Anesthesia, Resuscitation, and ICU: Q&A

Sam Hall15 said:The surgeon is the one who ultimately provides the indication for surgery. A neurologist might suspect that surgical intervention is necessary, but the final call and the decision to proceed lie solely with the surgeon.
As for the anesthesiologist, their role is to assess the patient's overall health to determine if they can actually withstand the specific procedure. If they decide the patient isn't fit for surgery at that moment—just like Scott Allen10 pointed out—they have the authority to pull them from the schedule. Regarding the anesthesia itself, there’s no simple answer; you don't just pick between "Anesthesia A" or "Anesthesia B." It involves various physical delivery methods, different anesthetics, analgesics, relaxants, and many other drugs used to facilitate the process. It's all about individual assessment. We usually plan a certain direction, but during induction, we might pivot to something else based on how things look in the moment.

Oh, really??? So the surgeon calls all the shots... What if the brain is in total crisis and the patient is already physically failing—blood sugar, blood pressure, everything? Does the surgeon just ignore all that and operate anyway? Shouldn't there be some kind of medical board reviewing cases to decide if someone is even capable of undergoing surgery? The doctor who operated on my dad told me there wasn't any committee involved at all.

silverridge36 said:Are you serious? The surgeon makes all the calls... But what if the brain is in terrible shape, or the patient is just too weak—dealing with blood sugar issues or high blood pressure? Can a surgeon really just ignore all that and proceed with surgery anyway? Shouldn't there be some kind of medical board before an operation to decide if someone is actually fit for it? The doctor who operated on my dad told me there was absolutely no committee involved.

I just explained above who manages those specific concerns—the anesthesiologist and the internist who performs the preoperative clearance. As for the core reason for the procedure itself, the final decision rests with the surgeon performing the operation...

silverridge36 said:Are you kidding me? The surgeon just calls all the shots? What if the brain is in terrible shape and the patient is already struggling—you know, blood sugar issues, blood pressure, all that? Can a surgeon really just ignore all those red flags and go ahead with the surgery anyway? Shouldn't there be some kind of medical board or committee reviewing things before an operation to decide if someone is actually fit for it? The doctor who operated on my dad told me there wasn't any committee involved at all.

I am so incredibly sorry about what happened to your father. I truly get why you're hurting and feeling so much resentment right now, but honestly, I don't think this forum is the right place to conduct a legal investigation or hunt for someone to blame. If you genuinely believe the surgeon messed up or that your dad didn't meet the medical requirements for the procedure, you should take legal action. Gather up all the medical records, find a solid lawyer, and file a lawsuit. You could also sue the hospital if you feel like the decision to operate wasn't properly vetted by a review board. Let a judge decide the outcome.
Again, I’m so sorry for your loss, and I wish you nothing but the best with whatever legal path you choose to take.

I’ve gotta hand it to you moderators on this health forum. On top of pulling shifts at the hospital—whether you guys are med students, doctors, or something else entirely—you’re still coming home just to answer messages. When we're feeling under theweather, we know exactly who to turn to!

So, what's actually the difference between getting anesthesia through an IV versus just breathing it in through a mask? I ended up with the mask for my tonsils, but then for my weight loss procedure, they went with an injection... you know, straight into the vein.

I’d also like to circle back to that question Hudson brought up... if someone actually goes through true anesthesia awareness, what are they supposed to do? Who can they even talk to? It seems like so many papers out there just say people don't believe them when they report it, which is... well, yeah. Hm.

The difference lies in the administration method, the specific drugs used, and how the anesthesia is built up. Nowadays, we mostly use balanced anesthesia; this means induction happens intravenously, while maintenance involves a combination of inhaled gases—like a mixture of a potent anesthetic such as Sevoflurane, N2O, and oxygen—alongside other IV medications, primarily analgesics and sometimes muscle relaxants. If a shallower plane of anesthesia is desired, such as for short procedures where relaxation isn't necessary, intravenous anesthesia is typically used. Depending on the duration of the procedure, this can be paired with inhalation via a mask, though without additional drugs to deepen the state. You likely received an IV induction for your tonsillectomy as well, since that helps avoid some of the unpleasant side effects seen when transitioning through the stages using pure inhalation...

electricpanther82 said:I’d also loop back to that question Hudson asked—what should someone actually do if they experience true anesthesia awareness? Who can they even turn to? I’ve seen so many articles mentioning how people just aren't believed when this happens, right?

In my book, the first step would be reaching out to the Chief of Anesthesia. They’d need to sit down with the patient and the anesthesiologist to review the anesthesia record, which gives a clear picture of what was happening during the procedure. Ideally, all three parties should sit down together and just talk through it. From there, the patient should notify the hospital administration and maybe even bring on a lawyer to negotiate a settlement for the pain and distress caused. If that doesn't work, well, then you look at filing a lawsuit.
Of course, you’ve got to have proof. It’s much easier if the patient has a crystal-clear memory of everything—the conversations, the specific people in the room—and those folks can back them up.
It gets way messier, though, if a patient claims they were awake but can’t remember a single thing, especially if the anesthesia chart and vitals don't show anything suggesting they were conscious. In those cases, it’s incredibly hard to prove the patient's word, and it’s easy for people to assume they’re just looking for a payout.

When we’re filling out an anesthesia record, we input precise vitals—blood pressure, pulse, breathing, oxygen saturation—and there’s absolutely no "massaging" the numbers. We can't afford to, because that record is our only defense if something goes sideways. Everything is documented in duplicate (one goes into the medical history, the other to the anesthesia archive), along with the patient's signed consent (signed before premedication, obviously), so the risk of tampering with the charts is kept to a minimum.

Looking at all that, you can see why it’s such a tough sell for staff to believe someone was awake. No one goes into general anesthesia intending for a patient to be conscious, and if the physiological parameters don't show signs of wakefulness, the team feels confident they followed protocol perfectly. If a patient can't recall the flow of surgery, the chatter in the OR, or the people present, it’s really hard to take their word for it. There’s been plenty of talk about depth-of-anesthesia monitoring, too. Unfortunately, most operating rooms in the US aren't equipped with that kind of tech, so I won't even go there (plus, even when you *do* have it, there’s still room for error).
On top of that, it's nearly impossible to predict how a patient will react to our meds. The human psyche is a weird thing. Some people get sleepy during premedication, others get relaxed and chatty, while some might become aggressive or even psychotic. Trying to figure out how much they actually remember versus how much their brain has scrambled is—honestly—nearly impossible. You see similar stuff during induction (before they hit deep enough anesthesia) or even more often during emergence. Waking up is a longer, slower, more dramatic process, and usually, the whole crew is there—surgeons, nurses, techs—everyone is talking, laughing, or moving around the patient.

When you pile all that up and try to make sense of it, I think you get a pretty clear picture of why proving awareness is such an uphill battle in most cases.
The question: "Why doesn't every single one of our ORs have objective depth-of-anesthesia monitoring?"
The answer: Money.

Thanks for letting me in 😁
I've got nose surgery coming up in about two months under general anesthesia—woohoo! Honestly, at this point, I might just prefer being knocked out with a blunt object to the head 😂

I’ve been under general anesthesia three times now. The first time was rough—I couldn't stop throwing up after I woke up, and I felt pretty out of it for a while. The second time? Totally different. I was wide awake almost immediately and just had some mild nausea. It honestly felt like I hadn't even had the anesthesia or anything. (Plus, my anesthesiologist was top-tier; they really took the time to prep me and kept talking to me because of how bad that first experience was. Sadly, I didn't catch their name.)
The last time, about a month ago, they put this tube through my nose down into my stomach. It meant I didn't throw up at all since the tube (which is super uncomfortable, but still better than puking) was draining my stomach, but it left me feeling totally groggy all day. I couldn't even speak coherently. I mean, I understood what was going on, but I couldn't give normal answers to questions. I even said some things to my mom that I don't even remember saying.

Anyway, while I was at the hospital, I saw them give a woman general anesthesia directly into her spine using a catheter they left in, and they used that same line for her IV fluids later. Apparently, it's some kind of new method. (Sorry if someone already posted about this, I haven't read everything yet.) Maybe they would've tried it on me, but I had to go under surgery urgently, so there wasn't any time to experiment with new techniques.

Everything’s fine by me—honestly, I don't mind throwing up at all, as long as we don't end up like those guys in that old joke:

-Doctor, did the surgery go okay?
-I'm not a doctor, I'm Saint Peter.

Trust me, when you’ve got an incision running from just below your chest all the way down past your belly button, vomiting is the absolute worst kind of nightmare.

Brenda Ramos2 said:Trust me—when the incision line is sitting just below the chest and runs all the way down past the belly button, vomiting is an absolute nightmare.

I'm actually having nose surgery... :S so, what was it you had done?

So, I dealt with an intestinal volvulus. They ended up removing a section of my large intestine. That was the most recent thing. Before that, my first two surgeries were on my shoulders.

Brenda Ramos2 said:About a month ago, they popped this tube down my nose right into my stomach, so I didn't have to deal with throwing up at all. That thing is super uncomfortable, honestly, but I guess it beats being sick, since it just drains everything out of your stomach—though it left me feeling totally woozy and unable to even hold a conversation for the rest of the day.
..............
Anyway, while I was at the hospital, I saw them give this woman general anesthesia straight into her spine through a tube they left in, and then they used that same tube for her IV fluids later on. It sounded like some kind of brand-new technique. (Sorry if someone already mentioned this, I haven't caught up on every single post!) Maybe they’ll try that with me too, but I had to go under surgery so fast that there wasn't really time to mess around with experimental methods.

That stomach tube wasn't actually about the anesthesia or stopping you from vomiting; it was likely because of the surgery for your bowel obstruction (ileus), which is a total emergency and needs immediate surgical intervention. After a procedure like yours, your bowels basically go dormant for a bit, meaning nothing is moving through them. Meanwhile, your stomach keeps pumping out acid, and since things aren't moving along normally, that stuff has nowhere to go.
Once the surgery is done, everyone waits for things to start moving again. But until that happens, it's pretty standard for a patient to have a nasogastric tube to drain that stomach contents out. Also, while your gut is resting, you definitely can't eat or drink anything! If things don't kick back into gear on their own, besides maybe giving certain meds (usually neostigmine), doctors might resort to enemas or suppositories and other "fun" little tricks... but none of that has anything to do with the anesthesia itself.

"General anesthesia straight into the spine through a tube..." sounds like you're talking about an epidural, which is the exact same thing they use for things like pain-free childbirth. And honestly, that isn't some cutting-edge new thing; it's a standard procedure that American anesthesiologists have been using for decades.
There are specific times when you use an epidural and times when you absolutely shouldn't. Your situation definitely isn't one for an epidural, and even if an anesthesiologist wanted to help, they wouldn't be doing that for an ileus. Usually, it's reserved for surgeries on the legs or pelvic area... that's where an epidural is perfectly fine, both for the surgery itself and for managing pain afterward. When you say they were giving her "infusions through it," it sounds like they were just providing post-op pain management through an epidural catheter. It's not exactly like a regular IV drip because those doses have to be incredibly precise, but that's a whole different conversation...

northernpanther12 said:Honestly, everything is fine by me—I don't mind dealing with nausea or throwing up, I just don't want to end up like that guy in the joke:

-Doctor, did the surgery go okay?
-I'm not a doctor, I'm Saint Peter.

When it comes to the actual risks of anesthesia, potential hiccups, complications, or even just what you should expect to feel once you're recovering, you really need to have a real heart-to-heart with your anesthesiologist. Surgeons tend to be pretty surface-level about all this stuff... they usually just give you the "here’s the plan, it might hurt a bit, you'll be home in a few days" routine and call it a day... but when you realize there's so much left unsaid that could actually matter... man, it's a real trip.☕

Scott Allen10 said:"giving general anesthesia directly into the spine through a tube..." ...it's most likely epidural anesthesia, the same kind used for things like painless childbirth. And honestly, this isn't some groundbreaking new thing; it's a procedure that's been standard practice across all American anesthesiology departments for decades.

Maybe you've got a point there, but I seriously had no clue you could even administer general anesthesia that way. The woman was actually having surgery on her lizard. And the anesthesiologist who showed up insisted it was a brand-new technique, so... look, I'm no expert.

BTW. There was a lady lying right next to me with a "tube in her nose," and she was just having jaw surgery.

Honestly, I find myself completely adrift... I have poured over everything written here, yet I am still left without any clarity on what path to take...
I have an ankle surgery scheduled in a few days to have some screws removed. Back when I broke my leg and they installed them, I was given spinal anesthesia. It wasn't a bad experience in itself, though I did suffer through intense pain afterward because I needed to use the restroom and simply couldn't—that specific area stayed numb for about half an hour after my bladder was already full 🙄.
Now, the prospect of that discomfort haunts me, which makes me lean toward requesting general anesthesia. Yet, I can't shake the thought that being hit with waves of nausea and vomiting is its own kind of catastrophe... It leaves me feeling utterly conflicted.
I have never undergone general anesthesia before; that first surgery was my only introduction to the whole process, so I truly cannot fathom how my body might react. A girl who was staying in the same room as me for the exact same procedure requested general, and just an hour after she was brought back from the OR, she was sitting there devouring her lunch as if nothing had happened, without a hint of sickness.
I am also wrestling with one more question: what is the actual possibility—and how significant is the risk—of remaining paralyzed or incapacitated following spinal anesthesia?
I am hoping that one of you medical professionals might be able to offer a suggestion or perhaps some seasoned wisdom on how to proceed...
Thank you in advance!