Choosing anesthesia type/your experience

[Oakviewneighbor]

Hi Roza,
I had pretty much the same experience as Sarah. I had no effect from having a GA for a Brachial Cleft Cyst removal from my neck. This mass was rather deep and the surgery took over two hours remove. The anesthetist put a shot in my IV and said count from 1 to 10. I remember saying one and then waking up in recovery. I had no sore throat from the tube.

Pat

 

[calmom51]

I haven't had my hip surgery yet, but I have had 3 other different surgeries in the past.

My first surgery was on my foot. I had an extra Navicular bone that needed to be removed. I opted for an Epidural Block and Sedation. I have had 2 previous Epidurals when I had my two children and they are no big deal. You just need to bend over and stay still. Believe me, it's much harder to do that when your belly is huge and you're in labor than when you're getting some other type of surgery!!!

I remember being in the op room and they were prepping my foot and lower leg with betadyne. That started to freak me out a little bit and I began feeling anxious. So I turned to the anesthesiologist and said, "knock me out now!" And he did. Next time if I have a choice, I will want to get knocked out before they actually start doing anything to me.

The only thing is, it takes a while for and Epidural or Spinal to wear off so you can actually stand up and move your legs around. I remember one time (don't remember which) needing to pee and not making it to the bathroom successfully, which was embarrassing! Other times I think I had a urine catheter for a while.

The worst part of that experience was that IMO they woke me up too soon from the foot surgery. The team was finishing up and I felt some pressure on my leg where they had a turnicot (sp?). It took them a couple of minutes to remove the turnicot and then I felt OK.

My second surgery was on my shoulder to remove calcium deposits. I'm pretty sure I had general for that one. I was not happy to wake up and feel like there was a two-ton truck sitting on my shoulder. That's because they didn't start the pain med soon enough (maybe they couldn't, IDK). They had put some sort of pain pump into my shoulder, so as soon as they turned it on I was fine. But for a few minutes (maybe 5 minutes) I was in agony and it was scary.

The third surgery I had was on my sinuses to remove a benign tumor. I'm pretty sure that one was general (just remember breathing into the mask). I woke up from that one shaking badly. I was really cold. I couldn't stop shaking and shivering for a good 10 to 15 minutes. It was extremely uncomfortable. I also think I may have been nauseated for a while, as well. But not for days, maybe only for a few hours.

With all that in mind, when I do have my THR (or any other surgery) I will opt for the Spinal/Epidural with Sedation. I will tell them that I don't want to feel any pain when I wake up (that is my biggest concern -- it actually traumatized me a bit). And that I want to be knocked out before they begin prepping me.

For those of you afraid of getting a Spinal/Epidural, I will tell you that there is nothing to be afraid of. The doctors who do this know what they're doing. They do it all the time. I'm not keen on getting a needle and medication stuck into my spine, either. But I've done it several times with no bad results. It did not damage my back in any way. I agree with what others are saying about recovery being easier from a Spinal than from General.

In all of the surgeries I've had, I don't remember hearing anything. I was totally out. Peaceful sleep, remembering nothing at all. I only remember hearing voices as they woke me up. And that is what I will stress this time....that when they wake me up, and I begin hearing those voices, I do not want to be in any pain if at all possible.

But others here have said that they wake up from their surgeries feeling very comfortable. So I'm not worried about it too much. I just need to make sure I communicate my concerns to the doctors who are involved.

 

[Josephine]

First, they don't use endotracheal tubes any more unless the patient needs to be paralysed for the surgery such as in chest or abdominal surgery. A device called a laryngeal mask is used which is a cross between a tube and a face mask and no paralysing agent is required to insert it. It goes into the throat, beyond the tongue into the larynx and closes off the trachea, protecting it should any fluid be regurgitated from your stomach. It's very soft, with an inflated ring which causes no irritation to your throat at all.

So at no time will you be rendered unable to breath and you will be out when they insert this device. Removal occurs as you are regaining consciousness but before you are even aware of your surroundings. That phase can take about 4-5 minutes in all. Once the larry mask is out and you are made comfortable in your bed, you will likely relax and sleep again until taken into recovery where the nurses will rouse you again! That's the one everyone remembers, saying they knew nothing until they woke up in recovery!

 

[Roza53]

I was hoping it would be the mask Jo just described. When I talked over the phone to anesthesiologist from the hospital, I asked specifically what devise they insert: mask or tube, and he said clearly it will be endotracheal tube.
He also mentioned that the surgeon wants to give his patients medication for muscle relaxation.... I do not understand well the connection between GA (tube) and muscle relaxation... I thought muscle relaxants can be done intravenously... I have read somewhere that spinal anesthesia also gives good muscle relaxation.

 

[Josephine]

Okay, I get that ...

First stage is that IV muscle relaxants must be given in order to intubate someone. It's essential that the vocal chords and larynx are paralysed during this procedure. What I was describing before is that most patients are permitted to come out of that whilst still remaining anaesthetised (and therefore unconscious) but able to breathe spontaneously.

The second stage is where the anaesthetist and/or surgeon requires the patient to be totally relaxed so the IV muscle relaxant, suxamethonium, is given in small quantities throughout the surgery, just enough to keep the patient totally relaxed. This is in addition to the drugs and inhalation agents given to maintain unconsciousness. Because is this, the patient is unable to breathe and is therefore attached to a ventilator. Once the surgeon starts sewing up, the anaesthetist will commence the reversal of the suxamethonium so the patient starts breathing spontaneously again. It is at this point that the tube is removed and very shortly thereafter, the patient will begin to regain consciousness and be transferred to the recovery room, often before they are fully awake.

This is the different types of devices that I have mentioned

Face mask

Laryngeal mask

Endotracheal tube

 

[rider1960]

I've had both spinal and general and I much preferred the spinal.

I had general for my hysterectomy and woke up in a lot of pain. I still remember that moment to this day. I was also hoarse from the endotracheal tube and I didn't get my true voice back for a week or more. It just wasn't a pleasant experience all around.

I had the spinal for my hip replacement. I was taken into the OR, leaned over a pillow and next thing I knew I was waking up in the recovery room, all comfortable and peaceful. They definitely gave me enough Versed and other happy drugs because I don't remember a thing from the surgery. I had plenty of time to get my bearings before the block wore off and I felt the surgical pain in my leg, and that was more of a gradual onset. I had a lot of muscle spasms and nasty ache in the entire leg, so it was good that the block wore off gradually and I had a chance to keep ahead of the pain better with the morphine.

I'll definitely have a spinal for my next hip.

Dorothy

 

[Roza53]

Thank you, Jo, for detailed explanation. It seems like my surgeon wants to be able to control better muscle relaxation...

 

[DallasSarah]

Hi Roza and Josephine,

That was interesting about the different ways they perform, thank you for sharing Josephine.

I still have no clue what they did to me, but it was defintely GA. The one thing that really surprised me and my friend was they were getting me ready, the
anesthesiologist came in and I was like ERRRR wow you are young, she was maybe mid 30's it made her laugh..I instantly felt comfortable with her and trusted the team that took me into the OR.

Roza I think there are lots of fears and risks with any type of surgery, I think these types of things you have to have faith and not get crazy about, they know what they are doing.

xxooxx

 

[klalota]

I'm 5 days post-op and wholeheartedly support spinal with sedation! I was nervous pre-surgery, but the anesthiologist and the surgeon assured me I wouldn't hear, see, or smell anything and they were right. The insertion of the IV was more uncomfortable than the spinal. In fact, I remember hugging the nurse awaiting the shot, but I can't even remember feeling the shot. I awoke like one awakes from a pleasant nap. I kept telling the recovery room nurse how amazed I was by the shole process and the excellent care I was receiving.

Having had both GA for my gallbladder removal and spinal w/sedation with the hip, I will definitely go the spinal route whenever I have that option in the future. Awesome!

 

[debkakes]

Just had my pre-op appointment yesterday, and the anesthesiologist informed me that my surgeon prefers GA with epidural. From all the accounts here, I was sort of hoping for spinal block/sedation, but I signed on with this surgeon for a reason, and whatever he wants is good with me!! I've never had any ill effects from GA, so it's AOK. As long as I have that epidural with a pump :th_heehee: I'm happy.

 

[JohnHurst]

Athe time of my surgery, I really didn't know enough to make a decision. Had GA 20-some-odd years ago for elbow reconstruction and was happy enough with that at the time - remember a shot of something pre-op that made me feel like I was floating, counting while they delivered the gas, and then waking up in recovery. I DO remember that I was several days recovering from the effects of the anesthesia (I have asthma, so that didn't help).

For my hip, my surgeon preferred spinal plus sedation (plus a femoral block I believe), and I wasn't going to argue. My only concern was that I did NOT want to wake up during the surgery, and I made my concerns known to my surgeon, my anesthesiologist, my OR nurse, my prep nurse, the intake assistant,... and a couple people passing by that had no connection with my surgery:th_heehee: They all assured me that wouldn't be a problem.

They wheeled me into the OR, and I remember a spirited discussion among the docs/nurses about whether to give me the spinal in the pre-op bed or after they moved me to the Hana table. They asked me to sit up, I felt some cold wipes on my back, a very brief sting in the back... and I woke up in recovery.

No pain, some minor discomfort, and I was eating lunch that afternoon. The pain came back gradually as the block wore off, but it was all very manageable with Norco tabs and the occasional morphine shot.

Definitely recommend the spinal/sedation route if you have the choice.

 

[Lgastreich]

I had general anesthesia--it was my surgeon's preference as well as mine. I was just a little freaked out by the idea of a spinal and any hint that I might be aware of what was happening. Although after reading this thread, that may have been an unnecessary fear. I did let the anesthesiologist know that I had trouble coming out of anesthesia before--nausea and low blood pressure. But this went flawlessly--the easiest I've ever experienced. I did have another nice surprise. I was dressed in a paper gown for surgery into which they pumped warm air. I woke up in this lovely cocoon of warmth and absence of pain.

 

[debkakes]

Ended up indeed with GA, no spinal epidural. I was indeed nauseous, but it didn't kick in for several hours, and lasted for about 10 hours. I also suffered from low blood pressure, but my BP is usually on the low side. If given the choice of GA or spinal/twilight, I'm not sure what I'd pick, but any further joint work I have done will be by the same surgeon and I will always go with his preference. As a side note: I DO wish I had banked my blood. I had very low red count that persisted and probably prevented me from going home sooner. I am only now on the other side of it. Had I banked my blood, they probably would have done a transfusion without blinking and I would have bounced back quicker.

 

[vicledsome]

I had spinal with twlight, also had nerve block. I had TKR on June 5, 2012. I remember nothing but was very sick for 1 day. Also had severe itching for 2 days. itching is the worst part of surgery. I am having a second surgery next week. Thinking of spinal again but hate the thought of throwing up and itching. Anyone have any answers for itching?

 

[GrahamDee]

I was given no choice at the point of having surgery, despite what I was told during preop. Every request was flatly ignored. I lived in pain for years over the fears I had about spinals.
My experience was 'trumatic' to say the least. I was told I was going to have a spinal, then given drugs to sleep, but I was so hysterical with fear, I had to be sedated first, then spinal and then given the sleepy drugs.

Today, even three weeks after, I am extremely angry and resentful as to how I was treated.

 

[Elle11]

I had a very clear idea of what I wanted (epidural), but when I met the anetheseologist, I decided to go with her, as did with my OS's choice in approach/hardware. However, like with my OS, I had a very high trust level. I did have the epidural with twilight gas. The discomfort was not the needle, but having to go in fetal pose when my hip was killing me. This lasted very briefly however and before I knew it, I was looking into the face of my beautiful OS still in his scrubs who was smiling and saying, "You are done, Elle! Perfect placement; extremely successful!" (It wasn't until later that I foudn out my husband was a mess because I was the last patient out of the OR after midnight, the operation twice as long as expected because of unexpected blood loss. The expected 1.5 surgery was more than 3. But here I am-very healthy, with four new unknown blood siblings!)

 

[Kelsey]

It's fascinating to read everyone's experiences. I got to experience the best (and worst) of both worlds with my THR and subsequent revision, two weeks later. I chose to go with spinal and sedation for my THR. Receiving the spinal injection was not traumatic- just a slight pinch, and they had already given me slight sedation. But then I awakened in the middle of surgery! The surgeon was hammering the implant into my femur when I became very aware of a "CLANG! CLANG!" I quickly went back under, and mostly found the whole experience funny. In my spinal, I was given intrathecal morphine, which, it turned out, made me very nauseated (we're talking dry heaves post op). So, though I awakened quickly, I felt awful.
For my revision, I had general with a nerve block. They did the nerve block, again, with just slight sedation, so I was aware of what was happening. It felt weird, but not painful. I informed the anesthesiologist that I had a history of nausea with general anesthesia, and they medicated me properly. I woke up starving! The downside was the amount of time I spent feeling exhausted. I'm not sure how much of that had to do with having two surgeries in two weeks, but my guess is a lot of it was related to the general. It took a week of a lot of sleeping for me to clear the fog.
So, ultimately, if I had it to do again, I'd probably do the spinal (and ask that they not do the morphine). I liked being aware and "with it" so quickly!

 

[Kelsey]

I had spinal with twlight, also had nerve block. I had TKR on June 5, 2012. I remember nothing but was very sick for 1 day. Also had severe itching for 2 days. itching is the worst part of surgery. I am having a second surgery next week. Thinking of spinal again but hate the thought of throwing up and itching. Anyone have any answers for itching?

Vicki, I had itching, too, along with nausea. Ask if they anesthesiologists gave you intrathecal morphine. I bet they did, and a reaction to that can include these symptoms. Best wishes and speedy recovery to you!

 

[vicledsome]

Vicki, I had itching, too, along with nausea. Ask if they anesthesiologists gave you intrathecal morphine. I bet they did, and a reaction to that can include these symptoms. Best wishes and speedy recovery to you!

Someone else mentioned that could be the issue. I will definately check it out.
Thanks!

 

[Poppet]

Yes the itching is certainly related to morphine and we are given pretty strong doses of it.

Hopefully it will ease for you soon, but not pleasant that is for sure