Near the end of this thread, I reported that after a lumpectomy last Thursday (3/12/15) I had a really bad reaction to general anesthesia. I have some questions about how to avoid this should I need more surgery (the chances of that are not great, but are not zero).
I don’t know how long I was in surgery-- my friend said I was gone for three hours, but I don’t know if I was out the whole time. Before the surgery, the doc said it would likely take two hours. When I got into the recovery area, I was violently nauseated and dizzy for at least 12 hours. At one point the gave me Zofran in my i.v. line, but my impression at the time is that it made me feel worse, so I opted to just let everything wear off naturally. I did throw up once, but that didn’t help, as the nausea wasn’t due to anything I had ingested. Originally it was going to go home that same day, but I wound up staying overnight, and the nausea finally abated around midnight.
I have never felt that sick in my whole life. I had no pain from the surgery at all and still don’t, three days later, but that dizziness and nausea were among the worst things I’ve ever experienced. Even prior to the surgery when they stuck needles in my nipples-- THAT wasn’t as bad as the violent nausea after the surgery.
I’ve only had one other surgery as an adult-- broken ankle in 2007 and I do NOT remember any adverse effects from anesthesia at all. Three days before the surgery I was asked if I tended to react badly to anesthesia, and I said no, based on my one experience.
Questions:
Is there any advantage to finding out exactly what was used so if I’m asked in the future, I can say, “I had a bad reaction to XYZ?” I know NOTHING about anesthesia, what kinds there are, how they work, etc. My friend said that if I had a bad reaction to one, I’ll probably have a bad reaction to all, so inquiring about this would be pointless.
Would it be worthwhile to research what anesthesia was used back when I had my ankle surgery, as I didn’t seem to react badly to that? Not sure I can find out, but maybe.
I had taken .25 (1/4) mg of xanax on Tuesday, and again on Wednesday-- surgery was 7 am Thursday morning. I know xanax has a half-life, but surely those amounts would have been too small to cause a problem? I asked the anesthesiologist on Monday if it would be all right to take the xanax in the days prior to surgery and he said okay.
Any tips, comments, anecdotes, info, wisdom, etc., welcome.
Yes, I think that would be a very good idea. You should be able to get a copy of your medical record to indicate what was used.
And if you ever need general anesthesia again (hopefully never), you should be able to meet with the anesthesiologist beforehand to discuss making it a less unpleasant experience.
I had a really bad experience with one anesthesia during an upper GI endoscopy. The IV sedation didn’t sedate me enough for them to do the esophageal stretching so they had to use general. I woke up paranoid, sobbing, in mid-panic attack. My muscles had seized up so much that I could hardly walk for two days. It was horrible.
For my next endoscopy with esophageal stretching at the same hospital, I told ***everyone ***about the problem. The nurses, the GI surgeon, the anesthesiologist. When they wheeled me in to the OR, I told the anesthesiologist again. He had looked at my records, called the previous anesthesiologist, found the problem, and had come up with something that caused no side effects. He told me all this before proceeding, too. He also listened when I told him that my dentist normally uses child-sized bite blocks on me and used pediatric-sized stuff when needed.
I didn’t know exactly what caused the problem, and don’t know. But it is in my electronic records at the medical center/hospital I use.
tl;dr – YES, tell everyone repeatedly. And get your records. Using the same hospital has benefits, too.
I did meet with AN anesthesiologist ahead of time, but he was a complete idiot and couldn’t even figure out how to take my blood pressure. I’m not kidding. The cuff was partially inflated and he didn’t know that you have to squeeze all the air out. And yes, he did have “Doctor” appended to the front of his name. He didn’t ask/tell me anything relevant or helpful except that it was okay to take .25 mg of xanax the day before. And having virtually no prior experience, I didn’t know what to ask. That pre-op visit was a complete waste of time. I made sure I didn’t draw him on the day of surgery.
Another chiming in for finding out what they used, and mentioning it in the future.
I haven’t had anesthesia since high school, when I had my wisdom teeth removed. But I’ve sat through countless prep sessions with my parents while waiting for their surgery, and the anesthesiologist asks about past sessions and any trouble they’ve had.
There are options for what drugs to use, and what the dosages are.
If you request your records, be sure to ask specifically for the MAR (Medications Administered Record) and that you’re looking for the medications used for anesthesia… I work in the Release of Information department for a local health system, and that’s not part of the default package we release for patient requests.
I also had a really strong nausea reaction to GA once, and since then I’ve let the anesthesiologist and pre-op visit/call people know this. They usually add extra anti-nausea meds to what they administer prior to/during the surgery, which has a better effect than medicating after you’re already suffering.
In my experience, the anesthesiologists can be extremely helpful and explain a lot of things, IF you ask a few questions. In my experience, they tend not to volunteer much. So, if you can get the info about what made you so sick and then ask the anesthesiologist what else he/she can use, you will probably get some useful answers.
I also agree about getting it in to your records.
A few years ago, I was given ether because, I was told, people with asthma often react badly to other anesthetics. I was sick as a dog. Later, I was told that there are now a lot of better alternatives for people with asthma. I won’t let them give me ether again, for sure!
Here’s hoping that the few hours of nausea and so forth are the only bad part of your surgery and that your prognosis is good trending to better.
Like you, I’ve had bad reactions to anesthesia. Actually, I get bad reactions to many drugs. I have a little spiel I go through whenever I’ve had to have anesthesia:
"Dear Doctor: I’m very sensitive to drugs. I seem to react more to drugs than most people. The last time (or some previous time) I had very bad nausea after surgery, and I believe it was from the anesthesia.
I’d like to ask you to do this: please use the minimum number of drugs that you can. This will eliminate bad side effects from all of those drugs that you don’t give me. Also, please use the minimum amount of any drug you DO use. Definitely keep me out – I don’t want to wake up on the table! But don’t give me more than you have to. Thanks."
You’d be surprised at the number of drugs they give you. I remember one – versed, I think? – whose main purpose was as an amnesiac. It just made you forget the time around the surgery, including some of the time after you wake up. (Other medical professionals will probably chime in here and say that versed is actually used for something else, and it probably is. But I just remember being told about its amnesiac qualities.)
The last time I had amnesia, the anesthesiologist, after my spiel, decided to only give me a single drug. He told me I would feel some pressure in my arm after it was given. I did for about 10 seconds, then I was out. I woke up as they were finishing the bandaging and had no problems after.
Rather than going straight to all that medical records stuff, you could start by asking your surgeon to ask the anesthesiologist what might have given you the problem. It might even already be in the surgeon’s records, and possibly in the notes of whatever doctor signed off on your overnight admission.
There are a number of risk factors for post operative nausea and vomiting. These include type of anesthetic (volatile gases such as sevoflurane cause it, but N2O is even worse), amount of opioid painkiller used intra- and post-operatively, type of surgery (abdominal surgery, especially laparoscopic, certain ENT surgeries), patient’s sex and age (young females are at higher risk), weight (thin patients are at higher risk) and smoking status - smoking actually has a protective effect here.
Anti-nausea meds such as zofran and others are usually given as prophylaxis during the surgery. Propofol, an anesthetic drug which is mostly used when inducing anesthesia before surgery may be used as a maintenance drug during surgery as it decreases nausea and vomiting and also allows for decreased use of volatile gases and N2O.
Use of regional anesthetic and nerve blocks can greatly decrease the amount of opioid needed.
While it may be helpful to get your records, I doubt that anything specific will jump out as the cause. The main thing is to inform any future anesthesiologist that you had very bad nausea after your last surgery/anesthesia, so they will be able to minimize risk factors for it and give additional anti-nausea prophylaxis.
jharvey963: I don’t think midazolam/versed given before or during induction of anesthesia contributes significantly to post operative nausea and vomiting. In addition to its amnestic properties, which are valuable, it is a very effective anti anxiety drug and in general decreases the quantity of other drugs needed during induction. Amnesia is especially desirable if you are one of those unfortunate few patients who experiences intra-operative awareness, btw. One important side effect, as with other benzodiazipines, is post operative cognitive dysfunction/delirium so it should be used with caution in the elderly.
Generally the goal is in fact to use multiple drugs at lower dosages rather than one drug at a higher dosage; they tend to work synergistically with fewer side effects. This is known as “balanced anesthesia”.
I’ve never heard that about ether and asthmatics. I’m asthmatic and I’ve had easily a dozen procedures and surgeries with varying levels of anesthesia. I had all four impacted wisdom teeth out in hospital because the oral surgeon said NO WAY to a moderate-to-severe asthmatic having that surgery in the office (it was 1987; the preventatives sucked and my asthma was not well-controlled). No problems at all. In fact, the only time I’ve had nausea was with sinus surgery (and the surgeon said he thought that was due to the bleeding you get with it, not the anesthesia). The only bad whole-body reaction was the time I mentioned in my earlier post, and that was in part because they had to put me into full anesthesia partway through.
I’ve had both Versed and Propofol for minor procedures (spinal epidurals and Botox for migraines), and never had a problem. I always ask the anesthesiologist for a to-go cup to share with coworkers. Never have got one, though.
I was talking about the anesthesia thing with a friend today and she said she had a very bad reaction to anesthesia, and the next time she had to have surgery, she told the docs. What they did was after surgery when they were taking her on the gurney back to the recovery area, they stabilized her head so it couldn’t move from side to side, and that seemed to head off the vertigo/nausea.
This friend is NOT good with precise details… but is this credible to anyone?
I had midazolam once, in my 40s, and I had significant cognitive dysfunction for at least a day afterwards. I basically couldn’t do anything that day, and had trouble sleeping that night, and was running on less than all my cylinders the following day. I didn’t have nausea, but the recovery from it was so unpleasant that the next time I needed an upper GI scope, I did it with no anesthesia. That was also unpleasant (there’s a lot of gagging involved) but at least it ended quickly, and then I was okay for the rest of the day. The only residual effect from that procedure was a slightly sore throat.
I had knee surgery 3 years ago. The worst part was the pain killers and what they did to me. Most people gain weight after surgery I lost over 30 pounds in 3 months because of the oxycodone ( now hate that crap). And they did not relieve much pain.
I developed a hernia doing therapy, and needed surgery. I was more terrified of the pain killers and if they were going to use morphine on me than I was of surgery. I made my worried known to the surgeon and she used different drugs.
MAKE YOUR CONSERNS KNOWN TO ALL DOCTORS involved. And if anyone brushes you off tell them good by.
