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Unread 09-30-2010, 08:41 AM
 
Location: Ohio
889 posts, read 1,327,931 times
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Default Anesthesia is hard on the body

I kind of understand, but are there any people in the health profession that can give me a more detailed explanation on why anethesia is so hard on one's body? Especially older people. It seems like they are never the same after going under. (Especially memory.)
Also, what is the cocktail of drugs they give when they put people out for surgery? Are there any parts of the cocktail one could ask them to forgo?
Thank you!
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Unread 09-30-2010, 04:26 PM
 
Location: St. Louis
7,187 posts, read 7,156,780 times
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I'm glad you brought this up--I can't answer your question, but I can add some of my own.

ABout 5 years ago I had a colonoscopy and they gave me general for it. It took me a week to recover and my bones hurt during that whole time--I felt mildly flu-ish. Also, it took me quite a while to wake up and I couldn't eat for the rest of the day. What could have caused that? Is it likely to happen again? I would be seriously afraid if I had to have a major surgery like heart surgery done. But then again, I'd be afraid to tell them for fear that they wouldn't put me enough under and I'd wake up. I'm not a fearful person and had no worries before the colonoscopy, but now I'd probably worry myself sick. I'm 50, so not young, but not exactly elderly either.
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Unread 09-30-2010, 05:17 PM
 
Location: Wallis and Futuna
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I'm not a medical professional but I've had bunches of different types of surgeries for assorted things (from getting my tubes tied, to steel plates/rod in arm/leg for broken bones from a car accident, to lumpectomy, to arthroscopic knee surgery, etc). I've also been on hand when my sister had a series of recent major surgeries.

I can tell you they used to use sodium pentathol in the cocktails but too many people have adverse reactions to it so it isn't used anymore. All "cocktails" are custom "blended" to suit the patents' surgical needs. Height, weight, body mass, the actual surgery being performed, allergies, known reactions, and in some cases even patient request, can be contributing factors into what goes into the mix.

When I had my knee surgery I asked to be awake for it. And so I got what amounts, mostly, to a really strong valium drip. Very cool surgery, if you ever have to have arthroscopic surgery, and the doctor feels you're a good candidate for it, I highly recommend watching the whole thing "live" on the monitor over your head.

When I had bone grafting on my upper jaw to accommodate a dental implant, I was required to take 4 Halcyons (an incredibly powerful amnesiac/sleeping medication) 15 minutes before sitting in the dentists' chair. Apparently I was awake for most of it, and even started singing to the dentist (who is also an oral surgeon). And at one point I had to go to the bathroom and demanded that my husband escort me, so they had to fetch him from the waiting room. But I don't remember a thing.

In other cases I had serious general anasthesia, which involved valium (that seems to be pretty common), demerol, an amnesiac of some kind, and nitrous oxide gas. Those are the drugs I respond best with so those are mostly what I end up getting. The proportions might even be different from one surgery to the next but in general - a cocktail will consist of:

1. something to make you fall asleep - not unconscious, just heavily asleep. A strong sedative.
2. something to make you not remember what happened, IF you wake up during surgery - an amnesiac.
3. something to dull/mute/obscure the pain - a narcotic painkiller

The amnesiac is actually a lot more important than you might think - but it, combined with the narcotics, can cause confusion upon waking up and even for a few days after that.

During general anasthesia, you're also dealing with being intubated - having an oxygen tube insterted down your throat to breathe for you, and keep you motionless. This can cause a patient to become -extremely- stressed, if they wake up while the tube is still in there. I was intubated after my car accident in CICU for 4 days, and they had to keep me heavily sedated with morphine, because every time I woke up, I'd try to take a deep breath and it would set off the monitors and they'd be all running in to see if I needed a defibrillator. That was a life or death situation though because I had an embellism running up a vein toward my lung at the time so keeping me perfectly still, unstressed, and oblivious, was an urgent matter.

Usually though, they pull the tube out of your throat shortly after surgery, once they've determined that your vital signs are stable. Then, you wake up with cotton-mouth and a sore throat, and the combination of intubation plus all those drugs that keep you from waking up in the middle of surgery really throws your body for a loop and makes you feel like you got run over by a truck. If you're in good health (other than the reason for the surgery, obviously), it fades quickly. If your constitution is weak, it takes longer.
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Unread 09-30-2010, 05:29 PM
 
Location: Georgia, USA
8,516 posts, read 7,228,969 times
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The "cocktail" varies with the patient's age and general health and the expected duration of the procedure. It may include a pain medication (starting it before surgery to be "ready and waiting" afterwards), something for anxiety, something to make you drowsy, something to decrease oral secretions (spit, in other words), something to reduce recall of the more unpleasant aspects of the whole process, and something to prevent nausea.

In the operating room, a fast acting sedative is given IV --- usually works in a few seconds. A gas is then administered through a tube down the patient's trachea or by a mask over the nose and mouth.

Decreasing anxiety and making you drowsy helps to reduce the total amount of anesthesia needed. Decreasing spit means not having to suction secretions out of the patient's mouth and throat while the patient is unconscious.

With pain medication and something for nausea, the goal is to have a patient regain consciousness with a minimum of discomfort.

I recently had general anesthesia. When I woke up, I was not in pain and had only very slight nausea, for which I was given more medication in the recovery room.

I really would not expect any long term effects from the anesthesia.

An alternative for many surgical procedures is "regional" anesthesia, such as an epidural or a spinal. Many orthopedic procedures can be done by blocking the nerves to an affected limb. This bypasses general anesthesia altogether. I personally had a nerve block to set a broken wrist. The block worked great, but I got a little antsy because it took a long time. In retrospect, I might have preferred the general anesthetic.

So you see, each of the drugs in the "cocktail" serves a purpose. If you have concerns, ask to be set up with a consultation with the anesthesiologist before the day of surgery, so you can work out the best type of anesthesia ahead of time.
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Unread 09-30-2010, 05:31 PM
 
Location: Georgia, USA
8,516 posts, read 7,228,969 times
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Quote:
Originally Posted by AnonChick View Post
I'm not a medical professional but I've had bunches of different types of surgeries for assorted things (from getting my tubes tied, to steel plates/rod in arm/leg for broken bones from a car accident, to lumpectomy, to arthroscopic knee surgery, etc). I've also been on hand when my sister had a series of recent major surgeries.

I can tell you they used to use sodium pentathol in the cocktails but too many people have adverse reactions to it so it isn't used anymore. All "cocktails" are custom "blended" to suit the patents' surgical needs. Height, weight, body mass, the actual surgery being performed, allergies, known reactions, and in some cases even patient request, can be contributing factors into what goes into the mix.

When I had my knee surgery I asked to be awake for it. And so I got what amounts, mostly, to a really strong valium drip. Very cool surgery, if you ever have to have arthroscopic surgery, and the doctor feels you're a good candidate for it, I highly recommend watching the whole thing "live" on the monitor over your head.

When I had bone grafting on my upper jaw to accommodate a dental implant, I was required to take 4 Halcyons (an incredibly powerful amnesiac/sleeping medication) 15 minutes before sitting in the dentists' chair. Apparently I was awake for most of it, and even started singing to the dentist (who is also an oral surgeon). And at one point I had to go to the bathroom and demanded that my husband escort me, so they had to fetch him from the waiting room. But I don't remember a thing.

In other cases I had serious general anasthesia, which involved valium (that seems to be pretty common), demerol, an amnesiac of some kind, and nitrous oxide gas. Those are the drugs I respond best with so those are mostly what I end up getting. The proportions might even be different from one surgery to the next but in general - a cocktail will consist of:

1. something to make you fall asleep - not unconscious, just heavily asleep. A strong sedative.
2. something to make you not remember what happened, IF you wake up during surgery - an amnesiac.
3. something to dull/mute/obscure the pain - a narcotic painkiller

The amnesiac is actually a lot more important than you might think - but it, combined with the narcotics, can cause confusion upon waking up and even for a few days after that.

During general anasthesia, you're also dealing with being intubated - having an oxygen tube insterted down your throat to breathe for you, and keep you motionless. This can cause a patient to become -extremely- stressed, if they wake up while the tube is still in there. I was intubated after my car accident in CICU for 4 days, and they had to keep me heavily sedated with morphine, because every time I woke up, I'd try to take a deep breath and it would set off the monitors and they'd be all running in to see if I needed a defibrillator. That was a life or death situation though because I had an embellism running up a vein toward my lung at the time so keeping me perfectly still, unstressed, and oblivious, was an urgent matter.

Usually though, they pull the tube out of your throat shortly after surgery, once they've determined that your vital signs are stable. Then, you wake up with cotton-mouth and a sore throat, and the combination of intubation plus all those drugs that keep you from waking up in the middle of surgery really throws your body for a loop and makes you feel like you got run over by a truck. If you're in good health (other than the reason for the surgery, obviously), it fades quickly. If your constitution is weak, it takes longer.

Glad to see we are of like mind!
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Unread 09-30-2010, 05:37 PM
 
Location: Wallis and Futuna
10,497 posts, read 12,627,731 times
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You know one thing I've never experienced (that I can recall - might've been all those amnesiac drugs, heh) - is feeling nauseated after waking up from surgery. Usually I just shiver uncontrollably for a half hour and have that general malaise and sensation that someone drove over me with a steam roller.
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Unread 09-30-2010, 05:44 PM
 
Location: Mostly in my head
15,731 posts, read 26,011,016 times
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Quote:
Originally Posted by AnonChick View Post
You know one thing I've never experienced (that I can recall - might've been all those amnesiac drugs, heh) - is feeling nauseated after waking up from surgery. Usually I just shiver uncontrollably for a half hour and have that general malaise and sensation that someone drove over me with a steam roller.
I used to feel like that but since propofol is available, I don't. I've had it for colonoscopies and a major surgery. I love it! It's like turning off the light then turning it back on. Michael Jackson didn't have an anesthesiologist, a few nurses, and a good doctor in a hospital OR. It's perfectly safe when used as intended.
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Unread 09-30-2010, 05:45 PM
 
Location: Georgia, USA
8,516 posts, read 7,228,969 times
Reputation: 8259
Quote:
Originally Posted by stepka View Post
I'm glad you brought this up--I can't answer your question, but I can add some of my own.

ABout 5 years ago I had a colonoscopy and they gave me general for it. It took me a week to recover and my bones hurt during that whole time--I felt mildly flu-ish. Also, it took me quite a while to wake up and I couldn't eat for the rest of the day. What could have caused that? Is it likely to happen again? I would be seriously afraid if I had to have a major surgery like heart surgery done. But then again, I'd be afraid to tell them for fear that they wouldn't put me enough under and I'd wake up. I'm not a fearful person and had no worries before the colonoscopy, but now I'd probably worry myself sick. I'm 50, so not young, but not exactly elderly either.
Why did they use general anesthesia? Most colonoscopies are done with "concious sedation" --- usually a narcotic and a short acting benzodiazepine (frequently one called Versed).

With the flu-like symptoms, I wonder if you didn't perhaps have a virus incubating when you had the procedure.

If you need surgery again, try to get the records from the colonoscopy to give to the anesthesiologist. Perhaps they can tweak the drugs and avoid the symptoms you notced afterwards. The loss of appetite may have been from the prep and the procedure itself. After drinking a gallon of the make-you-go juice the day before, I wasn't very hungry either.
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Unread 09-30-2010, 08:32 PM
 
Location: Colorado
1,135 posts, read 1,246,149 times
Reputation: 1143
Quote:
Originally Posted by AnonChick View Post
You know one thing I've never experienced (that I can recall - might've been all those amnesiac drugs, heh) - is feeling nauseated after waking up from surgery. Usually I just shiver uncontrollably for a half hour and have that general malaise and sensation that someone drove over me with a steam roller.
Ugh... My normal reaction is nausea. After I had my ACL done, I threw up for 14 hours straight. I was given four or five different medications to help the nausea. I was 31 at the time too. In fact, I came out of the OR into the recovery room vomiting.
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Unread 09-30-2010, 09:33 PM
 
Location: grooving in the city
7,371 posts, read 2,812,284 times
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Interesting thread. I will add my own experience. About five years ago I had gallbladder surgery with a general anaesthetic, and was sick to my stomach for the first four days afterwards, and felt unwell for several days afterwards, very weak and tired. I had requested an epidural because I had one ten years ago for a very serious abdominal surgery. The surgeon told me that he could not give an epidural for gallbladder surgery. I have had epidurals twice (once for a serious abdominal surgery), and I definitely prefer it to the two experiences I had with a general anaesthetic. The recovery time was so much faster.
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