Anesthesia, Resuscitation, and ICU: Q&A

So I finally went under the knife yesterday to get this tattoo removed—local anesthesia only. Honestly? Total breeze. The doctors nailed the dosage so I didn't feel a thing—plus, I had a total babe of a nurse keeping me company! 😁

Quick question for urbanscout50—and it’s a straightforward one—why do some people experience vomiting after surgery? In my case, I had a middle ear procedure that lasted about an hour and a half to two hours, and once I woke up, the nausea was intense, followed by nearly two days of vomiting. They mentioned it could be due to the nature of the surgery itself—since you're working near the equilibrium center and all that—but my gut feeling is that it was actually the anesthesia. I had three much lighter surgeries back when I was a kid, and I never dealt with any vomiting then.
Is there any way to prevent this, or at least make it more manageable? Honestly, the whole experience was just a nightmare.🙂

While we wait for urbanscout50 to weigh in, here is my take on this. Certain anesthetics can certainly trigger nausea and vomiting, which is why antiemetic drugs are standard protocol following surgery. However, prolonged vomiting is almost always a direct consequence of the surgical procedure itself rather than the anesthesia, particularly when propofol is used as the induction agent. There are several different ways to prevent these symptoms, so it is quite possible your discomfort wasn't addressed by the anesthesiologist...

Sophia Thompson46 said:If I could just ask a quick question—it seems pretty straightforward—why do some people end up throwing up after surgery?

The question is simple enough, but man, the answer is actually pretty complicated.
Postoperative nausea and vomiting, or POMP, is a super common side effect of general anesthesia. It’s honestly one of those incredibly unpleasant, draining things that can really wear you down. I hear patients say all the time that the vomiting feels way worse than the actual pain from the procedure.

Whether it happens depends on the patient, what kind of surgery they’re having, and the specific anesthetic used.
1. People who are just more prone to it: folks who have dealt with nausea after previous anesthesias, women, people who get motion sickness easily, and non-smokers (and hey, I’m not out here telling anyone to start smoking!).
2. Types of surgeries where it’s more common: brain surgeries, ENT stuff (like middle ear procedures), major chest surgeries, big abdominal or laparoscopic surgeries (think gallbladder or gyno stuff), and even eye surgeries like correcting strabismus.
3. The drugs involved: the opioids used during or after surgery for pain management (for example, a lot of people feel sick after taking Tramadol, which is a common painkiller), and volatile anesthetics (those gases the patient breathes in).

So, what can we do about it?
1) During the pre-op checkup and chat with the anesthesiologist, we look at how many risk factors a patient has for developing POMP.
2) Once we weigh everything up, we estimate the risk and adjust our anesthesia technique accordingly, using different anti-nausea meds to help out.
For instance:
- If we can swing it, we use regional anesthesia instead.
- When general anesthesia is necessary, we try to avoid the specific drugs known to trigger POMP.
- We often use Propofol for general IV anesthesia.
- We give anti-nausea meds either right before or towards the end of the anesthesia.
- After the surgery, we want to stop the opioids as soon as possible and switch over to non-opioid painkillers.
- We keep the anti-nausea meds going once the patient is moved to the recovery ward.

So yeah, that’s the short version of the deal with POMP. In your case, the most likely culprit for the lingering nausea is probably the surgery itself, especially since your previous anesthesias went smoothly without any issues. Unless they stopped the anti-nausea treatment in the recovery unit—which I doubt, because nobody wants patients throwing up on their watch—then, well, that’s just bad luck.

P.S. Unfortunately, there are some people where nothing seems to work, and they keep throwing up despite all our medications and best efforts to help them feel better. In those cases, our hands are tied... or maybe their body is just giving us feedback on how it handled the anesthesia and the surgery. 🤷

Thanks for all the input!

Hey everyone,

I was thinking today—has anyone here gone through surgery recently, or maybe you're currently gearing up for one? If so, did you ever stop to really think about the potential risks involved with anesthesia?
Did you find yourself feeling anxious or having specific questions about it, and if you did, did you reach out to someone, like your primary care physician, to talk it through?
It’s funny how we often overlook the anesthesiologist. Most people don't realize they are essentially your guardian angel in the operating room. They are literally the ones managing your breathing and keeping your heart beating while making sure you stay safe and pain-free throughout the entire procedure. Plus, they act as such a vital check-and-balance for the surgeons—you could honestly consider them your biggest advocate once you're under the lights.

I'd love to hear your thoughts on this!

Man, Jerry Fowler6... honestly, if you check out the top-tema forums, there's actually a whole section dedicated to anesthesiology where an actual anesthesiologist will jump in and answer all those kinds of questions when they get around to it anyway.

I don't even get why this thread exists... 🤷...it’s totally redundant... locking this down now.

I have combined 😁
...

Scott Allen10 said:Oh man, Jerry Fowler6... honestly, just remember that we have a dedicated section on top-tema specifically for anesthesiology. Once things settle down, an actual anesthesiologist will jump in there to address those kinds of questions and everything else you're wondering about!

What’s even the point of this thread?🤷There’s really no need for any of that... I'm locking this down...

Oops, my bad! I totally missed that—I clearly wasn't paying close enough attention. 😉

When someone is facing surgery for a blocked carotid artery, who actually makes the call on whether they’re fit for the procedure—the anesthesiologist or the neurologist (especially if there's a history of stroke involved)? What specific health factors are being weighed during that decision? Also, what type of anesthesia is typically considered the best approach here?

I mean, deciding whether someone is actually fit for surgery isn't really up to the neurologist—they don't have much say in the actual risk assessment or how the procedure goes down. That’s really on the anesthesiologist. They run those pre-op exams to gauge the risks and walk you through everything, and if they decide on the day of the procedure that things just aren't looking safe, they have the final word to pull you from the schedule. A neurologist basically doesn't have a clue when it comes to those specific surgical risks...

urbanscout50 already did a deep dive on the different types of anesthesia, making the point that you can't just pick one without looking at a bunch of different factors. You can't just hop on a forum and give a simple "this is the best anesthesia for this condition" answer, even though I know that's probably the quick fix everyone is looking for.

Ultimately, it is the surgeon who determines if surgery is necessary. While a neurologist might suggest that a surgical intervention is warranted, the final decision and the responsibility for the procedure itself rest solely with the surgeon.
Regarding the anesthesiologist, their role involves assessing the patient's overall health to determine if they can safely undergo the procedure. If they decide the patient isn't in the best condition at that moment, they have the authority to pull them from the schedule, just as Scott Allen10 so aptly pointed out. As for the anesthesia itself, there isn't a simple answer to that question; you don't just choose between two or three different types of anesthesia. Instead, it involves various physical methods and a combination of different anesthetic agents, analgesics, relaxants, and many other medications used to facilitate the process. It is a highly individualized assessment where a general plan is established, but the specific approach may shift during induction based on how the patient responds in that exact moment.

Carol Price79 said:Unfortunately, it was my mother. She survived a C-section with me 34 years ago. The doctors didn't believe her at first, but once she recounted snippets of conversations from the OR—things like what the surgeon said to a nurse—they finally had to take her seriously. She felt the pain whenever she regained consciousness, and given how intense those pains are, the doctors actually called her a medical phenomenon. Looking at the advanced monitoring equipment you're hooked up to today, it seems a bit strange to me that her heart rate would have stayed within normal limits.

I don't have time to quote everyone, so sorry if I'm repeating myself...

There’s a fascinating phenomenon discovered through hypnotic regression: most people can actually recall quite precise details of what happens while they are under anesthesia, even though they aren't consciously aware of it.

It suggests that even under anesthesia, some part of the mind is recording everything. That might even explain those "out-of-body" experiences where people describe surgical procedures with startling accuracy...

What’s even more interesting is how suggestible people seem to be during that state. These insights into regression actually surfaced while studying postoperative depression. It turns out a lot of the time, the cause was just a careless comment or a joke made by a doctor during surgery. They might think the patient is "unconscious" or can't hear them, but the patient subconsciously absorbs that suggestion, and later behaves accordingly. Apparently, there were experiments where one group received standard care while others were given positive suggestions during surgery; there was supposedly a significant difference in recovery speed and success based on the attitude and words used by the surgeon and staff. I’m not sure who was specifically tasked with talking to the patient under anesthesia—probably the anesthesiologist?

Anyway, whether we realize it or not, it seems something is always being recorded, even under sedation.

Hypnosis alone is utterly insufficient to establish any semblance of truth. It has been established repeatedly that in countless instances where an individual claims to recall events—even with vivid detail and intense emotional weight—what they are actually experiencing is nothing more than the hypnotist's suggestion. We have seen high-profile cases where adult daughters, following hypnotic sessions, leveled accusations of sexual abuse against their fathers; despite being profoundly convinced of their own recollections, investigations proved those claims were entirely false. Yet, they remain unshakably certain of what they "remember."
I won't even begin to mention that individuals susceptible to hypnosis are, by definition, highly susceptible to suggestion. If even a single question posed during the session was framed toward eliciting memories of a surgical procedure, then the outcome is already predetermined.

Regarding those experiments involving positive suggestions during surgery, you really ought to track down that specific study. It is entirely plausible that the researchers simply treated that group of patients with a bit more care both before and after the operation. That kind of variable is enough to completely invalidate an experiment.

What you’ve written is certainly possible, but I suggest we approach it with a healthy dose of skepticism.

stormymaker24 said:Hypnosis alone isn't enough to prove anything. It’s already been established that in countless instances where people recall things—even in vivid detail accompanied by intense emotion—it’s actually just hypnotic suggestion. There are some pretty famous cases where adult daughters accused their fathers of sexual abuse following hypnosis; even though they were absolutely convinced it happened, investigations proved the opposite. Yet, they remain certain about what they "remember."
I won't even get started on how people susceptible to hypnosis are essentially just highly suggestible. If any question asked of them was even slightly steered toward recalling surgical details, the case is closed.

As for those experiments involving positive suggestions during surgery, you'll have to track down that specific study. It’s entirely possible that the researchers simply treated that group of patients a little better both before and after the procedure. That would ruin the whole experiment.

What you wrote is possible, but let's take it with a grain of salt.

Of course, regression itself is never proof. I’m aware of those cases. My first point is that regression can't be used to verify things like past lives, and you can't rely on it to confirm factual events with certainty. Even if an experienced therapist knows how to avoid nudging a client through indirect suggestions, there are still no guarantees. No argument there. However, the fact that a patient can describe specific surgical details that neither they nor the therapist could possibly know is much more interesting.

By the way, I'm not sure what you mean by "people who are susceptible to hypnosis." Everyone is, unless there's significant brain damage. Hypnosis isn't just that old-school "Freudian 30%" versus a few percent of "somnambulists" anymore. Our understanding and approach have progressed since then, even if there are still plenty of therapists—and even researchers—who only have a surface-level grasp from a weekend seminar and end up with those same old results. 😁

It's unlikely I'll find that paper right now; I have no idea where I read it. 🤔

I’m going to dive right in here 🤦

No, you absolutely cannot hypnotize just anyone. You can only influence those who possess a certain level of suggestibility; it is a matter of temperament. Furthermore, there is a vast spectrum regarding the depth of that influence. With some, you might induce a trance; with others, you may merely facilitate a conversation. Some will recount their dreams to you, while others might spill childhood memories or even describe a movie they watched as if it were a lived experience. There are even those who would act like manic fools upon command. However, everyone—without exception—will snap out of it the moment a suggestion conflicts with their core moral values or threatens their life, provided they aren't already suicidal.
It is also an empirical reality that those most susceptible to hypnosis tend to be less educated and fall below average in intellectual capacity.
A significant portion of the population stands zero chance of being hypnotized; if you even attempt it, they will look at you as if you’re the last person on Earth.

As for these "specific details" of a surgery that supposedly no one could have known? What on earth are we talking about? These days, you can find an exhaustive, granular description of almost any surgical procedure online. While individual physiological differences certainly exist, if hypnosis is actually occurring, a considerable amount of time has passed between the operation and the "recollection." There is an immense amount of information a person can absorb in that interval. And if a surgeon is called in to validate a memory... well, I personally had to struggle to remember my own actions a full week after my own surgery. Human beings are prone to forgetting, and they fill the gaps in their memory with whatever nonsense comes to mind.

I truly believe that life, in all its chaotic glory, tends to scramble one's faculties enough (now including my own personal experiences 😁) that maintaining true consciousness is a struggle. I can barely recall the things I did when I was simply intoxicated, let alone anything involving anesthesia, unless there was a genuine failure in the medication's efficacy or a lack of proper sedation.

And at this point, we have drifted quite far off topic.

stormymaker24 said:I’m about to dive headfirst into this. 🤦‍♂️

Don't bother. It isn't worth chasing after someone just because you're chasing a delusion. 😛 😬

No, you can't just hypnotize anyone.

You can hypnotize pretty much any normal person. At its core, hypnosis is just manipulation through standard psychological mechanisms. We enter a "trance" all the time—when we're daydreaming, zoning out in front of the TV, driving down a highway, or during a massage. Only someone with a cold, robotic, purely analytical mind—someone who isn't really human in the traditional sense—would be incapable of hypnosis. It’s also a misconception that hypnosis requires a relaxing trance. Under US legal definitions, for example, hypnosis is simply bypassing the mind's critical factor. You don't need your eyes closed or to be physically relaxed; those are outdated concepts, just one possible way to do it. But let's set that aside and stick to the classic idea of a trance. Even then, almost anyone can be hypnotized. The only exception is someone who consciously or unconsciously resists, usually out of fear. That's really it. Virtually everyone—or nearly everyone else—can be hypnotized, provided you strip away the fears and the nonsense ideas people pick up from movies, stage performers, and a whole heap of other unprofessional sources.
The idea that a client can't be hypnotized is usually just an excuse. It’s a convenient way to dodge the fact that the hypnotist simply couldn't make it happen. Honestly, it's a standard defense mechanism. Unless someone is dealing with a truly severe neurological disorder, hypnosis works. 🙂

You can only hypnotize people who are naturally more suggestible and prone to it.

Like I said, I was completely off base. 🙂

There’s also the question of just how deep you can actually take someone under.

It’s possible, though you could pretty much induce sleepwalking in almost anyone, whether it happens during the first session or the third.

Fewer people actually reach that hypnotic coma or Esdale state. Usually, they have to work a lot harder with hypnosis to get there. As for reaching the Sichort level? Even fewer manage that, though honestly, the whole concept is questionable. It’s not even certain if we can define it as its own distinct state yet—it's still pretty new territory.

You can always put someone to sleep.

If you induced anesthesia, then we aren't talking about hypnosis. That has absolutely nothing to do with sleep.

You can actually talk to someone. Someone will end up recounting their dreams to you.

With hypnosis, you can talk to anyone right up until they hit a somnambulistic state. Once you go below that level—into territory like Esdale or Sichort—things get tricky. At that point, people start pushing back. They might still hear what the therapist is saying, but they just stop caring. As for Sichort, honestly, there isn't much data on it yet.

It’s also worth noting that people who are most susceptible to hypnosis tend to have lower levels of education and fall slightly below average when it comes to intellectual capacity.

Nonsense.
There’s some talk out there suggesting it might be easier to hypnotize someone of the opposite sex, or that people from laid-back, tropical climates make better subjects than those from colder regions. But honestly, I think education and profession play a much bigger role in how you approach a session. Take a guy who is completely burnt out from a high-stress corporate job in New York City. He isn't going to respond well to standard relaxation inductions; he’ll either pass out immediately or get too agitated to actually settle down. Then you have the highly analytical, skeptical types—people who overthink every single suggestion. Their constant need to dissect everything makes it nearly impossible for them to just let go. In those cases, if we're talking about direct hypnosis rather than the more subtle Ericksonian style, you're better off using rapid confusion techniques instead of trying to force relaxation. 🙂 To someone with less education, hypnosis might seem like some mystical old wives' tale. But if you're dealing with someone more educated and skeptical, you’re going to have to work harder to explain the actual mechanics of it. The truth is, anyone can be hypnotized. I once had this experience with a university professor who was incredibly dismissive of the whole thing—thought it was just silly nonsense. If I had tried to force him into it right out of the gate, it wouldn't have gone anywhere. But we talked. We went through the explanations and cleared the air. After a little while, it worked perfectly. It wasn't that he was "unhypnotizable"; it was just a case of a mediocre hypnotist failing to build rapport.

There’s a huge chunk of the population you simply can’t hypnotize. If you try, they’ll just stare at you like you’re some kind of total weirdo. Not directed at you specifically, just a general observation.

I’ll say it again: you can hypnotize anyone if they actually want to be hypnotized. If someone develops the motivation—say, due to a psychological issue where their therapist suggests it—and their fears are cleared up, they’ll likely go under. Most people's resistance just comes from a lack of understanding or all those myths they see on TV. It isn't that they aren't "suggestible"; it's that they don't want to be. That's assuming we're talking about direct hypnosis. If you're an expert using more subtle, indirect methods, you could probably slip someone into a trance regardless of their attitude. Just ask Sacreus. He’s studying psychology and going through psychotherapy training, which involves a lot of work with indirect techniques. He’s successfully hypnotized plenty of people who swore they were impossible to hypnotize—people who insisted it wouldn't work on them—only to find themselves staring at a watch with a total gap in their memory. 😁
I was just saying how much hypnosis has evolved since the days of staring at a pocket watch or lounging on a couch. It’s honestly baffling that you still see such outdated information being peddled in the public eye—and frankly, even among professionals.

Specific surgical details that nobody could have known? Like what? These days, you can find a granular description of almost any procedure online. Sure, there are individual differences, but if hypnosis was involved, some time has definitely passed between the surgery and those "memories." There’s an enormous amount of information a person can stumble upon in the interim... and if they went looking for the surgeon to validate their story... well, I had to struggle to remember what I’d actually done a full week after my own surgery. People forget things, and they fill in the blanks with whatever helps them make sense of it.

Honestly, anything is possible. I haven't participated in these studies myself, nor do I know where to track them down to be certain of anything beyond a few general conclusions drawn by 🙂 If we're talking about a complex procedure—especially one where complications arose and things weren't routine—if someone describes details unique to a specific OR, like the exact layout, colors, the specific people present, or more importantly, what was being said, then it’s harder to dismiss it as mere coincidence. I heard a case once during a lecture by a well-known hypnotherapist—a patient was dealing with postoperative depression and phantom pains without a physical cause. They "uncovered" that the surgeon had made an inappropriate comment, making her believe she was "beyond saving." If it’s later confirmed that the surgeon actually said that during the operation, that’s a very specific detail. Again, anything goes. I don't recall many specific studies, and the mind is tricky enough to manufacture all sorts of things. It doesn't mean it's true, but I've read about such research and I'm just sharing what I remember. Take it or leave it 🙂

I think drugs mess with you enough—and I'm speaking from personal experience now—that staying conscious isn't really the issue. I can't even recall half the stuff I did when I was drunk, let alone anything under anesthesia, assuming there wasn't some level of "wakefulness" or insufficient medication.

We simply can't consciously recall everything, because things can be unearthed through both hypnotic and non-hypnotic methods (though "hypnotic" is a pretty relative term, and I don't want to overcomplicate things 😬 ). I don't think the existence of memories that aren't easily accessible to the conscious mind should be a point of contention 🙂

It is only now becoming painfully obvious to me why naturalists harbor such an unrelenting disdain for psychologists. 🤦
An incredibly dangerous neurological disorder... oh my God! 🙂

If a person is squinting their eyes shut, how on earth are they supposed to perceive the colors in the room? Perhaps through a third eye?
I know exactly what the room looked like because I was brought in while fully awake, so I fail to see why that is considered controversial.
Look, you’ve certainly spun quite a yarn here. Based on your opening remarks, it is blatantly clear that everything you've said is nothing more than hearsay. In fact, large portions of your argument don't hold water at all—not even close. And yes, the human brain is capable of anything once you unshackle it; it invents, it patches over gaps, and it concocts utterly bizarre explanations for perfectly simple occurrences. That is far more likely—and scientifically proven—than any "memories" being dredged up through hypnosis.
But fine.

stormymaker24 said:If someone’s eyes are squeezed shut, how on earth are they supposed to see the colors in the room? Maybe they've got a third eye tucked away somewhere.

That was just a silly example I threw out there. Let's stick to the actual discussions in the OR. Like I said, I don't recall the specific details of those conversations, but I was just pointing out what would logically be possible. In this particular case involving the colors, it just doesn't make sense. 😁

It’s pretty obvious she was just talking out of her neck.

Like I said before, I recall reading about a study like that. I don’t know the specifics, and I'm certainly not claiming to be an expert here—just passing along the info. 😉

I just stumbled upon this while Googling. It isn't the exact study I had in mind, but the subject matter seems identical...

http://bja.oxfordjournals.org/cgi/reprint/72/6/730-b

It doesn't offer much in the way of actual help beyond confirming the topic exists; they're asking for a subscription to Anesthesiology.