Anesthesia, Resuscitation, and ICU: Q&A

Kevin Garcia12 said:Edit:
By the way, just a heads-up—American hospitals don't always stock every single anesthesia drug out there. They definitely don't have enough variety to allow for that kind of "personalized choice" based on what a patient wants. So, the idea that certain dosing shouldn't happen—which might be a reasonable assumption if you could tailor everything perfectly—just doesn't hold up in the reality of our healthcare system. If my only option for pain relief is something that lasts at least an hour, and I don't have access to the stuff that lasts 10 or 30 minutes, I'm stuck. I either let you suffer or risk complications during waking... Pick your poison, I guess...

In that case, is there any scenario where the anesthesiologist does a pre-op check and tells the patient: "Look, given your medical history and the type of surgery, we really need drugs X, Y, and Z, but the hospital doesn't have them in stock. Do you want to go buy them and bring them in before the procedure?"

amberpilot8 said:It’s all about that enzyme-protein connection and how it drives muscle function, right? If you're using muscle relaxants during general anesthesia to shut everything down, but then the patient wakes up and those relaxants haven't worn off yet—it’s likely because there was some kind of enzymatic deficiency or just a breakdown in the process. Honestly, it usually just comes down to a slip-up by the anesthesiologist.

Scott Allen10, man... you really should've seen this coming.

☕.....

I mean, there’s no way you’re actually trying to lecture me or "test" my knowledge based on some random Google searches... especially when we're talking about anesthesia protocols and those endless, messy interactions where everything affects everything else. Don't get mad at me, but honestly, it feels a little unprofessional. I was genuinely just trying to help you out earlier, man.

edit
I just realized that Kevin Garcia12 really went all out with that breakdown...

crimsongull20 said:Is there any scenario where an anesthesiologist does a pre-op checkup and just tells the patient, "Look, because of your specific diagnoses and how complex this surgery is, we really need drugs x, y, and z, but our hospital doesn't stock them. Would you mind picking those up and bringing them in before the procedure?"

Nah, that’s just not how it works. Especially not when you're dealing with anesthesia.

amberpilot8 said:They pushed my surgery back the first time because they were totally out of anesthesia supplies, and when they finally called me back, they said they had just enough to squeeze us in—a few patients who apparently had some kind of "connection." As for what they actually used and how good it was... let's just say it wasn't exactly top-tier American healthcare.

Look, I'm sorry, but where on earth were you getting this done? There is no way a hospital can just be "out of all anesthesia drugs," for crying out loud! Or that they have "just a little bit" and then somehow "squeeze in" a few people... those excuses just don't hold water; they sound completely nonsensical and bizarre. Honestly, it reminds me of those sketchy surgeon excuses I've heard before where they always blame the anesthesia because it’s the easiest way out...

In the US, even if you're talking about a tiny rural clinic, every single hospital keeps their anesthesia supplies and necessary meds stocked at all times. Sure, they might not have every single niche brand, and maybe one thing is running low while another is plenty, but they always have the essentials. So, please, let's not spread misinformation here.

amberpilot8 said:Given how tricky my situation was, I really needed a top-tier anesthesiologist, and thankfully, we found one; honestly, my whole surgical team felt like having an expert on hand was the absolute priority just to make sure I woke up okay, but then everything just went sideways because of some totally unnecessary mistake.

I honestly feel like there’s a bit of unnecessary drama going on here, and if I'm being real, I'm pretty sure a standard anesthesiologist would have handled your case just fine without any major hiccups.

amberpilot8 said:The surgery was postponed the first time because they didn't have any anesthesia supplies at all, and then when they called me back the second time, they claimed they had just a little bit left, so a few of us patients who had some kind of "connection" managed to squeeze in. But honestly, what they actually had and the quality of it... let's just say it wasn't exactly top-tier American standards.

It’s strange to think they wouldn't have anything unless we're talking about some tiny private clinic that doesn't usually handle general procedures, which would mean they had to scramble to organize everything, and if that's the case, it might explain why things went sideways... if the selection of meds was incredibly limited, even the best anesthesiologist is going to find themselves in a tight spot regarding how long the drugs last and all that...

amberpilot8 said:I get that we laypeople can't really dive into such deep technical territory, but when it comes to calculating risk, we really need to know certain basic factors to decide whether to go through with something like this or not... unfortunately, right now we're only learning through trial and error because there's a lack of time and dedicated patient care, so we have to go looking for information online ourselves.

Dedication is dictated by external circumstances—the sheer number of people waiting in line, or the fact that someone has another job on the side; otherwise, you might be surprised to learn that most people don't even want to know too much about these things, so those who actually do want to know need to ask directly to get straight answers, and obviously, you shouldn't wait until two minutes before they start the pre-op exam to have that conversation...

amberpilot8 said:I've had both negative and positive experiences with doctors, including situations where I basically had to save my own organs through sheer intuition. The hardest part is handing your life over to someone else when you know absolutely nothing about the disease or the treatment itself.

I know, it's especially hard for people when it comes to anesthesia where you lose consciousness and control, but that's just how it is; once you lie down on that table, you're putting your life in my hands, and it all boils down to whether you trust that I know what I'm doing and that I'll do everything humanly possible to ensure you wake up without complications...

Most of the time we succeed, sometimes we don't...

amberpilot8 said:And honestly, I had no clue anesthesia was such a massive headache until now, but I definitely get the gravity of it all...

Thanks for laying everything out so clearly for me.

Don't mention it...

crimsongull20 said:In that scenario, is there any chance an anesthesiologist could just tell the patient after the pre-op exam, "Look, because of your specific diagnoses and the nature of this surgery, we really need drugs X, Y, and Z, which the hospital doesn't carry. Would you like to buy them and bring them in before the procedure?"

No way. Even with standard hospital medications, the whole concept of "bringing your own supplies" is a logistical nightmare in the US medical system, so in a situation where everything being used is either administered strictly by the doctor or is on a controlled substance schedule, it’s basically impossible... plus, when you get into anesthetic gases, you have to deal with manufacturer-specific formulations and all that technical stuff...

The only real move is to hope the hospital is well-stocked and try to schedule things for the middle part of the month—not right at the beginning when everyone is scrambling—because that's usually when they actually have "everything" they're supposed to have...

Kevin Garcia12 said:It’s quite peculiar to suggest they wouldn't have any supplies unless we were talking about some tiny boutique clinic that doesn't typically perform these procedures and had to scramble to organize everythingbut even if that were the case, it might explain the complications that arose; if the selection of medications available was extremely limited, even the most elite anesthesiologist could easily find themselves in a precarious situation regarding the duration of effects and such...
One's level of dedication is often dictated by external pressures—the sheer volume of patients waiting, or other responsibilities one must attend to. Otherwise, you might be surprised, but most people simply don't care to know the gritty details, which is why those who actually want answers ought to ask them directly; naturally, this should happen during the preoperative consultation, not two minutes before the procedure begins...
I understand that for many, the idea of anesthesia is deeply unsettling because you lose consciousness and all sense of control, but that is simply the reality of it. When you lie down on that table, you are placing your life in my hands; it all boils down to whether or not you trust that I know what I am doing and that I will do everything humanly possible to ensure you wake up without lasting consequences...

Most of the time we succeed; occasionally, we do not...

Don't mention it...

.

I sent you a private message regarding this matter.

It is highly probable that the anesthesiologist had to squeeze every bit of potential out of minimal resources, especially considering he is truly one of the oldest and most seasoned doctors on staff.
Furthermore, one must question the quality of those anesthetics, because all three of us in the room ended up complaining about the exact same pains afterward—stomach issues, aching legs, aching arms—even though the surgery had absolutely nothing to do with those parts of the body.

Thanks so much for all the help! 😍
Just one more thing—what’s the standard prophylaxis used for high-risk cases?

When people talk about "low molecular weight heparin," they're usually referring to taking Fragmin 5000 between 5000 and 7500 units once a day, or maybe splitting up 2500 units into two doses... or even using things like Clexane, Fraxiparin, or Arixtra at the appropriate dosages. If you look at the medical literature over here in the States, it's pretty common to manage this with Warfarin too, but that just isn't how we typically do things around here...

Do you think the anesthesiologists at the hospital where I'm scheduled for surgery might give me a hard time if my pre-op exams were done somewhere else?
And seriously, why do I need to redo my blood type and Rh factor testing at Mayo Clinic if I’ve already had X surgeries and have the paperwork on hand? It's not like those things change in two months. Can someone explain why they insist on having results specifically from the Mayo Clinic facility?

It’s actually pretty funny how every hospital seems to have its own little "personality" when it comes to lab results... they all want things done their way. You know that annoying "let's just run the tests again from scratch" philosophy? Yeah, it pops up more often than you'd think.

So, the first scenario is definitely possible, though it really just depends on which hospital you're dealing with... but the second part shouldn't actually matter. I'm talking about the crossmatch and the blood type specifically. Even so, there's no harm in them drawing blood for a transfusion if they need to check for interactions or prep specific units, just in case things take a turn and you end up needing them...

Look, like my colleague was saying, the whole point isn't really about the blood type or the blood itself, it's more about the fact that when you're sending samples over for a transfusion during a T&S procedure or if there's some kind of interaction happening, they run a routine blood group check anyway, regardless of whether they already have those records on file from before...

As for Petrov, I honestly don't see any reason why he’d need to be from there, nor is there any actual advantage to that at all...

Regarding the "clearance" for surgery—I mean, hospitals do recognize those clearances from outside facilities to varying degrees, but most of the time, local anesthesiologists are still going to insist on doing their own assessment and actually talking to the patient, and frankly, most of those outside clearances don't even include specific "premedication" orders because every single hospital system has its own preferred drugs and dosages...

Thanks for the feedback. I checked, and it turns out I have to get my pre-op done at the same hospital, and they didn't really give me a clear answer regarding the KG or the US medical protocols. Since the risk level is low, they aren't planning on any blood doses for the surgery, so... yeah. One extra referral is what it is. Thanks again.

Hey everyone

So, here’s the deal: I’m heading in for thyroid surgery under general anesthesia in two weeks. I’ve scrolled through this thread to get a rough idea of the whole process and what to expect...

I’ve been under general anesthesia twice before, but both times they used an induction mask—which was honestly terrifying. Last time, I actually went into shock from it. My anesthesiologist mentioned that can happen with those inhalation methods, so she told me this time I’ll be put under via IV instead (NO MASK, they just intubate me after). Since I’ve never experienced IV induction before, can anyone walk me through how it actually goes down? If I’m freaking out big time, how fast am I going to drift off? And what does it actually feel like right after they inject the anesthetic?

I would seriously appreciate any insight
I'm terrified 😢

Thanks, and cheers to you all

Speaking from experience, it was fine for me. They give you the anesthetic through the IV, you count down to five if you can actually manage it 😁, and then after a few seconds, I got that sensation in my lungs—kind of like inhaling eucalyptus airway spray—and I was out cold. When you wake up, your throat might be a little sore from the intubation, but that’s about it. At least that was my experience; it was totally positive. I didn't feel any pain because they hit me with enough Tramadol to make me feel great 😁 😁 😁 I wish it could be like that again...

hollowmoose75 said:what does it generally feel like once you get hit with an anesthetic?

Nothing much—everything just goes dark immediately. 😁

Linda Perez50 said:Nothing. I’m seeing straight-up black spots right now. 😁

Yeah, that’s exactly how it went down.

I had surgery three days ago, and this morning they hit me with Solu-Medrol and Synopen in my IV—not even sure why they thought I needed that combo. Then they followed it up with 7.5 mg of Dormicum, and man, that completely wiped me out. I am absolutely trashed.

So, they stuck me with this massive needle in the OR because I had a TIA, and the whole surgery dragged on for five hours. After the first injection, I felt nothing. But then they hit me with another 20 mg of that stuff—not Propofol, mind you—and suddenly everything went sideways. Next thing I knew, I was waking up in the ICU, where I spent the next 24 hours. Honestly, they couldn't even get me standing up by the following morning; the anesthesia had me spinning like a top. My surgeon actually told me I was acting so out of it that he felt awkward just being in the room with me. 😢 😢

I have undergone general anesthesia three times so far, along with several instances of local anesthesia; twice during my childhood and once at the start of high school. This coming Tuesday, I am heading to the surgeon for a consultation regarding the removal of an 8mm mole that has shown some concerning changes. It is located in a rather tricky spot right above my heart, and since I am on the leaner side with bone situated directly underneath, what kind of anesthesia would be most appropriate for this procedure? If they decide to go with general anesthesia, does the fact that I’ve already had three prior procedures under general anesthesia matter? Does having that history increase the likelihood of any complications?

Honestly, I don't see any real reason why anyone would bother putting you under general anesthesia for such a minor procedure. It doesn't matter if you're on the leaner side, and that whole "above the heart" thing is just overthinking it—we're talking about something superficial on the skin here. You just get some local lidocaine to numb the area, a quick incision, a few stitches, and you're done with it.

neontinker5 said:So far, I've been under general anesthesia three times, plus a few rounds of local; twice back when I was a kid and once right at the start of high school. This coming Tuesday, I’ve got a surgical consult for some moles—one is about 8mm and showing some suspicious changes. It's in a pretty tricky spot right above my heart, and since I'm on the skinnier side with just bone underneath, what kind of anesthesia are they actually going to use? If they decide on general, does the fact that I've already been under three times change anything... like, does it increase my risk for complications?...

The likely call is local anesthesia, though they might consider general if that growth is stuck to the bone and they practically have to "grill" the area... having been under anesthesia a few times before doesn't inherently spike your risk for problems. There is always a tiny possibility of developing a sensitivity to one of the drugs used, but unless you have other allergies, it's almost negligible. Honestly, having had several successful procedures without any issues is actually a good sign to the anesthesiologist; it suggests there aren't any glaring red flags hanging over your head like there might be when someone is stepping onto the table for the very first time...