Anesthesia, Resuscitation, and ICU: Q&A

wearymason2 said:Hey, I’ve got a quick question regarding CPR.

Everywhere I look, the guidelines say you should start CPR when an accident victim isn't responding to stimuli and isn't breathing—or isn't breathing normally. What exactly does "not breathing normally" mean in this context? I was digging through the official American Red Cross guidelines from back in 2015, and all it really said was that agonal gasps shouldn't be mistaken for normal breathing, but that was it. I can't find any specific details on what kind of respiratory deviations actually trigger the call to start CPR.

From what I understand, you don't bother checking a pulse anymore; you just check for breathing, because if there's no pulse, there's no breathing and vice versa when looking at CPR indications, am I right?

When you're stepping up to perform CPR, you're essentially doing a lightning-fast assessment of the victim's status—checking consciousness, breathing, and heart function all at once.
It basically happens in one fluid motion, maybe three or four seconds tops. You drop down, shake them, and shout... then immediately go for the carotid artery, lean your face near their mouth/nose, and watch the chest... it all happens simultaneously. While your finger is checking for a pulse, you're combining that with feeling for breath on your cheek and watching the chest rise and fall to gauge their breathing.
In a cardiac arrest situation, like when someone is in asystole or ventricular fibrillation, you'll see those agonal gasps, which definitely aren't normal breathing. An unconscious person might make these deep, heavy "gasping" sounds for a minute or two after their heart stops, and people often mistakenly think, "Oh, they're breathing!"... but they aren't actually breathing; they're dying.

Scott Allen10 said:You initiate CPR after evaluating the victim's status—which means doing a rapid assessment of consciousness, breathing, and obviously heart rate. It’s common sense.
Basically, in one single motion, almost within 3-4 seconds, you step up, kneel down, shake them, and shout... finger on the carotid artery, face positioned over their mouth/nose, eyes on the chest... and... everything happens at once. Under your finger, you check for a pulse, and by combining that with feeling their breath on your cheek and visually watching the chest rise, you evaluate breathing.
In cardiac arrest, where the heart is in asystole or ventricular fibrillation, you see what’s called agonal breathing, which should never be mistaken for normal breathing. An unconscious person might occasionally, maybe for a minute or two after the arrest starts, take a deep, loud "gasp" for air... and people mistakenly think, "Look, they're breathing!"... but they aren't breathing; they're dying.

Thanks for the answer; that clears things up. This specific way of checking breathing and pulse isn't in any of the textbooks I've been studying. Best regards. 🙂

Jerry Alvarez7 said:Hey everyone! First off, huge thanks to the experts here for taking the time to answer our repetitive and—let's be honest—sometimes totally clueless questions. 🙂

My gut feeling is that I need an endoscopic reconstructive nasal surgery under enhanced local anesthesia, plus getting my discharge instructions.

Basically, I can barely breathe through my nose; I've been struggling with this for years, and after dealing with constant post-nasal drip and sinus infections, I finally decided to just get it fixed. I got some results from a private clinic, and their doctor suggested doing the whole thing under local anesthesia with some extra sedation.

I'm 31, about 6'4" and 205 lbs, a smoker with borderline high blood pressure and pollen allergies.

I’d love to hear what you all think—is going with local anesthesia actually a safer bet, or should I just opt for general anesthesia? It's an endoscopic procedure. To be totally real with you, I have this irrational fear of general anesthesia—like, the "what if I don't wake up" kind of fear—which is honestly why I've put off this surgery for the last few years.

Someone mentioned that enhanced local anesthesia can be a bit of a nightmare because you can actually hear everything happening, which sends your blood pressure spiking and turns the whole thing into a mess. Apparently, they don't even offer the enhanced version at Rebro.

Please help me make a call on this. 🙂

Thanks in advance!

Better late than never, right? Honestly, go with general. When someone is literally reshaping your bone and pulling tissues around in there, the last thing an anesthesiologist wants is a patient conscious enough to freak out, especially given all the variables involved...

Hey everyone! If anyone happens to catch this before the day after tomorrow, I’d really appreciate your thoughts. 🙂 I’ve been scrolling through all the discussions here about colds, heavy periods, and surgical procedures, and honestly, it’s a bit overwhelming. As luck would have it, I woke up today feeling a bit under the weather with a cold, and my period decided to show up at the exact same time. Now, I’m just heading in for a quick procedure to have some Botox removed from my face, which I assume will just involve some local anesthesia. Since some of you clearly know way more than I do... do you think they might send me home because of this? 🙂 thanks so much

rowdybadger65 said:Hi everyone. If anyone sees this before the day after tomorrow, that would be great. 🙂 I've been reading all sorts of things here about colds, periods, and surgeries. Well, I caught a cold today and I also have my period. But I'm just going in to have some Botox removed from my face, which I assume involves local anesthesia. If anyone knows more than I do... 🙂 Will they send me home because of this? Thanks.

I had full anesthesia while on my period. I asked before scheduling the surgery and they said it didn't matter (I was having gallbladder surgery). As for a cold, I guess I don't know..

Brenda Rogers71 said:I actually went under full general anesthesia while I was on my period. I made sure to ask about it before I even scheduled the surgery date, and they told me it wouldn't be an issue at all—this was for when I had my gallbladder removed. As for dealing with a common cold, I can't say for certain...

Thank you so much, hearing that part really helped put my mind at ease! 🙂
Just wanted to share this here in case anyone ever needs some insight and happens to stumble upon this thread.
When I had moles removed, I just had local anesthesia, so neither being on my period nor having a cold (even a nasty one) was any kind of obstacle for me. 🙂

Look, I’m aware that anemia can be a real headache when you're dealing with leg vein surgeries—I can't speak to every single procedure out there—but having a common cold or running a fever? That is definitely not ideal for elective surgeries. It’s especially risky when you're talking about kids, given the whole danger of potential laryngospasm or bronchospasm...

Does anyone happen to have info on what kind of anesthesia is typically used for VATS, thoracotomy, or a "standard" thoracotomy? Also, I'm wondering if it's even possible to anesthetize or operate on a patient with lung disease affecting both lungs...

Hey everyone. Sorry in advance for the long one. I’m a mom to a little girl who isn't quite six yet. She needs to have all three tonsils out because they're basically trashed and causing major issues like constant ear infections and temporary hearing loss—whenever she catches a cold, her hearing goes way down. She also has an innocent heart murmur, so we're waiting on an EKG and an echocardiogram, which isn't scheduled until June 1st. Of course, I'm stressed. Between the heart stuff and the anesthesia, my nerves are shot. To make matters worse, my son had a routine circumcision two years ago, and during the procedure, the doctors said he actually stopped breathing and had to be intubated through his... well, either nose or mouth, honestly I'm not sure. Thank God everything turned out fine. Please, tell me if I should be terrified that something similar might happen to my daughter under anesthesia, and just how risky this really is? Thanks in advance for any advice.

goldenpanther14 said:Does anyone have any info on what kind of anesthesia they use for VATS—thoracotomy versus a standard thoracotomy? And is it even possible to anesthetize or operate on a patient who has issues with both lungs?

Still waiting on an answer here, anyone? 🙂

Can someone help me make sense of this pre-op assessment?

What's the deal with these numbers: Preoperative risk classification - ASA: 2, MET: over 4

As for the premedication, is this pretty standard stuff...?

Diazepam 1X5 mg. p.o.

1 hour before the procedure: Dormicum 1X7.5 mg. p.o.
Antibiotic and antithrombotic prophylaxis as per the surgeon's orders

Thanks!

ASA—that’s basically the risk assessment for anesthesia based on your health, specifically looking at how your heart and lungs are holding up. It uses a scale of six levels, where a lower number means less risk...
MET—this measures your functional capacity; essentially, how much you can move around and handle physical exertion.

Every Anesthesiologist evaluates patients on an individual basis, which is why those assessments exist. There isn't some "one size fits all" approach... it's all specific to the person.

Usually, they'll give you Dormicum, sometimes right before they call you back to the OR, but it could be something like Concor 2.5 mg instead. It really just depends on the patient and their current condition or regular meds...

Can anyone tell me what might have happened while I was under general anesthesia? The idiots at the hospital didn't say a single word to me. When they discharged me the next day, I started feeling this pain in my jaw and the bone right below my ear, and it’s been hurting whenever I touch it for two days now. Is it even normal that they didn't mention anything about this happening? The surgery was just a hysteroscopy.

ambermason822, how old is your son? Did he have his phimosis surgery done under local anesthesia?
neonhawk24, if you ask me, it doesn't sound like anything too crazy was going on—maybe your tongue just kept getting in the way. They probably had to lift your lower jaw angle (the angulus mandibulae, right about below the ear) just to clear your airway after they extubated you (took the breathing tube out). That specific spot is pretty sensitive and can be quite painful with even a light touch...
2. A hysteroscopy is a much shorter procedure, so you might not have even been intubated at all. Instead, the anesthesiologist likely just held a mask over your face, and to make sure you were getting enough air, they’d press the mask down by tilting your lower jaw...
3. Even if they used an I-gel mask, they still have to manipulate the airway to open it up...
I'm thinking it's one of those things...
Look, I'm just an anesthesia technician—if you want a more technical or expert breakdown, you should definitely ask an anesthesiologist.

Amanda Sullivan8 said:ambermason822, how old is your son? Did he have that phimosis surgery under local anesthesia?
neonhawk24, honestly, I wouldn't sweat it. It probably wasn't anything major. You might have just felt a bit tongue-tied, and they had to lift your jawline—the angle of the mandible, right under the ear—to clear your airway after they extubated you (pulled the breathing tube out). That spot is super sensitive and can be pretty painful if someone touches it too roughly...
2. A hysteroscopy is a much shorter procedure, so you might not have even been intubated. The anesthesiologist probably just held a mask over your face, pressing against your lower jaw to make sure you were getting enough air...
3. Even if they used an I-gel mask, they still have to manipulate the airway to get it positioned right...
That's my best guess...
Look, I'm just an anesthesia tech, so a real anesthesiologist will give you the technical deep dive.

Thanks for clearing that up. I was seriously starting to think I’d had some crazy reaction to the anesthesia and had actually smacked my head against the bed or something...

Melissa Sanchez8 said:ASA—that's basically the risk assessment for anesthesia based on your overall health, specifically looking at how your heart and lungs are holding up. They use a scale from I to VI, where a lower number means you're in much better shape and there's less risk.
MET—this measures your functional capacity, basically seeing how much physical activity you can handle without breaking a sweat.

Every single patient gets evaluated individually by their Rebecca Murphy2, which is why those specific assessments exist in the first place. There’s no such thing as a "one size fits all" approach here; it's all about the specifics of the person.

Most of the time they'll give you some Dormicum, sometimes right before they call you back into the OR, but depending on what you're already taking and how you're doing, they might also use something like Concor 2.5 mg. It really just comes down to the patient and their current meds.

Thanks for the info!

A little while after coming out of general anesthesia—could have been hours or days, honestly can't quite remember—I started feeling this pain in both my lower legs. Over time, the ache in my left leg totally cleared up, but the right one is still acting up; it’s moved from the whole leg to just this one specific muscle that’s cramping up and hurting like crazy. It's been 13 days since the surgery.

Is this actually normal, and is there anything I can do to get some relief (I heard drinking tons of water might help...)?

I would really love to get a professional opinion from an anesthesiologist on this...
Is it actually okay, or even recommended, to head into general anesthesia when you're dealing with low iron levels and a Hemoglobin-76 reading? I'm just wondering what kind of specific risks that might pose for the patient during the procedure...
Thank you so much!

I was wondering if anyone here could clarify what kind of anesthesia is typically used during a vaginal hysterectomy?
Specifically, I’m curious whether they go with general endotracheal anesthesia—where the anesthetic is delivered through a tube—or if it’s general intravenous anesthesia using either a standard mask or a tube that just provides oxygen and air?

It seems like this thread has gone a bit quiet lately, even though we've had some wonderful anesthesiologists in the past who provided such insightful information and helpful advice.

Has everyone moved on? You all were such a massive help!

I have a question for anyone who has undergone surgery, or even better, for an anesthesiologist.
I am scheduled for gallbladder removal soon. I’ve completed all my tests, including the pre-op anesthesia assessment.
There is one detail that's confusing me: I'm arriving at the hospital on the morning of the procedure, but the anesthesiologist noted that I need to receive a Clexane injection the evening before. My primary care physician says they don't carry it and won't be able to provide it.
How, and where, am I supposed to get this necessary medication?