Anesthesia, Resuscitation, and ICU: Q&A

Hey there, new girl on the forum! To keep it brief—call me Jeremija, or just the English version, since someone already snatched my first nickname. I ended up going by Jeremija because it feels like I'm constantly heading into surgery. One minute the doctors aren't telling you much, and the next, you're scrambling to save your own head.
Think of me like a bunch of used parts—kind of like nuclear waste in half-decay. There’s still some radiation left, but I’m not a threat to the environment😛... Anyway, I really need someone to help me make sense of this. Between all my old discs, kinetic joints, and leaky seals, my transmission is officially shot. I have an upcoming surgery scheduled at Mayo Clinic, but get this—the anesthesiologist turned me away because of an ear infection.🙂 It's nothing crazy, except for the fact that I've been dealing with issues in both ears due to chronic mastoiditis for years. All my swabs come back clean, my CBC and CRP are sitting at 2.8, and allergy tests are negative. Yet, every three months, it's one antibiotic after another. I just finished two boxes of Sumamed and a round of Klavocin. Even after seeing several ENT specialists, nobody can figure out why my ears are inflamed and hurting; they just shrug their shoulders. The only thing that actually showed anything was an MRI confirming the chronic mastoiditis. How much of a real risk is intubation and anesthesia when you consider the tube, the Eustachian tubes, and everything else? And what am I supposed to do when I've been sniffling all year and my ears have felt like this almost constantly?🙂

Look, having any kind of infection lingering in your system when you're heading into surgery is never a good thing. It’s not just about the intubation—that’s a minor headache compared to the other complications waiting in the wings. At the end of the day, it all comes down to the clinical assessment... weighing whether the necessity of the procedure actually outweighs the massive risks involved...

Look, I know this isn't just some run-of-the-mill cold, but honestly? Hearing an ENT claim they've "never heard of" someone being held back from surgery because of an ear infection is just wild. Where on earth did that guy go to medical school? 🤣/It wouldn't be such a massive headache if I wasn't stuck in this endless cycle. It flares up for months, goes quiet for a month, and then boom—just as I finally get my surgery date confirmed, everything resets to zero. 🙂

Honestly, they really ought to swap out that ENT specialist because he clearly doesn't have a clue when it comes to peri-operative management; if he did, he’d realize we’re constantly pulling people off the surgical schedule due to respiratory issues and other infections—including ear infections—on a daily basis, especially when dealing with elective procedures...

Since I don't know the exact diagnosis, the specific reason for the surgery, or any of the gritty details regarding this particular ear infection, I can't really judge why my colleague made that call, but personally, I’d probably just clear you for surgery without making a scene, no matter what's going on in that ear, provided you sign a specific waiver acknowledging that proceeding with an untreated condition could lead to complications ranging from severe disability to death...

Yeah, that’s exactly what I was thinking... Thanks.😂 He’s a specialist, dealing with PTSD, which is why they assigned him his own clinic. And me? I just seem to stumble into experts everywhere. Like I said before, I’m going to write a book—something slim, but packed with gems...

I’m writing this because I saw a news story about a surgery performed a few days ago in that new operating room over at Mount Sinai. It was pretty specific—the patient stayed awake through the whole thing.

The main things I'm wondering are: given how far medical tech has come, can any surgery actually be done without general anesthesia? And if so, is that something only possible in high-end facilities (like that new unit at Mount Sinai), or could any hospital pull it off?

I actually have a procedure coming up myself. I mentioned to my anesthesiologist that I'd really rather skip the general anesthesia—maybe it's just irrational caution on my part, I guess—but she basically told me that while "any surgery can technically be done under local anesthesia," doctors prefer general because it's just easier and more comfortable for everyone involved.

Then I asked the surgeon if local anesthesia was an option, and he just looked at me like, "Don't be ridiculous."

So, who's actually right here?

I get that general anesthesia is more pleasant—mostly for the patient, but also for the surgical team—but why shouldn't a patient have the final say on how they're treated, assuming it's medically feasible?

Neurosurgery combined with awake anesthesia is a pretty niche field, and I won't get bogged down in the technical weeds right now because it wouldn't make much sense to anyone else—it’s done more for specific clinical necessities rather than just keeping a patient conscious for the sake of it. Even within "awake" procedures, there are different variations where a patient might be asleep during certain phases and awake during others, so it’s not always constant wakefulness, though when we say "awake," we mean the patient doesn't lose consciousness entirely...

Regarding local or regional anesthesia and general procedures—yes, you can perform most standard operations using one of those methods, provided you keep in mind that they carry their own set of risks and potential complications. To give you a straight answer, I’d need to know exactly what procedure we're talking about, but aside from massive, complex surgeries involving the chest, major blood vessels, the heart, or deep abdominal work, you can almost always find a way to manage if the patient stays conscious...

In my opinion, whenever it's feasible, the patient really ought to be fully informed about their anesthesia options and any possible complications; they have a fundamental right to participate in deciding how the procedure is handled through consultation with both the surgeon and the anesthesiologist. An operator's or anesthesiologist's personal comfort isn't a valid reason to force a specific type of anesthesia on someone, but then again, if I, as a surgeon or an anesthesiologist, don't feel comfortable performing a procedure under certain conditions, that's also my right and I can refuse to proceed...

Look how Scott Allen10 breaks it down perfectly:

But what do you even do with those geniuses who think "just rest" isn't enough? They go out and light up a cigarette, then come crawling back swallowing painkillers because their head is absolutely splitting.
Someone needs to explain to them that the real culprit behind that headache is Gravity. Because of gravity, you get this pressure drop in your skull because the CSF leaks out through a tiny little needle hole. And that hole is the problem because it didn't hit the right spot immediately—it went rogue and made a bigger tear in the dura mater. Which, by the way, is also to blame because it isn't elastic enough to snap shut the second the needle pulls away. Plus, maybe the CSF should be a bit more self-contained instead of being so damn curious and trying to squeeze through every microscopic gap it finds.
So, for you smart guys—say, after something like "transurethral resection of the prostate under spinal anesthesia"—for the love of God, don't lift your head above your waist. You'll get hit with a hellish headache. Just bury your head at the lowest point of the hospital bed and stay there. Then you can sit there and obsess over how unfair life is all you want.

hm... posted this nine years ago... damn, has it really been that long?.....🤔....yeah..... looks like it.....😢......

Looking back at the actual medical stuff compared to how we do things now.... let's just say anesthesiologists nowadays lean a bit more toward epidurals (though just by a hair).... and a big update since then is the move toward combined epidural-spinal techniques where you get both options in one kit... basically, you'll perform a single-shot spinal first, then drop in the epidural catheter to keep titration going.....

As for those massive headaches, they aren't super common and don't happen to every "genius" out there... but when they do hit, honestly, no amount of painkillers is going to touch them.... there was a period where we tried doing "blood patches," but that didn't exactly take off as a standard, so I can't even remember the last time someone actually pulled that off. The whole idea was to draw blood from a vein and inject it into the spinal space so the blood—with all its platelets and everything—would essentially "plug" the puncture site.... mostly felt like a waste of time, though....

....9 years.... mmm.... man...

What’s the deal with using Dormicum for anesthesia? My kid needs to undergo a gastroscopy under Dormicum via an IV in the arm.
What should I realistically expect? Is there a genuine chance they’ll just drift off, feel absolutely nothing, and have no memory of the whole thing?

bolddriver12 said:What’s the deal with using Dormicum for anesthesia? My kid needs to go in for a gastroscopy under Dormicum via a line in the collarbone area. What should I actually expect? Is there a real chance they’ll just sleep through the whole thing without feeling a thing or even knowing what happened?

It’s excellent. It kicks in fast, and once they stop the drip, they usually wake back up pretty quickly without much trouble in most cases. Plus, the doctors have total control over it, and patients generally handle it quite well. Any anesthesiologist—or honestly, any doctor trained in emergency medicine—can run this procedure smoothly. Everything should go perfectly fine.😉>

Will I feel like I'm choking, or will I get that awful sensation you get during a gastroscopy? Or does one just drift off to sleep?

bolddriver12 said:Will I feel like I'm choking or get that awful sensation from a gastroscopy? Or will I sleep?

Usually—you're out cold.
Like a little baby 😉

Thanks so much, really appreciate it 🙂

I just found out it comes in a syrup form—does that actually change anything?

bolddriver12 said:I just found out they give it to him as a syrup. Does that change anything?

No.

Hi everyone. I had general anesthesia about 7 or 8 years ago and everything went fine, but for the past year, I’ve been dealing with hives and can't figure out the cause. If I take an antihistamine, I'm mostly okay, though a few spots might pop up. However, if I skip my medication, I break out in a massive rash and sometimes experience swelling. I've been planning a procedure for a while now, but I keep postponing it because of this allergy, even though it could last for years. Is it safe to undergo the procedure while on antihistamines (or if they add something extra to the anesthesia for safety)? Has anyone dealt with this before?
Thanks in advance.

Jacob Stewart11 said:Hey everyone! So, I had general anesthesia about 7 or 8 years ago and everything went perfectly fine, but lately, for about a year now, I've been dealing with this mystery urticaria that I just can't pin down. Everything stays under control if I take an antihistamine—maybe just a stray spot or two pops up—but if I skip the meds, I end up looking like I walked through a patch of poison ivy, sometimes even with some swelling. I've been planning on having a procedure done for quite a while, but I keep putting it off because of this allergy, and honestly, since these things can drag on for years, I'm a bit stuck. Is it actually safe to go through with the surgery while taking antihistamines (and maybe whatever else they might add to the anesthesia cocktail just to be safe)? Has anyone dealt with this before?
Thanks in advance.

The anesthesiologist will have the answer.
Just bring all your medical records along to your pre-op appointment so the anesthesiologist can review everything. Any decent specialist will know exactly how to handle it to make sure everything goes smoothly and safely. 😉

Casey Campbell said:I was heading in for surgery and mentioned to my anesthesiologist that I’d much rather avoid general anesthesia (maybe it's just irrational caution, but still...), and she responded by saying that "any procedure can be performed under local anesthesia," ...

I feel that fear too. My anxiety is so intense that the mere thought of being put under makes me freeze up completely. 😢
I’ve been putting off my surgery for two years now, all because of the terrifying thought that I might not wake up. My doctor has warned me several times that I can't delay this any longer, but the fear is simply overwhelming. It's hard to understand why I feel this way; I'm generally an optimist who views life's hurdles as things to be overcome, but the idea of surgery and general anesthesia is a total nightmare... I am almost certain I won't open my eyes again.
Perhaps it stems from having experienced that moment of complete helplessness and "waiting" before, though I was fortunate enough to be in a hospital where they successfully "brought me back."

Is there any kind of psychological preparation for this, or is the burden entirely on the patient? How common is this level of panic before a procedure?

Honestly, everything you just laid out is exactly what every single patient goes through right before surgery. The only real difference is how people handle it—some folks wear their heart on their sleeve, while others try to act all tough and play the "I'm not scared" card... but let's be real, everyone is terrified, no exceptions. If anyone tells you otherwise, they're just lying to themselves. So, don't feel like you're some outlier or a special case here. There isn't some magical psychological ritual you need to go through either. Just make the call, get it sorted, head to the hospital, and there's a massive chance everything will turn out just fine.
Good luck