Any anaesthetists around?

[TubieRuby]

I have a really weird phobia question for you.

I have anaphylaxis and have been intubated before several times, for several lengths, in various settings (A and E, ward, pavement), and some times it's been done when I am awake, sometimes I have collapsed or been sedated. It's a bit of a mixture as to whether I can remember that bit where they intubate to be honest, but in all cases I do remember being awake before it comes out- sometimes for a few hours (obviously in intensive care).

I have to have some surgery and I am wondering how it works in surgery, do they have to intubate me or is there a way for me to be asleep but without the tube in? I know it sounds really stupid but will I remember the tube being in when I am awake if you do have to use a tube?

Hopeful bump.

Hi OP. DH is an anaesthetist. I'll ask him when he is down from toddler's bed time

Hi, I'm not an anaesthetist but an ODP so I assist with putting people to sleep. If you've a history of anaphylaxis they are more than likely to want to put a tube down to keep you safe (they absolutely 100% need to ensure they have secured your airway, this is the case for all patients having anaesthesia), you won't know anything about it because they put you to sleep first, wait a minute and then pop the tube down. It gets removed before you go to recovery as they can't take you there before you're breathing on your own, and patients are usually too sleepy to remember it.

I’ve had surgery twice and the tube was put in when I was already under the GA. The first time I was told when the tube is removed people often come to a bit so they can sometimes recall this when they wake but they go straight back to sleep after it’s removed.

Not an anaesthetist but a medic. You'll be asleep before the tube goes in. Patients begin to wake up at the end of surgery and the tube is removed when they stop tolerating it/begin to come round. Patients don't generally remember it being removed and the whole thing happens very quickly.

The anaesthetic agents may be different to the sedation you've had in the past. For example, one common agent basically causes you to forget everything that has happened. Rather than going to sleep, you just miss that part of your life, so to speak. You may have had this before but it's hard to say.

For proper reassurance, ask to speak to the anaesthetist at your preop check if tou can. They can explain the bespoke plan for your surgery, what they will use and how it will affect you, in whatever level of detail you would like.

I'm a Dr but not an anaesthetist but I do watch people getting anaesthetised most weeks

If you are going to be asleep, and in particular if you are going to be paralysed, for any length of time then you need a tube in to help you breathe as far as I know.

For procedures like colonoscopy you can just have sedation and not be paralysed so you don't need a tube but for actual surgery unless it's something where you can be awake and have a local or a spinal anaesthetic then you need the tube to be able to breathe when you are paralysed.

I think for some short procedures they can use an alternative called an LMA rather than intubation but not sure it would be much advantage from a patient experience POV as it's still a thing going down your throat just a different kind of thing.

You obviously would be put to sleep before they intubate you in a planned surgical procedure so you would definitely not be aware of it going in but you might well remember the spitting out the tube bit when you come round. Maybe you can ask if there is some way to minimise this eg take it out as early as possible and bag you for a bit but it's probably less safe so may not be advisable.

*I explained that badly but I mean it doesn't feel like sleep/dreaming. You will of course be totally unconscious and unaware of the surgery.

Tube is put in when you are asleep, very few people remember it coming out, I’ve had 9 GAs so very familiar with this, mention this fear anyway and they will assure you It’s usually oxygen mask over your face just oxygen, propofol to put you sleep, by then you’re out and next thing you’re in recovery. Hugs

The answers to your questions depend a lot on what the operation is, whether the trigger(s) for your anaphylaxis is/are known, how easy your airway is to manage normally.

Not every operation needs a general (you might prefer to have a spinal regional block of its something that could be done that way).

Not every operation requiring GA needs a tracheal tube. If your anaphylaxis trigger is known and can be avoided in theatre then you may not need intubating (there are other airway devices that may be appropriate).

If the trigger isn’t known and could be something encountered in theatre then that may make them keener to intubate you as it’s better to do it calmly at the beginning rather than I response to an emergency.

If your airway looks like it might be difficult to manage normally then an awake intubation might be safest, but if, when you’re not having anaphylaxis, things look easier then that probably wouldn’t be necessary.

How much people remember waking from surgery is quite variable. Most people don’t remember being extubated in theatre. Some do though and that doesn’t necessarily mean anything’s gone wrong.

The anaesthetist looking after you on the day will be able to chat in detail with the benefit of your full history and having examined you though - they may have strong feelings one way or another and will be able to explain that, but broadly the sorts of things we think about are the things I’ve mentioned above. Hope that helps.

Came back but I see others have given the info! Good luck OP

Thank you so much everyone, it's really reassuring.

Sadly, I have to have a general - and they are doing further allergy tests to make sure that theatre side of things are not going to cause a reaction.

I am sort of OK with everything as I appreciate it will be more calm as it would be planned, but I have absolute kittens in my stomach remembering the tube/ballon feeling - and, due to the pandemic the psycological debrief from intensive care the last time hasn't been able to happen (obviously for very good reasons)

When I had surgery a few years ago, I woke up in recovery and the tube was still in place - I removed it myself much to my amazement as I wasn't fully aware but realised something was in my mouth.
The nurse monitoring me said 'oh, you're awake' and took it from me! 😆

@Horsemad I did that the first time I was intubated. I kinked my arm somehow, woke up in a dark ITU thinking I had been drug raped, tried to shout and realised there was a tube down my throat.

Having worked both in ITU and in theatre/ recovery, I hope I can reassure you that the removal of the tube post operaratively is very different than post ITU intubation.
In ITU, we will gradually reduce your sedation to ensure that you are awake and behaving appropriately to commands as you will have had a longer sedation than for an anaesthetic for an operation.
We have to ensure that you can protect your airway well enough to not require reintubation.
For your operation you may not be intubated with the same type of tube, you might have one without a balloon and as soon as you come round enough to breath for yourself, the tube will be removed.
This isn’t always done in theatre, where I work, we often have patients brought into recovery with an airway still in and we monitor you very closely (we don’t leave your side) and as soon as you make a move or open your eyes we will remove the airway. You may be asked to poke your tongue out or spit out the tube and it will just slide out.
Usually you’re unaware of this stage. Very few people remember us from recovery 😊

If it helps I had a short surgery under GA yesterday, and the only way I would even know it had happened was a slight sore throat and a horrible taste in my mouth!

My DH was a medic and he used to say that the safest you will ever be in your life is when you have an anaesthetic, as it is the only time in your life that you have people around you whose sole focus is in keeping you alive! The rest of the time we just take our chance!

Thank you very much everyone, it is very reassuring to read the replies.

I have a difficult airway and have to have awake intubation. Had this twice. It’s as bad as it sounds!

I remember having the tube taken out when I woke up in recovery, felt very strange and had a sore throat afterwards