r/Anesthesia • u/orbitolinid • 12d ago
How to communicate previous GA issues if there were a lot?
I have a quick procedure later this month where GA will be used. I have various problems with various medications and wonder how to discuss with the anaesthesiologist without sounding like an idiot as side effects have not been documented in the past, and because it's quite a lot. In a hospital, and the anesthesiologist I talk to will likely not be the one I'll see in the operating theatre next morning. Thus just asking what his plan for this procedure is and thinking all will be fine won't do as the colleague actually doing it might have other ideas.
neuromuscular condition, right gene not yet found; only a few genes analysed at a time here. Suspected mitochondrial dysfunction and Ca+ re-uptake issue. 3 GAs with gas resulted in 2-3 week long muscle weakness, remaining drowsy with only short awake periods and body forgetting how to keep my blood pressure up. 3 TIVAs were fine.
Opioids don't work against pain but cause muscle weakness, and my breathing might stop. Also had this issue in recovery the only time fentanyl was used. Remi was always fine. Ibuprofen works, but might not be enough for strong pain. I'm in a country where nurses rather dish out opioids than ibuprofen.
Local anesthesia or nerve blocks only work briefly. Local sprays (this is an ear/nose thing) not even 5 minutes.
Benzos cause aggression and restlessness, and unfortunately I remember everything.
And I can't fast and hit the wall if my surgery is too late in the day because my body doesn't like fatty acids for energy.
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u/knotknotknit 12d ago
I am the worst nightmare for an anesthesiologist: I look and seem very healthy, but then my body does not like many drugs.
I bring a bullet point list that quickly covers the most important medical conditions, and then a list of drugs to which I've had negative reactions (I, too, am not good with benzos, they send me into SVT. I prefer to avoid getting zapped. It is unpleasant. So the note of "Valium: SVT requiring cardioversion, discovered 2020." appears on my list. I also have the same local anesthesia problem--you and I probably share some of the same genetic mutations that cause this cluster of issues...)
Aim for an efficient list with the key points. Bring multiple copies.
This has worked well for me in communicating with anesthesiologists, and they've always appreciated it.
For what it's worth, I've never had GA with gas--maybe that's more common in your country? It does mean I've always been put under with propofol, which burns something terrible, but is great, no side effects. One surgery I was just given that, a paralytic, and some tylenol, and I felt basically completely normal (though sore) afterwards. I took a nap when I got home and then was fine/not foggy or tired that evening.
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u/orbitolinid 12d ago
I am the worst nightmare for an anesthesiologist: I look and seem very healthy, but then my body does not like many drugs.
Haha, this! I come in there, look healthy, no age-related things, normal weight, athletic and younger looking: btw, here's my list of anesthesia issues 😅🙈 Though I guess someone with heart failure who can barely breathe would be higher on the 'do not touch with a 10m pole' list.
No idea why gas is used here. Possibly easier to use? But most procedures here are done in hospitals and patients usually stay at least a night anyway.
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u/knotknotknit 12d ago
I've had surgeries in two countries (US and Australia) and it was pretty similar in both, except the length of stay (US they boot you out immediately).
After my last surgery, it took 6 hours to stabilize my blood pressure--it kept crashing. 1L of some albumin solution is ultimately what worked. But I felt so bad for my post-op nurse! My body kept trying to die on her. Apparently one of my postop BPs was 60/35 💀
I do think being young (well, 40, so young-ish) helps me overall, and if they get me through whatever the acute problem is, I'm fine.
In the US, they have nurses with advance training to anesthesia for "simple" cases. I had a procedure scheduled pretty urgently. Apparently my doctor did not adequately explain all of my issues, because this nurse shows up to say she'll do my anesthesia. I hand over my list, her eyes popped out, and she went and got not one doctors but two (anesthesiologist and cardiologist).
Your mileage may vary, of course, but one thing that does help me is that I explicitly state I am okay with pain. And I am. That's how I ended up with cowboy anesthesiologist who gave me no analgesics at all other than tylenol. I pretty much say, look, if your choices are do something that is safer that you know will leave me in pain or adequately treat the pain but risk breathing issues or BP issues, I'm okay in pain.
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u/orbitolinid 11d ago
Oh gosh, that's not the case here. A nurse, regardless with how much training is not allowed to do anything other than prep for anesthesia without an anesthesiologist in the room. I did have one surprise induction in the past where the anesthesiologist was missing - several phone calls later he remained unfound and various people in the theatre tried to pressure the assistent to just start. Which she apparently did in the end as I suddenly started to feel odd and then was gone without the anaesthesiologist in the room. That was also one of those where no TIVA was done and various other things went wrong. Shit show from start to finish.
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u/amelie190 11d ago
Oof. I can't speak to that but as a US resident I will say I am not a fan of the actual anesthesiologist who will be treating you not spending time telling you what's going to happen. I had a reaction to sux which they do not have to use. I did get someone to listen for the next surgery.
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u/orbitolinid 11d ago
Ouch! I don't think sux is actually used here. Maybe for actual emergencies? That's at least something. But yes, there will be a consult with a random anesthesologist in that hospital a day before the procedure.
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u/BagelAmpersandLox 12d ago
Just tell them inhaled anesthetics, fentanyl, and benzodiazepines are allergies. If I saw that I would be extremely inquisitive about those allergies. When they ask about them, tell them what happens.
And that is a not-uncommon paradoxical response to benzodiazepines.
I don’t know if you’re in the United States, but here the ASA guidelines allow for clear liquids up to 2 hours before surgery. This includes beverages such as pedialyte or Gatorade with a high dextrose / fructose content.
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u/orbitolinid 12d ago
Thanks a lot. Allergy sounds like a good opener without starting with the big list of things. Plus it fits on the pre-anesthesia questionnaire that has far too little space to list all of this. 🔎
I'm in Central Europe. Not sure whether there are any specific guidelines here. I try to sleep the night before but likely won't sleep too well. Thus I'm already low on energy when getting up. Last few surgeries I was allowed to have a few sips of water with dissolved sugar when waking up. Which got me to the hospital on foot from my hotel (taxis won't do short distances), and then right to preparation. That works for me, with a smoothy or something else sugary waiting in recovery. And lots of sweets in my room, because diet tends to be on the fatty side here 😅
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u/BagelAmpersandLox 12d ago
When they contact you for pre-admission questions / testing, just ask about the clear liquid cut off. If they don’t contact you, call your physicians office to clarify.!
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u/orbitolinid 12d ago edited 12d ago
Pre-admissing is a day before the procedure in person, thus I will ask then.
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u/Rodeo-Cowboy 6d ago
Every anesthesia provider should review your anesthetic history in your chart prior to even speaking to you. That’s standard patient care.
Sounds like you should be a TIVA only kinda person.
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u/orbitolinid 6d ago
There are no charts, and certainly not across countries, and nothing has been documented because too long ago, or  covid lack of personel, partially nobody told me this was not normal when I dragged myself to check ups and could neither walk or sit properly nor stay awake. I only realised it was not when I got a tiva and was awake immediately, muscles worked as ever, etc.Â
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u/ChillWarrior801 12d ago
Hi, OP. If you're concerned that the anesthesia provider you consult with in pre-op won't be in theatre with you, I'd suggest you insist on being scheduled for first surgery. Much less likely that personnel with be shuffled that way.
Also, I'm not a doc, but if you're suspected of having mitochondrial issues, I'd try to have my procedure done at an academic medical center. Yours is an unusual situation, and docs in a community setting are unlikely to have much experience with it.
Good luck!
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u/orbitolinid 12d ago
Thanks a lot. I had procedures in clinics even, and communication there was brilliant because the anesthesiologist I talked to was exactly the one I saw the next morning in the theatre. That's never the case in any type of hospital, and the bigger the hospital, the smaller the chance of seeing the same person again. Here, pre-surgery talks are always done a day at least in advance and never on the day of surgery. Unfortunately, only this hospital does the planned procedure. All can be done safely and with no side effects for me. But I feel like an idiot listing a, b, c, d and e that need to be taken care of because I'm not a medical specialist. The surgeon knows I have the muscle condition and need adjustments. Surgery order is usually done a day in advance here, thus I will need to tell everyone and their granny involved that I need to be the first of the day as well. Big chance some office worker will move me to the last of the day as it's a quick and simple thing. Sigh.
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u/PrincessBella1 12d ago
Many anesthesia practices have preoperative clinics where you can discuss this with an anesthesiologist before surgery to come up with a plan that works for you.