Anesthesia, Resuscitation, and ICU: Q&A

Eric Long22 said:Why on earth do they keep drugging people up for days before an actual surgery? It would be so much more logical if you just showed up, got your meds, and were in the OR by the next day at the latest. But at the hospital in the city, they just keep you stuck there for days, pumping you full of drugs while they lie to your face every single morning saying the operation is happening tomorrow.

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Charles Sanders51 said:Hey, if there’s an anesthesiologist hanging out here, could you give me a professional breakdown of what it actually means when we say adrenaline is diluted at a ratio like 1:1000? Specifically, how much adrenaline (and in what units) are we talking about when it's mixed with 1000 units of saline or whatever?
Also, when we talk about diluting adrenaline at 1:10,000, does that mean if I have 3 mL of adrenaline, I should mix it with 7 mL of saline in a 10 mL syringe, or is it more like 1 mL of adrenaline with 9 mL of saline?

Thanks!

Usually, the adrenaline in the vial is 1mg per 1ml... which is basically 1:1... honestly, that stuff is powerful enough to raise the dead. If Imhotep had access to that, he wouldn't be messing around with spells for Anck-Su-Namun in that Mummy movie.

So, you take that 1 ml vial and pull it into a 10 ml syringe (meaning 1 ml of drug plus 9 ml of saline... that gives you 1:10... which is pretty much a standard resuscitation dose...

Then, if you take 1 ml from that 1:10 syringe and draw it up again into a 10 ml syringe (another 1 + 9 ml), you’re looking at 1:100... that's what you'd use for something like titrating blood pressure after a procedure.

If you take 1 ml from that 1:100 syringe and go through the process one more time (again, 1 + 9 ml), you get 1:1000... which is perfect for fine-tuning blood pressure or handling anaphylaxis.

I showed up to every single surgery a day early, and all I ever got from the meds were some pills at night (to help me sleep) and then something right before the procedure (just to take the edge off).
Those calming ones didn't knock me sideways like they seem to do for some people.
It wasn't like I was floating on clouds or cracking up and laughing my head off. I still felt pretty jittery, just way less on edge than I was before taking them.
Honestly, maybe it was just a placebo effect... who knows? 😛

Back again. It’s like I had this gut feeling that something was going to go sideways. Basically, I was knocked out via IV, went through a laparoscopic appendectomy, and then someone starts calling my name and I open my eyes. I’m wide awake and just staring. Some voice calls me by name, asking "where are you?" And then, honestly, it felt like pure hell—like it would never end. I couldn't breathe. I tried, but I realized I physically couldn't draw air. I even tried to signal to them with my hand that I wasn't breathing, but I couldn't move a single finger. Then, I felt them pulling a tube out of my throat (I assume the intubation tube), and once that was finally out, I could breathe normally again. I could feel my body, my legs, my arms, but I had zero strength to actually move. Everything went back to normal about 20 minutes later. What actually happened to me? The surgeon tells me it's totally normal, but I didn't even see the anesthesiologist. Why couldn't I breathe? If I was intubated, why couldn't I pull air through that tube? How do they decide when it's time to pull the tube out? And of course, why wake me up only to extubate me immediately? Shouldn't it be the other way around? This whole thing really messed me up. Can anyone with more experience explain if this is actually okay...

That’s just standard procedure, honestly, but look—the anesthesiologist is right there with you, so don't even sweat it; she's watching everything. Anesthesiologists are like those invisible guardians, you know? They're basically ghosts in the room, totally unnoticed until you actually need them, but they're always hovering. You really need that window of time before you fully wake up so they can check if the anesthesia is actually doing its job and hitting the right levels.

I guess it’s my turn to weigh in. Liver transplant. It all started with an emergency call—"We have a liver for you in Chicago." I hopped on a medevac flight straight to the hospital, carrying a donor organ all the way from Amsterdam. I rolled in around 3:00 AM, ran through the lab tests, and they told me to just get some rest. So, I went to sleep. They came back at 6:30 AM like, "Let's go!" We headed toward the OR, me and the guy on duty, just walking. I vaulted over the desk, stripped everything off, tossed it to him, turned around, and there it was—all the surgical gear and tools laid out perfectly. Someone in a white coat pointed to the table and said, "Lie here, this is where we'll work." I lay down, and he hooked up my IV. I didn't wake up until 9:00 PM, strapped down by my arms and legs, totally lost in space and time. Later, they told me I was being pretty aggressive and shouting while I was coming around. Ever since then, for about 8 years now, I’ve been dreaming everything in vivid detail, like watching a movie. Mostly good dreams, though.

I guess I'm just glad we're actually out here living our lives, you know?

Hey everyone! I’m gearing up for knee arthroscopy soon, and I have a few things on my mind regarding the anesthesia side of things. I’ve got some questions 😁
Do we happen to have any anesthesiologists or orthopedic surgeons in the house? 🙂

Thanks so much in advance!

Hi everyone... I wanted to reach out and see if anyone here has dealt with a case of pneumococcal pneumonia that escalated into sepsis, heart failure, and kidney failure? We’re trying to figure out what the survival odds look like and what kind of long-term consequences we might be facing... Honestly, we are just completely devastated right now—a close family member is going through this as we speak, and the stress is just overwhelming. He's 54, and until this happened, he was a perfectly healthy guy who almost never even caught a cold... we are all just in total shock. He’s currently in the ICU receiving intensive care, but so far, there hasn't been any sign of improvement 😢((

Paul Ramirez59 said:Me again. It’s like I had this gut feeling something was going to go sideways. Basically, I was knocked out—they injected something straight into my vein, I'm not even sure what—and right after they finished the laparoscopic appendectomy, someone calls my name and I open my eyes. I'm wide awake and just staring. Some voice calls my name and asks where I am. That’s when the hell starts. To me, it felt eternal. I couldn't breathe. I tried, but I realized I just couldn't get air in. I tried to signal to them with my hand that I wasn't breathing, but I couldn't even move a finger. Then, I feel them pulling some tube out of my throat (I'm guessing the breathing tube), and once that was out, I could finally breathe normally. I could feel my body, my legs, my arms, but I didn't have the strength to do anything or move at all. Everything went back to normal after about 20 minutes. What actually happened to me? The surgeon tells me it's totally normal, but I didn't even see the anesthesiologist. Why couldn't I breathe? If I was intubated, why couldn't I draw air through the tube? How do they decide when the tube needs to come out? And seriously, why wake me up and then extubate me? Shouldn't it be the other way around? This whole thing really traumatized me. Can someone more experienced please explain if this is actually okay...

Wait, can that actually happen?
I'm reading this thread and I honestly can't believe everything I'm reading. 😢

I could really use some help here.

A close family member (64 years old, former smoker until about 15-20 years ago) underwent surgery five days ago at a hospital in a small town near the mountains: a mitral valve replacement (mechanical valve) plus two bypasses. This was probably his first or second time under general anesthesia in his life, and the whole thing lasted about eight hours.

He still hasn’t properly woken up; after the initial waking from anesthesia, he was extremely agitated, so they have him sedated now. At first, we were told patients need five to seven days to fully come to themselves, so we just wait. Fine. I guess.
In the meantime, he ran a fever of 100.4, so they started him on preventative antibiotics. His bilirubin levels were elevated, and yesterday they mentioned something about leakage in the lungs. Now they're treating it as diffuse brain injury—which, if I understand correctly, is a pretty broad term? I don't know.

Every day they attempt to wake him and check if he can breathe on his own so they can extubate him, but clearly, that isn't happening; he’s still intubated. We were told that if there’s no improvement, he’ll undergo a tracheotomy tomorrow or Thursday to remove the tube.

Two days after the surgery, they said that if things didn't improve, they would proceed with neurological diagnostics (a brain CT), but apparently, they've given up on that, partly because of the surgical drains (I have no idea what the connection is between drains and a CT scan, honestly). They also mentioned that the trip to get a CT—since they'd have to transport him to a major city like Chicago or maybe even New York—might carry more risk than any potential benefit.

When I asked if it was possible he suffered a stroke during the operation, the doctor gave some sort of dismissive answer, saying something like, "Don't go making up strokes; it's like tiny crumbs on a filter."🙄 "It's what you might call an induced coma." Then, when a different anesthesiologist was asked yesterday if the patient was in an induced coma, he said no.

One anesthesiologist said this complication happens in one out of a hundred cases, while another called it a fairly common occurrence. One says he'll definitely wake up, you'll see; the other mentions there's a rehab center right across the street so they can start training and exercises (swallowing, breathing, etc.) if needed. So, yeah, we are getting completely contradictory information.

From what I can gather, the doctors believe there is actual brain damage involved, rather than it just being a slow awakening from general anesthesia. I don't know what to think. I don't doubt he'll wake up, but I wonder... in what condition? I actually know people in the medical field, so I know nothing is ever certain, especially regarding recovery from surgeries this massive. I’m not asking for the full surgical protocol or to be briefed on every single diagnostic step, but I do think it would be decent to keep the family informed about the planned next steps.

We can't even get to him (he's in the ICU, obviously), and updates are only given over the phone twice a day. The main mantra from the anesthesiologists on duty is just, "Have patience, give it time, everything will be okay."
I'd really appreciate any comments or insights based on your experiences.

Hello there.
A family member of mine needs a follow-up bronchoscopy soon, as their last one was nine years ago. Last time, they underwent the procedure under general anesthesia, but this time it looks like they're opting for local anesthetic instead. Apparently, everything will be fully transparent and conscious, which is... quite something. 😱 Does anyone have experience with this? Can a patient typically walk out of the hospital normally afterward, and is there anything specific to watch out for? Any lingering pain to expect?
I am just a bit concerned about how much of a shock this might be to the system.
Thanks for your input.

I'm not quite sure where this belongs, so I'll just try my luck here. Last week, I had nose surgery. Separately—and this might sound strange—I've dealt with back pain for ten years, specifically moderate to advanced degenerative disc disease at the L4 / L5 segment. It was honestly tough just getting into a car, and certain positions—like sitting or standing for too long—would trigger a lot of discomfort. But since the nose surgery, all that pain has just... vanished. I don't really get it, and it doesn't make sense to me, but nothing hurts anymore. Is there some kind of rational explanation for this?

My experience - Memorial Hospital
Eleven days ago, I had gallbladder surgery under general anesthesia. This was my first time going under general; I've only had minor procedures using local anesthesia before.
The night before, they give you a thrombosis prevention injection and a sleeping pill. I wasn't nervous, nor was I afraid of the surgery. I just knew it had to be done. No other choice.
In the morning, they wheel you into the OR. You lie on the table. The anesthesia technician and the anesthesiologist come over, introduce themselves, and check your height, weight, and any medications you're taking. You extend your left arm, they strap your right one to the table, and they put the blood pressure cuff on. Then she said, "Let's get started," and ordered the Dormicum. I saw them inject it into my vein, then she placed a mask over my face and told me to breathe it in. I took maybe five or six breaths, and after that, nothing. Total blackout until I woke up—I think I even dreamed during the procedure. The next thing I heard was someone waking me up, asking if they could hear me and telling me to open my eyes. I opened them and they asked how I was feeling. I said fine, though my throat was sore. They told me that's normal from the tube. I asked if they did it open or laparoscopically. Then they moved me to my room. No side effects aside from the sore throat, which made it hard to talk, and a bit of dizziness when I went to the bathroom that evening. That was it. Literally felt like I hadn't even been in surgery.

The murky shadows of medical science

Hi there!

It’s been a while since I’ve had anything to ask here.
I was wondering if anyone has firsthand experience regarding brain tumor surgery—specifically targeting the hippocampus—and what the typical recovery or waking process looks like.
To give some context, this involves a close friend of my daughter; she’s 36 and just underwent surgery at Mayo Clinic today. They mentioned she’s still sleeping and isn't breathing on her own yet—she's currently on a ventilator. The nurse told us to check back later tonight if the doctor is available.
Is it standard procedure to have a patient on a ventilator following brain surgery? And generally speaking, how long does it usually take for them to wake up? 🤔

I’d really appreciate any insight if someone has a moment to reply—we’re all feeling pretty anxious over here. We’re just hoping everything is within the normal range; the most important thing right now is that she's stable.

God!
Was taken off the ventilator last night—waking up occasionally now, but everything seems fine so far 👍
Just taking it one day at a time.
Hi everyone!

Hi there! I have a quick question for an anesthesiologist... So, this coming Wednesday (that's only four days away!), I'm scheduled for cholesteatoma surgery. Last Wednesday, I came down with a bit of a mild cold... just a couple of sneezes, a tiny little cough, and my nose is running just a smidge. I've been taking a decongestant, which seems to be working—my nose is clear, I can breathe just fine, no fever at all... I've also been doing some steam inhalation and nasal rinses, and I don't have any pain. I was just wondering... should I look into postponing the surgery, or is it okay to go ahead? Help!

Don't even start with me, you'll be back on your feet and feeling fine in three days flat

I'm scheduled for inguinal hernia surgery pretty soon, and I was just wondering what kind of anesthesia they typically use for those kinds of procedures...

Is it actually possible to ask for general anesthesia to be administered through a laryngeal mask—or whatever that thing is called—instead of full intubation? Like, can I request to avoid the breathing tube altogether...