General Anaesthetic

[mrsblakey]

Am having surgery in a few weeks.
I haven't had a GA since I was young & can't really remember much about the procedure.
I am feeling more apprehensive about that rather than the surgery itself!
I have been told I won't be able to meet the anaesthetist until the day of my surgery so am bottling up more nerves.
I think my main fear is not waking up afterwards - I feel really silly admitting that!
Anyone had a similar anxiety?

[StillNoFuckingEyeDeer]

When you have a general anaesthetic you're given oxygen and often anaesthetic gases either via a mask or tube whilst you're asleep.
If its a short procedure the anaesthetist may just hold a mask over your mouth and nose. If its longer, they'll use a tube. Tubes can either go down into your trachea (windpipe) ('endotracheal tube' - this is intubation), or sit at the back of your throat ('laryngeal mask airway').
If the operation is in your mouth too, either the surgeon works around the tube, or a tube can be inserted via your nostril. Often for dental extractions, the tube is just tied to one side and the surgeon works around it.

[StillNoFuckingEyeDeer]

Wednesbury - the stuff that increased your heart rate was probably Syntocinon (Oxytocin), which is given after the baby is delivered at Caesarian section, to help the uterus contract and reduce bleeding.

[WhispersOfWickedness]

Thanks StillNo, that's interesting to know

[InPursuitOfOblivion]

fairykisses stillno is absolutely right, total intravenous anaesthesia (TIVA) is associated with less PONV, but there are so many variables. Agree that the best thing to do is mention it to your anaesthetist and get a load of anti emetics on board before you wake up.

georgedawes lots of patients need a bit of oxygen for a few hours post -op. Its usually nothing to be concerned about, but yes, do mention this to your anaesthetist next time. Even the smallest details can be important.

Wednesbury without looking at your notes it's hard to know exactly, but I concur with stillno that the most likely candidate is Syntocinon (a synthetic version of the naturally occurring hormone oxytocin) or possible Syntometrine which is a combination of Syntocinon and ergometrine. It is used to make the uterus contract after birth and control bleeding post delivery. Every patient who has CS will receive it.
With regards to your second question, it's quite difficult to answer. There are many ways to give an anaesthetic and everyone practices slightly differently. For a major surgery we won't give 'more' anaesthetic exactly, but because its likely to last longer your total exposure to anaesthetic drugs will be more. (I don't know if that makes any sense to you?) with major surgery we are also likely to give you a load of opiates for pain releif which can leave you feeling totally 'out of it'.
I'm sorry you didn't have a good birth experience, but please don't beat yourself up over it. There as nothing you could have done and I'm sure you are the most wonderful mother. Even years later counselling can help if you are interested. There are some therapists that specialise in medical counselling and even just one session might prove beneficial. I do think its a service that should be more widely publicised.

chestynut before your surgery make sure your asthma is really well controlled. Avoid (even more than usual) smoke, pollen, dust anything else that irritates your lungs.
Try to make sure you are as fit as you can be. If you use an inhaler, bring it to the anaesthetic room with you and take a few puffs before induction.
If no other medical conditions are present, propofol is the induction agent of choice in asthmatics. I know what you mean about it hurting though. Some people find it just a bit cold going up the arm, others find it unbearable! Mention it to your anaesthetist because there are things that can be done to make it hurt less. Finding a big juicy vein helps! Being warm and well hydrated helps to get those veins up. (Although when you are told to stop eating and drinking pre-op, it's really important that you do stop. I'm sure you know that anyway)
After consultation with your anaesthetist he may decide to use something else, but if he doesn't, remember going to sleep with propofol takes 30 seconds at the most.

An ODO is an operating department orderly. Think they are all called porters now, ODO is the old name for them and I'm showing my age!
It's a rare day that I get a break at work and if I do it's never long enough to get changed and leave theatres. So I give the porters money to buy me coffee and sandwiches from the shop. Honestly, it is the 'little guys' like the porters, cleaners and health care assistants that keep us off our knees!

Right will be back to answer more of the questions after tea.
You've asked some interesting ones

[Sallystyle]

I was petrified before having GA. I kept thinking I was going to wake up during the operation.

I was so scared the Dr gave me a sedative and then I told him that he was Dr Dreamy and I had the urge to kiss him

He then told me he was putting an antibiotic in my arm and I was about to tell him I knew he was lying then I was gone.

The only thing I didn't like, which I was warned about, is the fact that I went to sleep then woke up for a few seconds and knew they were wheeling me somewhere they I went back under.

I don't know how common that is? but they did warn me that it might happen, I have yet to hear it happen to anyone else though.

[mrsminiverscharlady]

Interesting answers, you seem very knowledgeable about anaesthetics. Are you an anaesthetist?

[Jaskla]

The last time I had surgery I told the anaesthetist that the propofol was previously very painful. I don't know whether she did something different but it didn't hurt. I'm not sure whether she gave me something else first through the IV.

And it makes sense waking up in the same emotional state - I was fine last time but the time before I'd remembered feeling pain and trying to pull my arm away and I woke up in tears.

All my operations have been ENT and I sometimes feel sick afterwards. One time was worse than any other for me.

[georgedawes]

Thanks for answering inpursuit

[ChestyNut]

pursuit I had propofol as sedation for a wisdom tooth extraction and it was like pure torture
Burned and I was still very aware of what was happening half way through. Give me midazolam any day

Do they routinely give lidocaine with propofol to reduce the pain?


I was told by a lovely anaesthetist to ask GP to test me as DF had a scholine allergy. GP couldn't have been less interested.

Do I just mention it if I have anaesthetics?

It's like question time with pursuit

[EauRouge]

I had my first and only GA a year ago. Best 2 hours sleep I've had since 2008. When I was coming around, I heard a nurse say that I'd just been in surgery and I replied woozily 'what surgery?'

The worst thing was that damn cannula, they're so uncomfortable. I just wanted to rip it out afterwards when I was in recovery.

[LauraBridges]

I've never had one.
Is it true that sometimes in rare cases the patient wakes up with a bad mental state, a sort of adverse reaction? I have read a few accounts of that.

[shouldnthavesaid]

Eau they are awful, last op I had I needed to shower the next morning but was still not feeling great. Stumbled into the shower and somehow I yanked it out. I remember looking at the blood, muttering that there was a lot (made worse by the shower water) and pulling the alarm. Landed up on the floor shivering and wrapped in a towel with the nurses telling me I'd fainted.. I never thought they would hurt but they do, it's a weird naggy pain.

Laura I had a psychiatric reaction not to the anaesthetic but to the sedative they gave me - had the same as a child. Both times I apparently became very aggressive, had to be restrained. I had flashbacks of the most recent time and can remember shouting at the doctor telling him I knew he was poisoning me, I threw an oxygen mask at him as well and I think I pushed one of the nurses out of the way when she tried to give me a hairner. Needless to say I'm not allowed sedation apart from extreme circumstances - and even then they'd apparently try gas and air etc first.

[ToffeeOwnsTheSausage]

I have had two. Apparently I sold my youngest .

I feel really off for a few days after, I am also allergic to something in it but never remember to tell them and I would like to not have another ever.

I hope all will be fine for you.

[neversleepagain]

I have had 6, my most recent one 14 months ago. There really is nothing to worry about and the medical staff will be lovely, I have always had really good experiences.

14 months ago I had my gall bladder removed when my twins were just 7 weeks old. It was fabulous, I got to have 6 hours uninterrupted sleep after the surgery and was looking forward to it for weeks :) Even the nurses commented how much I had slept was disappointed when they sent me home, I wanted to stay the night

[FruitbatAuntie]

Wednesbury - the stuff that increased your heart rate was probably Syntocinon (Oxytocin)

Yes, when I had my CS they said the same to me about my heart racing when they gave me the syntocinon - and it raced like mad and left me feeling very, very peculiar for a few minutes!

[QTPie]

Had my first GA just over 13 months ago and, like you, was VERY nervous...

It was absolutely fine and was actually like a nice nap. Everything was calm and had no anxiety before or afterwards.

Have had two heavy sedations (not far off GA) since and both were absolutely fine too :)

[InPursuitOfOblivion]

Shouldnthavesaid I've got no idea what your anaesthetists were up to!!
Awake intubation is rare as rocking horse shit these days. It does happen from time to time but I've only seen it once when I was a student.
I've seen many difficult intubations where the anatomy is bizarre to say the least and it was always done using a flexible, fibre optic scope. Makes things much easier!
TBH given the choice I would also opt for regional anaesthesia over general myself, it's not for everyone though. And yes, opiates can be used. Some patients can feel rather . . . erm . . . Amorous shall we say? Others seem keen to reveal every detail of anything you would wish (or not) to know!

I can't really comment on dental procedures as I've so far managed to avoid that particular speciality. (Both personally and professionally.)
I know some dentists can give IV sedation. Wouldn't be keen myself!
When it comes to wisdom tooth extraction, I'm guessing, although I'd have to ask somebody else about this, that a reinforced, flexible endotracheal tube would be used and secured to one side.

[Wednesbury]

Thank you very much StillNo and InPursuit especially for your answers and kind words. It being syntocinon or similar first time round making my heart race makes sense.

Although obviously the EMCS under general was not pleasant in that it was an emergency situation (though far worse for my DH I think!), I am OK with what happened under/after the GA. The quick action of all medical staff saved my DD's life and ultimately probably mine (they told me they had a 'decision to incision' time of 12 minutes). I know that I couldn't have got up to see her any sooner than I did or I would have, and it all felt very detached, but she is here and alive and well and so am I ... I am very, very thankful for modern medicine and to all those who practice it. It could have been very different. In fact it was the anaesthetist who gave it away to me that I was going under general as I heard him say 'I'll just get my GA gases mixed' or something and I thought oh right, this really is an emergency!

[raydown]

Just after the anesthetic was injected I had a choking feeling in my throat. It was like a very bad taste/smell and felt like I couldn't breathe, no time to panic though because then I felt my eyes go heavy and I was asleep. What causes the choking/nasty taste?

[InPursuitOfOblivion]

Everybody hates the cannulas!! I used to think patients were just being a bit whingey until I had one myself and then I understood.

Chesty- I wouldn't say lidocaine is routinely mixed with propofol but it is quite commonplace. There is evidence that lidocaine destabilises the propofol emulsion, although this does seem time dependant.
If you are allergic to scoline (succinylcholine) this is a BIG deal. Push for a test.

raydown this is a common side effect of the anaesthetic induction agent. Deeply unpleasant, but nothing to worry about.

I'll answer the questions about anaesthesia and emotions tomorrow if that is ok. It's kind of complex and I'm too tired to give a succinct answer!
If you've asked a question and I've missed it, I'm sorry! Pm if you like.
If you've got an op coming up and you do have questions it's probably wise to phone the department of anaesthetics and have a chat with them.

[fairykissesforyou]

InPursuit

Thanks for your really clear answers and useful information.

Now I just have one more question, why would you choose regional over general anaesthetic for yourself?

[Best1sWest]

I was one of those children's who had GA in the dentist's chair 40 years ago. Terrifying. Had a proper hospital one for a laparoscopy and that was fine.

[InPursuitOfOblivion]

fairykisses there are pros and cons with both. For me, I find the risks of regional more acceptable. One of my mentors told me there is no way he would consider it for himself though, so it horses for courses.
I'm also a massive control freak, it doesn't make a difference really but I just feel more in control if I'm awake and not sedated.

[ChestyNut]

Thankyou pursuit

Does scholine allergy have a hereditary component?