guess, though we generally know what initial dose is administered during anesthesia, and if that dose is too much for that 40-minute window then it's too much, but maybe they should have waited a bit longer or given a sedative so the patient wouldn't even remember the sensation, but honestly, regulating it that precisely isn't exactly... 🤷

Regarding the negligence part, I can't really comment since I wasn't there, but the doctor could have been busy with something else while the technician was supposed to be watching the patient, which is obviously what should have happened...

As for the equipment, if you're disconnected from it and the breathing tube is out, there's zero point in looking at the machine; at that stage, the only thing that matters is watching the patient... ☕

wiredpanther47 said:Oh my god, I got even more terrified, I'd honestly prefer if this could just be done under local anesthesia, ugh, but this whole overdose thing seems possible because my husband is an athlete, he's huge, like 115kg, so maybe they underestimated him and it hit him harder than expected, which is what I'm really hoping is the case ://///

I don't know, with an "instant overdose," it usually works the other way—you give too little and the effect isn't right, but it is possible they gave too little initially and kept adding more, so it's hard for me to say for sure, but regardless, I'll stick to saying that if the surgery is necessary, then it's necessary, and you shouldn't lose sleep over whether something might happen, though kids aren't exactly prime candidates for local anesthesia, especially little ones; I spent a fair amount of time in ENT and never saw major issues with kids, but like I said, there are certain genetic factors you always have to watch out for...

Amanda Perez42 said:Hi everyone, I wanted to get some advice from people here, so please help me out. In less than a month, I'm scheduled for an abdominal wall reconstruction, basically a tummy tuck.
However, I've been reading that it's a long and risky(?) procedure because of the possibility of developing venous thrombosis, which is apparently rare but still happens. Otherwise, I'm healthy, I don't take any meds, I am a smoker (I also read I should stop smoking and drinking herbal teas two or three weeks before the surgery?), etc...

So I was wondering if any doctors here or anyone with personal experience could tell me how risky this surgery actually is, because I've started getting really scared ever since I started researching online...

It carries about the same risk as any other abdominal surgery, maybe slightly more if they have to close it "under tension," which increases pressure in the leg veins due to higher abdominal pressure and slows down blood flow, plus the fact that you might have to stay lying down longer (because they insist you don't get up or strain too much so the plastic doesn't rip), but it's not significantly higher than any standard surgery of that type; standard high-risk prophylaxis should be plenty sufficient as long as you don't have serious underlying clotting issues...🤷

Kevin Garcia12 said:It is most likely because the procedure was incredibly brief, and they used a relaxant—specifically things like rocuronium or vecuronium, which are the standard go-tos in American hospitals today. Following an initial intubation dose, muscle function typically takes anywhere from 40 to 90 minutes to fully recover. In the case of a much longer surgery, there would be ample time for those relaxants to break down, allowing the anesthesiologist to observe how quickly you metabolize them and adjust subsequent doses or infusion rates accordingly. With a very short operation, you simply don't have that luxury...
In plain terms—you regained consciousness before your muscle function had completely returned to baseline. You aren't losing your mind; this does happen occasionally. While it is certainly preferable to avoid it, perfection isn't always guaranteed in clinical practice...

Laryngospasm or other physiological factors could also play a role in obstructing breathing despite having adequate muscle strength, but most likely, the relaxant was the culprit...

Plasma protein levels might play some minor part, but they are hardly the deciding factor here. It is quite simple: either too much medication was administered, or there wasn't enough time for the body to clear it. One might argue why plasma protein levels were low in the first place—whether that is an isolated issue or tied to broader organ dysfunction involving the liver and kidneys, both of which are central to drug metabolism and excretion... 🙄

This isn't about "protein-muscles," but rather proteins like albumin and alpha-acid glycoproteins that act as carriers for drugs in the bloodstream. As for the possibility of an overdose—perhaps. We generally know the initial induction dose, and if that dose is excessive for a 40-minute window, then it is excessive. Perhaps they should have waited a bit longer or administered a sedative so you wouldn't remember the ordeal, but can one regulate it with such surgical precision? Not exactly... 🤷

Regarding the claim of negligence, I cannot comment on that since I wasn't there, but it is entirely possible the doctor was occupied elsewhere while the technician was focused on you—which, by all accounts, they were...

As far as the equipment goes, if you are disconnected from it and the breathing tube has been removed, the machine is essentially useless to you in that moment; the only thing that matters is watching the patient... ☕

rolling eyes, sipping coffee, I don't know... I fail to see the point of these little emoticons.
Am I crazy? Certainly not.

I received a dose of hydrocortisone because, given my prolonged use of corticosteroids, they assumed my adrenal cortex function was suppressed.

Essentially, provided the anesthesiologist was fully briefed on the patient's overall medical status—which they should have been through the provided records and our conversation—what happened should never have occurred.

And all of this could be prevented if we prioritized establishing stable breathing before attempting to wake the patient. Why is that not the standard protocol??

Look, waking up from anesthesia while the muscle relaxants have completely worn off and you’ve still got a breathing tube in your trachea carries its own set of serious risks...

And let’s be real, it isn't always possible to perfectly "target" the exact duration of the drugs, especially when you're dealing with procedures that are either incredibly long or extremely short...

Plus, your overall health profile might not have signaled any specific red flags for risk, and even if there was a complication (which I don't know the specifics of), that doesn't automatically mean the procedure could have been handled in some fundamentally different way...

I honestly don't get why you're being so hostile in your posts and digging your heels in like this; if you truly believe the treatment wasn't adequate, you're more than welcome to take it up in court to seek damages, but if you're just looking for someone here to validate your belief that a mistake was made—you aren't getting that from me, especially not with such a vague and half-baked description of what happened. Without seeing your full medical records and knowing exactly what "proteins" or additional underlying conditions we're talking about, there is absolutely no way for anyone to judge whether the doctor should have known better, let alone whether the outcome could have been avoided...

So, there it is...

And the emojis are just there to emphasize my point...

I have always had a deep appreciation for precision, which is why I find myself leaning toward the answers provided by Scott Allen10; however, I am not searching for a scapegoat here. Perhaps you are simply overthinking things—though I suspect you shouldn't be carrying such trauma—but frankly, some of your responses feel somewhat dismissive. It makes one wonder if you and Scott Allen10 actually possess the medical credentials you claim, because this tendency to categorize patients as uneducated or completely oblivious to the truth is quite telling. To be blunt, you leave patients feeling insecure and ignorant, which only serves to fuel further fear and distrust.

I am not looking to point fingers or pass judgment; my sole intention is to obtain a plausible, realistic explanation for why this occurred.

Given the nature of my condition, it was imperative that I be under the care of a highly experienced anesthesiologist. That is exactly what was sought and secured. Every doctor involved in my surgical preparation, along with the entire medical team, operated under the shared belief that my safe awakening was the absolute priority. And yet, despite all that preparation, something senseless and entirely unnecessary happened.

But regarding what you just wrote to me;

"Because waking up from anesthesia while muscle relaxation has been fully reversed and you still have an endotracheal tube in place carries its own set of risks..."

And then there is the point that it isn't always possible to "hit the mark" regarding duration, especially during procedures that are either extremely long or incredibly brief...

All of this tells me just how unreliable the whole process can be, though I remain convinced that if a physician truly possesses both the knowledge and the experience, they should be able to prevent such a failure to breathe from ever occurring.

If you are truly as well-versed in the various scenarios that could lead to such a state as you claim, then I urge you to conduct all necessary analyses and reviews. For you, this might just be one more case in a long line of patients, but for us, the patients, it is an immensely unnecessary and harrowing ordeal.

Of course it’s unreliable... for certain drugs we still use daily in anesthesia, even today we don't fully grasp the exact mechanism of how they produce their effect, so we just rely on "educated guesswork." Besides, trying to give medical-grade answers to someone outside the profession—especially regarding an area as obscure as anesthesia—is incredibly thankless work... Even many colleagues who are brilliant in their own specialties have no clue about it beyond what they picked up in med school (which is minimal), particularly when it comes to general anesthesia versus local stuff which isn't even remotely related...

The reason we don't treat patients as if they're just ignorant or incapable of handling the truth isn't because we view them as simpletons; it's about the nature of the profession itself. To illustrate, I could sit here and write several pages of A4 text from memory about muscle relaxants, their interactions with other drugs used during induction, maintenance, and emergence, or the effects of various common and rare conditions... but that would be totally irrelevant to this topic and wouldn't be useful to anyone. By the way, I don't consider myself some massive expert—just compared to someone who actually is—and you’re more than welcome to have your opinion of me or anyone else, since opinions are free, but the idea that a layperson could truly grasp the (patho)physiological relationships at play in anesthesia is just insane... especially if that opinion is based on some quick, unstructured Google search in a field that is still largely built on speculation... Personally, I think it's great that you're interested in your own health, and when I conduct interviews, I always try to answer questions if there are any; sometimes a patient actually knows more about their condition than I do, especially with rare diseases, but expecting someone to explain EVERY single aspect of every possible outcome and every conceivable complication is just unrealistic...

Generally speaking, the lab tests and screenings done preoperatively are pretty standardized; a specific disease or condition will trigger a set number of additional tests, much like how it carries a certain percentage of risk for one complication or another. The tests ordered in any given case are limited by the cost-benefit ratio relative to the probability and severity of a potential complication. For instance, the standard battery of tests is sufficient for 99% of the population, but for that 1%—those who aren't quite "on the Gauss" level, so to speak—they might be inadequate, and a complication could happen because of that. Some adverse events will be managed by a doctor's experience, while others won't, whether it's because they couldn't, they missed it, or they didn't account for it...

Basically—running "full panels" on every single patient for every possible contingency is both impossible and unjustifiable, both from the perspective of the American healthcare system's finances and for the patients themselves... Just look at it this way: even now, people wait through "dozens of exams" before a surgery; imagine if we had to run ten times more tests at multiple facilities just to prevent maybe one less adverse event out of every 1,000 anesthesias—an event that ultimately wouldn't even impact the patient's health...

Now, let's be clear: based on what's been described, my assumption is that an excessive dose of relaxant was likely used, as that's the logical conclusion, but whether that could or *should* have been avoided is something I can't judge. There are far too many possibilities for drug interactions and reasons why things went wrong to make a definitive statement. Obviously, it would have been better if everything had gone "smoothly," but an adverse event happened. On the flip side, over-sedating a patient just to wipe away any trace of memory regarding their time in the OR is also unjustified and dangerous—a huge number of drugs used for that purpose have effects lasting several hours under normal circumstances, and especially when metabolism is slowed or multiple drugs are given simultaneously. You could end up "stuck" for an hour in the recovery room with nobody around to watch you or hear you scream... I think you get the idea of how that ends. Again, it all comes down to the clinician's experience in trying to "tailor-make" the anesthesia for every individual patient...

Edit:
By the way, just so we’re clear—hospitals here in the States don't always carry every single anesthesia drug on the market, and they certainly don't have enough stock to support some idealized version of "patient choice" where you get exactly what you want regardless of the circumstances. So, when people talk about how "titrating" medication shouldn't happen because it's supposedly bad practice, that logic falls apart pretty fast when you look at the reality of American healthcare... It’s easy to say the dose should be perfectly tailored to the situation, but if my only option for pain management is a drug that lasts at least an hour, and I don't even have the one that lasts ten or thirty minutes in the cabinet, then my choices are basically limited to letting you suffer or risking complications during emergence... It's a choice between two evils, really. You tell me which one makes more sense...

The procedure was initially postponed because they were completely out of anesthetic supplies; then, when they finally called me back, they claimed to have just a tiny bit on hand—so a few of us patients who happened to have the right "connections" just squeezed ourselves in. As for what they actually used and the quality of those drugs... well, let's just say you don't get that kind of service in a standard American hospital.

I realize that we laypeople shouldn't presume to dive into such complex medical territory, but when it comes to calculating risk, we really ought to understand certain fundamental factors before deciding whether to pull the trigger on a procedure like this. Unfortunately, it seems we're forced to learn through trial and error, because due to the sheer lack of time and dedicated patient care, we're left to scavenge for information online. I’ve had my fair share of both positive and negative encounters with doctors; there were even times when I felt I was essentially performing my own life-saving surgery through sheer self-diagnosis. It is an incredibly daunting thing, handing over your very existence to someone else's hands when you know absolutely nothing about the disease or the treatment being administered.

And I certainly didn't realize that anesthesia could be quite that damn complicated; now, I have a much clearer, albeit sobering, understanding of the reality.

My thanks to you for providing such an exhaustive explanation.