Anesthesia, Resuscitation, and ICU: Q&A

As I’ve mentioned before, it’s quite common for anesthesiologists to staff the clinic because they aren't heading into the OR as often, or due to various staffing shifts. Consequently, the chances of the same specialist performing both the initial assessment and the actual anesthesia are slim. That said, the clinician administering the anesthesia usually has plenty of context from the report provided by the assessing doctor. The real issue arises if a patient has specific requests or if circumstances change unexpectedly, as communication between the patient and the anesthesiologist once they are in the operating room is often limited...

Alright, I think I’m finally starting to wrap my head around this, but one thing still trips me up. How on earth does an anesthesiologist not realize someone is actually awake??
I mean, wouldn't your heart rate spike or your blood pressure go haywire? Or even just your breathing patterns? Is it possible that you lose all control over those things and the machines just make everything look perfectly normal on the monitors while you're actually conscious?

Technically, a patient can't be fully conscious in the literal sense. However, it is possible for anesthesia to be shallow enough that certain senses, typically hearing, remain active. Alternatively, they might just be slowly emerging from a deeper state. If you combine that with effective analgesia and muscle relaxation, it becomes nearly impossible to detect without neurological monitoring like an EEG, which isn't standard practice in most American hospitals.

When it comes down to pure precision, you don't see people running a classic EEG with all those wires looking like a floral arrangement on someone's head during surgery anymore. Instead, we usually rely on depth-of-anesthesia monitoring, specifically using things like BIS (bispectral index) or Entropy monitoring.
Basically, you just stick a sensor patch on the patient's forehead. That little patch uses a few different variables—including the core EEG signal—to track how deep the anesthesia goes. Whether you're looking at BIS or Entropy, you get both a visual graph and a number from 0 to 100. A 100 means the patient is wide awake and conscious, while a lower number shows they're drifting deeper into sedation or anesthesia...

Back in the day, because BIS required its own dedicated machine, it wasn't really a go-to everywhere. But nowadays, most monitors are modular, so you can just plug in a module to handle BIS or Entropy, which is why we're seeing this method become way more common in American hospitals lately.

Obviously, this stuff won't mean much to the old-school anesthesiologists who learned the hard way, but the younger generation will be living and breathing this tech in no time...

Oh, and just to clarify, we aren't doing full-head electrode monitoring here. Since the goal isn't to map out specific brain regions but rather to track alertness levels, we only need a few electrodes on the head—usually just four.

It sounds pretty comforting when you talk about those types of monitors, though I guess I’m just lucky. When I had my tonsils out, I didn't feel a thing—just slept right through it. They had me on an oxygen mask and pumped some stuff into my IV, and honestly, I don't remember a single second of it. Even for my gastroscopy, they gave me a quick sedation for maybe seven or eight minutes, and I know for a fact I was dreaming during that little window😛, and afterward, I was being incredibly chatty😂😂😂As for those horror stories involving surgery, I heard about this woman in the UK who started an online campaign to raise awareness about anesthesia awareness. People all over the world share their stories online, and most of them describe being fully conscious through the whole ordeal—aware of themselves, the surgeons talking in the room... some even reported feeling actual pain, whether they couldn't fall asleep at the start or woke up mid-procedure. I can't imagine how traumatic that is. If those people are seeing therapists now or dealing with nightmares and flashbacks... it's clearly very real for them.😢

Check out anesthesiaawarenesscampaign.com—that’s the site

I mean, how does an anesthesiologist actually figure out the dosage and which type of anesthesia to use, considering everyone is so different?

electricpanther82 said:How does the anesthesiologist actually decide on the dosage and the type of anesthesia used, since everyone's body is so different?

For the dose: It’s all about the patient's actual vs. ideal weight. For fat-soluble anesthetics, they go by what the person actually weighs right before surgery—basically, what the scale says in the OR. But for water-soluble stuff, like muscle relaxants, they usually base it on "ideal" body weight (you know, based on height). That’s mostly how they kick things off, but once the procedure is underway, they're constantly tweaking the dose based on how the body reacts and how much stress the surgery is putting on the system.
As for the type: They look at the patient's overall health, the specific technique they prefer to use, the nature and length of the operation, and honestly, just whatever tools and meds they have available in their kit.

I’ve been stuck on one thought lately regarding anesthesia. I take 50mg of Metoprolol twice a day, and from what I understand, this medication can interact with just about anything. Apparently, you absolutely have to let the anesthesiologist know you're on it before any surgery. But it got me thinking—what if there’s an emergency? Like, say, if I get hit by a car and need immediate surgery? What could actually happen if they put me under general anesthesia without knowing I'm taking this? There's no way to tell them in that moment... how does Metoprolol actually react with those types of drugs? If anyone knows, please help.😕

Hey there! 🙂

I was chatting with a doctor recently about how this works:

Apparently, when your body encounters an allergen for the very first time, it doesn't actually trigger an allergic reaction—meaning you won't see symptoms like swelling or breathing issues right away.

It’s only when the body meets that exact same allergen for a second time that the actual allergic reaction kicks in.

Is that actually true? It sounds pretty weird to me. I always assumed if something is bad for your system, your body would react immediately, regardless of whether it's the first time or the tenth.

Second thing—
Since I deal with food allergies myself (milk, eggs, walnuts... the usual list),
I'm wondering about medical procedures. If I ever need anesthesia, how do doctors ensure they don't trigger an allergic reaction? That goes for both local numbing and general anesthesia.

Thanks so much for any insight! 🙂

silentridge62 said:Hey there! 🙂

I heard this from a doctor recently:

When the body encounters an allergen for the very first time, it doesn't actually show an allergy—meaning there's no immediate danger of symptoms like swelling or breathing issues.

It's only when the body hits that same allergen a second time that the allergic reaction actually kicks in.

Is that actually true? It sounds incredibly weird to me. If something is bad for the body, shouldn't it matter whether it's the first time or the second? Shouldn't the body just react because it's being bothered?

Second thing—
Since I deal with food allergies myself (milk, eggs, walnuts... you name it)
I'm wondering, if I ever end up needing anesthesia, how can we make sure it doesn't trigger an allergic reaction? (Both local and general anesthesia)

Thanks a ton for any info! 🙂

To put it simply, that doctor gave you a pretty accurate breakdown of how an allergy develops.

But it doesn't necessarily mean you'll always have a reaction.

Generally speaking, things should turn out fine. Most issues tend to arise only if you fail to stay consistent with your prescribed medication, but even then, those situations are manageable. Anesthesiologists often enjoy experimenting with different drug combinations; they really are masters of the medical cocktail...

I’m kind of wondering what kind of sedation they gave me for my gastroscopy. I mean, I was out for maybe five or six minutes tops, and I even had some weird little dreams during that window. Is it possible it was something like Propofol or maybe Midazolam? I noticed the doctor's name on the consent form started with a P, so I'm curious. Does anyone actually know what those drugs do to you? I honestly don't remember a single thing from the procedure itself.🤷🤷🤷

Elizabeth Hill48 said:what happens if they give me general anesthesia and they don't realize I'm taking my meds? there's no way for them to know... how does Metoprolol actually react with those drugs?... if anyone knows😕

So, Metoprolol is a cardioselective beta-blocker. Basically, this group of drugs works on the heart by lowering both the heart rate and the strength of the contraction. By doing that, it reduces the workload on the heart and lowers its demand for oxygen, which helps prevent things like angina or even a heart attack. It’s kind of like giving your heart a little break. It's a super common class of medication, and tons of patients heading into surgery are on them.
The standard approach for anesthesiologists nowadays is to keep the beta-blocker therapy going right up until the day of the procedure (meaning you should definitely take your morning dose). They essentially act as a shield for your heart against the stress caused by the surgery itself—you know, before, during, and after the whole thing.
Now, interactions with anesthetics are definitely possible, and they do happen. See, anesthetics themselves can depress cardiac function, so if a patient is also on a beta-blocker, that effect can get amplified. This could lead to some significant hemodynamic issues, like a heart rate that's too slow or too weak, which then causes blood pressure to drop. That can lead to ischemia—which is just a fancy way of saying certain organs aren't getting enough blood. If that goes far enough, we're talking serious stuff like a stroke, kidney failure, liver failure, or even bowel necrosis.
Think about it this way: in certain situations where blood pressure drops suddenly—like during heavy bleeding—the body usually tries to fight back reflexively by ramping up the heart rate to compensate for the loss of blood. But if the patient is "blocked" by these meds, the heart can't speed up to respond, and boom, you're back to ischemia. It's a similar situation for patients with a pacemaker that's programmed to a fixed rate.
Man, I went on a bit of a tangent there, haha. But honestly, that absolute worst-case scenario is rare. It's possible, sure, but rare. In actual practice, what usually happens is just a slow pulse, and doctors typically only step in with medication if it's accompanied by a significant drop in blood pressure. Usually, they'll use drugs that work through different mechanisms to bump that heart rate back up. And if even that doesn't quite do the trick, they can always set up a temporary pacemaker to gently nudge the rate up to where it needs to be.
Just to hammer it home one more time: beta-blockers are taken right up to the day of surgery. Unlike some other heart meds, you don't skip them before anesthesia.
So, please don't worry. Stick to your prescribed routine and just leave the rest in the hands of your anesthesiologist.

silentridge62 said:Two things here—
I'm asking because I have all sorts of food allergies (milk, eggs, walnuts... you know the drill)
so I'm wondering, if I ever end up needing anesthesia, how do they make sure it doesn't trigger an allergic reaction? (That goes for both local numbing and going under completely)

That’s exactly why we have pre-op clinics and anesthesia consultations. It gives the anesthesiologist a chance to get a handle on your current health status, any medications you're taking, and those potential allergies. It allows them to coordinate and prep everything with their team beforehand. For patients like you, knowing exactly what triggers your system is crucial (it's definitely more than just "blah, blah, blah"...).
There's also this thing called a cross-reaction, where someone reacts to an anesthetic even though they've never actually encountered it before. Basically, they were exposed to something else that primed their immune system, and then when the anesthetic finally hits, the body overreacts. (A classic example is a cross-reaction between muscle relaxants and certain ingredients found in makeup—which is why some women who have used cosmetics for decades might be more prone to developing these types of reactions, which can sometimes get pretty serious).
And honestly, if I ever had to deal with a massive allergic reaction, I’d choose to have it happen in an operating room every single time. At least there, you're right next to the anesthesia team. They're the only ones with all the gear, the meds, and the skills needed to jump in and save you immediately.

electricpanther82 said:I’ve been sitting here wondering what kind of sedation they actually gave me during my gastroscopy. I was out for maybe five or six minutes tops, and honestly, I even had some weird dreams during that tiny window. Is it possible they used Propofol or maybe Dormicum? I know on the consent forms there’s always some doctor’s name starting with a "P," which makes me think. Does anyone actually know what those drugs do to you? Because, frankly, I don't remember a single thing about the procedure itself.🤷🤷🤷

Does any of that even matter? Honestly, the main thing is that you slept right through it, didn't feel a thing, and can't remember a single second of it. Plus, you hopefully didn't blurt out anything you’d rather not have on the record. That's really all that counts. 😕
P.S. It’s probably Propofol, honestly. That stuff gives you such a smooth anesthesia—you wake up feeling great, totally clear-headed, and just ready to go.

Sam Hall15 said:The previous post was addressing questions regarding beta-blockers.
Regarding allergies and anesthesia, there is a risk involved—it’s not massive, but you definitely can't just ignore it. Generally, if this comes up, the anesthesiologist will tailor the sedation using drugs that are less likely to trigger an allergic response. They might steer clear of Propofol, though they could still use it since reactions are pretty rare, and they'll typically avoid certain muscle relaxants—specifically those known for triggering histamine release. Depending on how high the allergy risk is assessed, preventative measures might also be put in place.

Edward Sanchez72 said:Basically, your doctor gave you a perfect summary of how an allergic reaction actually works.

You don't necessarily have to have a full-blown reaction for it to be happening.

urbanscout50 said:That’s exactly why we have pre-anesthesia clinics and consultations. It allows the anesthesiologist to get a clear picture of your current health, any medications you're taking, and potential allergies. This way, they can coordinate and prepare with their colleagues ahead of time. For patients like this, knowing exactly what they are allergic to is vital (it's much more than just some technical jargon...).
There is also something called a "cross-reaction," where a patient reacts to an anesthetic even if they've never been exposed to it before. This happens because they were previously exposed to a different substance that primed their immune system, and when they finally encounter the anesthetic, the body triggers an allergic response. (A classic example is a cross-reaction between a muscle relaxant and an ingredient found in makeup; this is why women who have used various cosmetics for many years may be more prone to developing these types of—sometimes very severe—allergies).
Ultimately, if I ever had to choose a place to experience a severe allergic reaction, I would ALWAYS choose an operating room near an anesthesia team. They are the only ones with all the necessary equipment, medication, and expertise to perform effective resuscitation.

Thanks so much for the info and the quick replies!👍

I’m wondering what kind of recourse someone actually has after experiencing true anesthesia awareness... You know, feeling the pain during surgery because the anesthesiologist just wasn't sharp enough to notice, all while the patient is paralyzed by muscle relaxants so they can't move or even scream. The person is absolutely traumatized from feeling every single incision. What should they do now that the surgery is over? What actually happens in these cases?

So the patient complains, the anesthesiologist feels a momentary pang of guilt, and that's the end of it? In the US, I'm honestly skeptical about whether you could successfully sue for PTSD. It feels like everyone would just shrug their shoulders and look the other way. That story about the 80-year-old lady sounds like textbook PTSD to me. A lawsuit? Unlikely. Reporting it to the Chief of Medicine? Probably just met with a wave of the hand... so what's left?