Anesthesia, Resuscitation, and ICU: Q&A

Can I take Tramadol before surgery (general anesthesia) if the pain kicks in? So far, nobody has given me a straight answer to this question.

What exactly do you mean by "before surgery"?....If we're talking about the day before while you're just chilling at home, then sure, go for it if it actually helps you feel better....But if you're already checked into the hospital waiting for the procedure to start, then absolutely not....I just don't have enough info here to give you a solid answer...

Scott Allen10 said:Local anesthesia won't be an issue with those meds, but there's really no harm in mentioning it to your dentist (actually, it's highly recommended). Honestly, probably every second or third patient sitting in that chair is on something similar these days...

Thanks for the reply!

The side effects from general anesthesia—you know, when they actually knock you out—usually include stuff like: headaches, nausea, feeling totally disoriented, dizziness, blurry vision, and all that good stuff...
Honestly, I’d suggest going with an epidural, regardless of how uncomfortable you think the idea might be. Don't sweat it, you won't feel a thing, so 😁

So, I’ve personally gone through three general anesthesias and six spinal ones now. Honestly? If I had to pick, I’d definitely go with the general one any day! 😁

I’m looking for some answers if anyone can help out—my dad had surgery seven days ago for an ascending aortic aneurysm (they used a synthetic graft) and his valve was replaced with a biological one. The surgery itself went fine, but since waking up, he’s been showing signs of postoperative delirium: total disorientation, confusion, and aggression. He keeps trying to rip out all his IV lines and wants to just get up and walk away—he doesn't realize where he is or even that he just had surgery. This delirium mostly hits at night... during the day he’s better, less aggressive, and doesn't complain about pain as much, though he still "zones out" occasionally. He knows he’s in the hospital and recognizes us as family... he even remembers trying to pull the wires at night and remembers them having to restrain him, but he swears he does it because of the pain.

The doctors say this happens and that it’s temporary (they have him on Haloperidol), but since these psychotic episodes are coming in waves and it's now the seventh day since he woke up—leaving him stuck in the ICU constantly (even though his other vitals are steady)—I’m terrified he might stay like this.

Just to be clear, he has no history of mental illness or addiction (other than being a heavy smoker who quit cold turkey the second he hit the hospital). He isn't an alcoholic, though he used to drink pretty heavily with his buddies back in the day. He’s 62.

I don't even know what I'm asking... I'm just desperate and wondering if he’ll ever go back to himself. I don't know if there's a link to the anesthesia... I posted this in the "cardiac surgery corner," but since nobody replied, I'm putting it here.

What you’re describing happens all the time, honestly.
The whole anesthesia process isn't exactly a walk in the park, but let's be real—modern medicine would basically grind to a halt without it.

It’s actually a good sign that most of the work is being handled during the day 👍, because it suggests that once they get discharged and head back to their own familiar surroundings, things will likely settle down and normalize.

Nighttime is when things get messy. That sense of disorientation—especially in a hospital setting where you're hooked up to all sorts of tubes, IVs, and bandages 😵—really hits hard, particularly with older patients.

In cases like that, Haloperidol is pretty much the gold standard. 🙏

EDIT: Just realized they're a smoker, which definitely doesn't make the recovery any easier.

@velvetmoose9/">@@velvetmoose9

Thanks for the reply.
It helps me out knowing he's more or less conscious during the day—fingers crossed things start looking up soon.

Is it actually possible for someone to stay unconscious for six days following gallbladder surgery? They’re currently in the ICU and aren't breathing on their own. Before the procedure, he was relatively stable and mobile, but his blood work and liver function tests were looking pretty rough. It was a high-risk surgery, but despite the complications, the medical board decided to move forward with it anyway. How can someone's overall condition just plummet like this?

Kate Mitchell87 said:Is it actually possible for someone not to wake up six days after gallbladder surgery? They’re sitting in the ICU right now, unable to breathe on their own. Before the procedure, they were relatively hydrated and mobile, but their blood work and liver function were looking pretty rough. It was a high-risk surgery, but even with the congestion issues, the medical board decided to go ahead with it. How does someone crash this hard?

Look, every single surgery carries its own set of risks.
General endotracheal anesthesia itself is a gamble—even if it feels— incredibly minor—for even the healthiest person out there.

To get any real clarity, we'd need the specific numbers from those labs, a full history of pre-existing conditions, age, and what medications they were already on...
Without getting a deep dive into the actual lab results, the clinical picture (maybe an discharge summary?), and the specific surgical protocol used, it’s impossible to offer even a ballpark opinion.

If I’m reading this right, the patient was fully conscious beforehand and understood the potential risks before giving the green light to proceed?

Yes, the patient gave their consent knowingly. But when you look at the whole picture—it’s this long, complicated saga involving the patient’s history, followed by a series of consecutive medical errors, and then, as if to drive the point home, the absolute worst possible outcome occurred. We managed to settle things with the doctors previously, but now that there's a new medical development, everyone has gone completely silent; nobody will offer a single comment or even a concrete answer. Because of that, I've decided to start moving forward through legal channels, so we'll just have to wait and see how that unfolds.

I’ve been pondering a bit of a medical timeline question: how much time really needs to pass between a bout of general anesthesia—assuming we're talking about a relatively quick procedure—and a subsequent spinal block? For instance, if someone were looking ahead toward a knee replacement where a spinal would be administered, I'm curious about the necessary interval. Thanks!

In theory, those two things shouldn't have anything to do with one another.

I always tell people that you have to prep for surgery just in case, regardless of what kind of regional block they're planning to use. You basically act like you're going into full general anesthesia... I mean, even if everything goes according to the initial plan, there's always that chance you might need to pivot to general anesthesia for some reason mid-procedure.

Thanks for getting back to me.

Does anyone have any insight on tendon transfers for the hand? Basically, the fingers on my left hand are stuck in this constant spasm—they'll flex just fine, but extension is non-existent, so I can't actually open my hand whenever I want... I survived two strokes and had a mechanical valve implanted...
I’ve managed to rehab pretty well, mostly, except for that hand and those fingers. I even tried Botox, but you'd need a literal money printing press to afford it since it isn't covered by Medicare...
Since my issues stem from a central cause, I followed a neurologist's advice and saw a plastic surgeon. He mentioned that getting some functionality back would likely require several surgeries. He suggested a tendon transfer under local anesthesia. Does anyone know anything about how that works or how risky these procedures actually are? Thanks!

My mother's partner had his right lower leg amputated at the Mayo Clinic due to thrombosis. He underwent spinal anesthesia for the procedure, and that’s where the complications truly began... about two or three months after the surgery—and after five agonizing months of waiting for rehabilitation at some local spas—his condition just kept spiraling downward. He started having breathing issues, sinus congestion, his voice changed, and he was coughing up phlegm mixed with blood. I ended up calling 911. After examining his mouth and neck, the doctor determined it was oral cavity cancer and asked where he had received the anesthesia; he told them it was in his back. During the follow-up CT scan at the Mayo Clinic, they asked the exact same question. Given how much they focused on that, you’d almost think they suspected the anesthesia was the root cause of the cancer. Then came the radiation therapy at Memorial Sloan Kettering—but instead of the scheduled seven weeks, they discharged him after just two, claiming everything was fine... only for the cancer to spread later on. He was a lifelong construction worker, a man who had never been seriously ill in his life. A year after the first amputation, his left leg had to be amputated as well—this time because of a doctor's oversight, someone who saw the state of the leg on a Doppler two months prior and did absolutely nothing. In the end, he passed away in unimaginable agony. Through all the tests, the MRIs, and the constant runaround, he bore it all with stoicism. From the very first day we walked through the doors at the Mayo Clinic, it felt like it was all for nothing.

Hi everyone.
My grandmother (91 years old) had a fall and broke her hip. On the first day after surgery, she was mentally doing great—she was totally with us, energetically explaining exactly how the fall happened, etc. It got to the point where we were joking at home that she felt "refreshed." She’s always been a very lucid, wise, and intuitive woman, though as people get older, they tend to drift off a bit into deep thoughts about the past (like she’s doing a full life review, wondering if 🙂 ). If she missed a connection in conversation, it was basically just because her hearing is a bit weak (even on the first day post-op, she "heard" something wrong while the nurses were talking)...
However, by the third day after surgery, she started having some strange ideas... she woke up convinced that someone she knew had passed away and that she had somehow received a liter of blood, among other things...
Today (the fourth day), my family says she was completely nonsensical, spinning made-up and disconnected scenarios.

I know postoperative delirium is a side effect in elderly patients, I know she's quite advanced in age, and I know there are cases where this becomes permanent and practically leads to death, but what I don't understand—how could she be so sharp for two days only to suddenly go off the rails today?

I'd be so grateful for any insight. I tried searching the depths of the internet, but the articles are all so vague, and the professional papers are packed with dense medical jargon that is totally foreign to me since I work in a technical field.🙂

My 20-year-old son just had surgery to treat ingrown hairs under general anesthesia. Things went south immediately after he was put under; he lost consciousness and stopped breathing for about 20 seconds. He spent four hours being monitored. Since coming home, he's been dealing with these intense, frequent headaches, and a CT scan eventually picked up a small 2mm cyst. It’s been two months now, and while the headaches have eased up a bit, we’re still pretty anxious about what's next. We’re planning to get an MRI to figure things out. Is it possible this was triggered by the anesthesia, and what kind of long-term issues should we look out for? What's our next move?

I would be so incredibly grateful if someone could maybe offer me a little comfort or perhaps some advice right now.

I don't have my mom's medical files right here with me,
but to give you the short version,
she has non-compaction cardiomyopathy, NYHA Class III,
with her heart function at about 30%,

and she has a CRT-D defibrillator implanted.
Things actually seemed to improve a bit after the implant,

but about three months ago, Mom suffered a pretty severe burn on her leg that just won't heal, so according to Dr. Morris, she's currently in the hospital waiting for skin graft surgery.

I did try to talk with the doctor about her cardiac condition and whether her heart can even handle anesthesia—since we are dealing with heart failure, after all—but I guess it didn't really seem to resonate much with them... it felt like my concerns just weren't being heard.

I am just so, so worried... I wonder if anyone else here has gone through something similar?

Thank you so much.

Listen, every doctor on call in the JIL is different. They’ll administer whatever medication they feel is best for the situation at hand. From what I've seen with my colleagues, even another anesthesiologist might choose a completely different cocktail than I would. Both approaches work, so ultimately, it just comes down to the individual physician. 😉