Anesthesia, Resuscitation, and ICU: Q&A

Six days ago, I underwent bilateral groin surgery under general anesthesia. Once I woke up, I was dealing with some pretty intense nausea, so they gave me something for it—which helped—leaving me with nothing but a lack of appetite and some mild weakness. Everything seemed fine until two days ago, when I was hit by this sudden, horrific wave of nausea and dizziness. Now, I have zero appetite, I’m barely eating anything, and I can't sleep. At first, I assumed it was just a reaction to the medication, but I haven't taken anything since. Is it actually possible for side effects to linger this long?

I really need some quick advice because I have a meeting coming up with my anesthesiologist...
I just finished my blood work for a minor outpatient procedure (general anesthesia), and everything looks fine except for my AST being a bit high at 38 (ref range 8-30) and my MPV sitting at 10.8 (ref range 6.8-10.4)...
Is this anything to worry about? When I had my full panel and enzyme tests done five months ago, everything was totally normal. Could this hold up the surgery, or should I be looking into getting more testing done first...

Maria Anderson59 said:I urgently need some input because I have a consultation with my anesthesiologist coming up.
I had blood work done since I’m scheduled for a minor surgery (general anesthesia), and everything looks fine except for a high AST (38, ref 8-30) and a high MPV (10.8, ref 6.8-10.4).
Is this concerning? Everything was normal when I did my metabolic panel and enzymes five months ago. Is this going to stop the surgery? Should I be getting any extra tests done?

I doubt this will stop general anesthesia. My own results were similar once, and the anesthesiologist didn't see it as an issue.

If these kinds of numbers were a dealbreaker, I guess almost nobody would qualify for general anesthesia...

Correct me if I'm wrong, I suppose. 🙂

So, in some hospitals across America, there’s a massive shortage of anesthesia specialists. You’ve got residents basically flying solo, performing anesthesia on adults and even kids without any senior oversight. They’re handling resuscitation and emergency surgeries all on their own... just wonderful news from this incredible country we call home.
👎 Honestly, maybe we really did earn the apocalypse... it’s coming soon.😵

Anesthesiologists during crises basically tell you, "God help you when your kid comes in for surgery." And then you're stuck there filling out the paperwork for a tonsillectomy, knowing the person actually putting them under is just a resident in their second year of training. It’s heavy. Like, what if they don't wake up? Or what if they do? The sheer weight of that responsibility on those residents is just... it's torture, really. I even know about this one case where an infant was oversedated with anesthesia for three whole months—they've been struggling ever since, barely walking, barely talking. Honestly, I can't wrap my head around how anyone could let that happen.

Honestly, I’m just sitting here waiting for the news that first-year residents are out there solo-inducing patients for six or seven-hour heart or spinal surgeries 🤦 which is basically just high-stakes roulette. You either never wake up, or you wake up right in the middle of the procedure feeling everything, or maybe—just maybe—everything goes fine. Total roulette!

So, I tried getting a gastroscopy done, but it was a total bust—I kept telling them my throat felt super tight, but they just wouldn't listen! So, they decided to just go under anesthesia, and here’s how things went down:
Anesthesia report: ASA II, TIVA 550mg, Propofol 120 mg Succinylcholine. They attempted the gastroscopy using TIVA, but trying to intubate was a complete fail—Cormack Lehan grade III. Saturation started dropping, so they had to switch to manual ventilation and popped in an LM no5, which worked like a charm because my saturation normalized right back to SpO2 100%. Once everything was wrapped up, I was breathing on my own and hemodynamically stable, so they moved me over to the ICU.

I’d love to hear from any pros out there who could comment or explain what happened...

Dennis Nelson said:Gastroscopy—it didn't go as planned (I told them my throat felt narrow, but they didn't really buy it), so we went under anesthesia and then this happened:
Anesthesia report: ASA II, TIVA 550mg, Propofol 120 mg Succinylcholine. Gastroscopy performed under TIVA; attempt at intubation was unsuccessful, Cormack Lehan grade III. Oxygen saturation dropped, patient was manually ventilated, followed by placement of an LM no 5, after which saturation normalized to SpO2 100%. Upon completion, the patient was breathing spontaneously, hemodynamically stable, and transferred to the ICU.

I’d love some professional insight/explanation here...

First off, it sounds like whoever was running the anesthesia was incredibly skilled and super meticulous.

Based on what you wrote, it looks like you probably have an anatomical quirk that made standard general anesthesia (endotracheal intubation) a bit of a challenge. That narrow throat you mentioned? Well, that makes things just as tricky for a fiberoptic scope or the actual tube the anesthesiologist needs to slide down into your airway to set up "artificial breathing"—which is actually why they noted it during the initial inspection of your throat/pharynx.

So, what they did was place a laryngeal mask over you to handle the ventilation—basically, they were "breathing" for you (and according to the notes, they did it perfectly well) until your own breathing kicked back in naturally.

Bottom line is, you aren't exactly a prime candidate for OET unless there's a really heavy medical reason for it.

I mean, what’s actually going to happen if I ever end up needing some kind of surgery?

Dennis Nelson said:So, what happens if I ever need surgery down the road?

Honestly, you just have to let them know there were issues getting you under last time. It’s probably best to grab your medical records so you can point out exactly where they noted the difficulty, which helps the surgical team prep for a tricky intubation.
I mean, think about it—during something like a quick gastroscope procedure, they usually don't have fancy gear like a video laryngoscope, a Macintosh laryngoscope with a flexible tip, or any of those other lifesavers used when things get complicated like they did for you. But if you can go under again, and they actually know ahead of time that you're a bit of a "difficult airway" case, the anesthesia crew can have all the right equipment and supplies ready to go...
At the end of the day, the big thing is that once they gave you the meds, especially the Propofol 120 mg Succinylcholine, they were still able to breathe for you manually without much trouble... or at least be able to use a laryngeal mask.
Bottom line, you really don't need to stress about future procedures as long as the team is kept in the loop about what happened before.
Good luck!

Hey there, fellow forum members and esteemed anesthesiologists—I am kindly asking for some help here. I’ve been wrestling with a question for quite a while now. I have an upcoming surgery to remove vocal cord polyps, and honestly, the general anesthesia part is what’s really getting to me. Everyone keeps telling me it’s a quick little procedure and that I shouldn't worry, but I can't just switch off two specific fears. First, what actually happens if the anesthesiologist on duty can't get the tube in right away after they've already given me the muscle relaxants? How do they handle that situation? Is death an inevitable outcome if they just can't get the tube into the trachea for some reason? Are there any alternatives to that scenario, or are we talking about a dead end? My second big fear is a equipment failure—what if the anesthesia machine itself malfunctions? What can be done in that case? I would truly appreciate any answers or insight you all could offer.

Eric Adams4 said:Dearly respected forum members and esteemed anesthesiologists, I’m reaching out because I really need some help understanding something that's been weighing on my mind for a while now. I have an upcoming surgery to remove polyps from my vocal cords, and honestly, the general anesthesia part is what's keeping me up at night. Even though everyone keeps telling me it's a super quick procedure and there's nothing to worry about, I'm stuck on two specific things. First, what actually happens if the anesthesiologist can't get the tube in quickly enough after they've already given me the muscle relaxants? How do they handle that, and is it actually life-threatening if they can't get the tube into the trachea? Are there any alternatives to that scenario, or is it just a dead end? My second big fear is what would happen if the anesthesia machine itself malfunctions—what's the backup plan then? I'd be so grateful if you could help clear this up for me.

I actually sent you a private message regarding that first part of your question... so seriously, don't sweat it.

As for your second concern about the equipment failing, you really don't need to worry about that either. I mean, sure, machines might act up occasionally or have their own little quirks, but no matter what happens, everything is handled professionally. You can trust that they'll manage the situation perfectly.

To my colleagues and those with experience, I have a question regarding testing for anesthetics and muscle relaxants. I am facing an upcoming surgery, and looking back about eight years ago, I underwent a procedure where I was administered Leptosuccin and Nalgol. Now, in the near future, I am scheduled to undergo testing involving Esmeron, Leptosuccin, Narcuron, and various relaxants including Hypnomidat, Thiopental, Propofol, Midazolam, Fentanyl, and Sufentanil. I find myself wondering—how long should one realistically expect to be hospitalized while these tests are being carried out? Thank you in advance for any insight.

@Scott Allen10/">@@Scott Allen10, I really hope you're actually a doctor and not some psycho pretending to be one like that guy 🙂

Alright, let me try my luck here. I'm gearing up for surgery and gathering all my labs, but my EKG isn't looking perfect. Can I just talk this out with my anesthesiologist, or am I going to need a formal sign-off from a cardiologist?

I also have my Holter monitor results, and they show quite a few irregularities, but honestly, I don't feel a thing.

Just figured I’d share this here, maybe someone else might find the info useful.

My EKG isn't perfect, but it’s definitely not enough to stop the surgery—my anesthesiologist gave me the green light. My primary care doctor told me the exact same thing beforehand, too. So yeah, two professional opinions agree.

On that note, I really have to mention the "expertise" I experienced at the Sun City clinic. A guy there actually told me they probably wouldn't even accept me for surgery with an "EKG like that," and then tried to push a bunch of mandatory tests on me costing anywhere from $800 to $333.
So, there you go. That’s my take on the professionalism and ethics over at Sun City.

Hey there, I’ve got a few questions (and I'm kind of freaking out about the timing):

So, my chart says ASA 1, MET over 7, NYHA 1, and GCS 15... what on earth do all those acronyms actually mean???

Also, I’m scheduled for a regional anesthetic—are there any issues if I’ve basically been smoking through a whole pack plus four extra cigarettes over the last month? I mean, practically speaking, I was smoking almost every single day, though mostly just when I was out and about. I had my last one this past Friday and told myself, "That's it, I'm done," and tossed the pack.
Before that, I was going through a pack that lasts maybe two weeks. In my opinion, you can't even call yourself a smoker unless you're burning through at least half a pack a day, right? 🤷

And regarding alcohol—I don't really drink normally. I only have a drink when I'm out, and I haven't been out much lately. I didn't tell them I drink because I don't consider someone a drinker if they only have something once every two weeks (or even less frequently). My last drink was also on Friday.

My blood pressure is low, I'm not overweight, and my heart and lungs seem fine (the X-ray mentioned some "BO" thing?), the only issue is respiratory arrhythmia, but the anesthesiologist said that's totally normal for someone my age (I'm in my early 20s).

Hey everyone, I have surgery scheduled under general anesthesia in just a few days. I’ve already finished my pre-op consultation with the anesthesiologist. Back when I had thyroid surgery two years ago, they gave me something to take to calm my nerves before the procedure. I remember swallowing it, and the next thing I knew, I was waking up in the recovery room. Honestly, I have zero memory of actually walking into the OR or talking to anyone—even though people tell me I was wandering around and chatting my way to the operating suite. All I recall is feeling totally buzzed, like I was drunk, and apparently being a bit of a nuisance. I can't remember the name of the medication. Personally, I thought it was great because I always get hit with massive panic right before entering the OR. I completely forgot to mention this experience to my current anesthesiologist. Does it really matter if they know? Should I specifically ask to speak to someone about this once I get to the hospital?

You can always give the anesthesiologist a little nudge when they’re filling out the consent forms, but honestly, everything is just logged into the computer anyway

Hey, I have a quick question regarding CPR.

Everywhere I look, it says you should start CPR when an accident victim isn't responding to stimuli and either isn't breathing or isn't breathing normally. What exactly does "not breathing normally" mean here? I was digging through the official guidelines from back in 2015, and all they say is that agonal gasps shouldn't be mistaken for normal breathing—that’s it. I can't find any specific details on what kind of breathing irregularities actually trigger the decision to start CPR.

As far as I understand, we aren't supposed to check for a pulse anymore; we just check breathing, because if there's no pulse, there's no breathing, and vice versa, when looking at CPR indications. Am I right?

Greetings! First off, I want to thank the experts here for taking the time to answer our repetitive and—let's be honest—sometimes silly questions. 🙂

My doctor’s recommendation is basically this: endoscopic reconstructive sinus surgery under enhanced local anesthesia. They've asked me to provide specific instructions regarding the procedure.

To give you some context, I can barely breathe through my nose. It’s been a struggle for years, and after dealing with constant post-nasal drip and sinus infections, I finally decided it was time to fix this. This information comes from a report from a private clinic, where the surgeon suggested performing the operation under local anesthesia with sedation.

I am 31 years old, 194 cm, 93 kg, a smoker, and I deal with borderline high blood pressure and pet allergies.

I would appreciate your perspective: is choosing local anesthesia a safer bet, or should I just go under general anesthesia? The surgery itself is endoscopic. To be completely transparent, I have this irrational fear of general anesthesia—specifically the dread that I won't wake up—which is actually what has prevented me from getting this done over the last few years.

I’ve been told that enhanced local anesthesia can sometimes be tricky because if the patient hears what's happening, their blood pressure spikes, which can turn the whole situation into a total mess. Apparently, they don't even perform this type of enhanced local approach at Rebro.

Please, help me make this decision. 🙂

Thanks in advance.