A question for any Anesthetists in the house..?

[Ray Luxury-Yacht]

Was reading this thread and someone discussed coming round from an anesthetic after elective operations.

I understand that maybe the duration of the anesthetic may have something to do with it. However, the poster said that when he came round from his general anesthetic after two different operations, he said that he was groggy for a long time after each one, and it took him another full day afterwards to feel like he had really got over it.

Well...I've had two elective arthroscopy ops on my knee, the second of which took slightly longer than the first. So operation one was about an hour and a quarter, and operation two 5 years later was about 2 hours. I was 34 and 39 years old respectively, and reasonably fit and well otherwise.

The procedures involved exploratory inspection, cleaning out the joint, with the second one involving some trimming of the meniscus cartilage and some trimming of bone that had grown awkwardly from the condyle of the distal femur. But on both occasions, nothing that prevented me from walking post-op.


One of my favourite things in life is sleep - I love it so I always rationalise the GA as another opportunity to sleep! It always intrigues me, and weirdly I enjoy the feeling of the anesthetic being injected into the cannula, the coldness of it running up my arm - whereupon I close my eyes and invite the welcome sleep - which comes within a few seconds, as anyone else who's had a GA knows...

Anyway the point to the thread is that on each occasion when I have come round from the anesthetic in the recovery room, I remember being woken by a nurse calling my name, I seem to wake very quickly, open my eyes and am almost immediately 'back in the room.' I then say to the nurse 'everything ok?' To which she's always replied 'yep - all done - how are you feeling?' And the answer is - yeah, fine - can I have a brew?

Once I have sat up for a while, had a brew and some toast if I'm really lucky, I just feel exactly the same as if I have just woken up in my own bed of a morning. After an hour or so, they usually invite me to swing my legs out of bed and see if I can stand and walk on the joint (I've been able to easily both times, with next to no pain at all).

After 2 hours, I have been pestering them about going home, and after watching me walk round the ward, have happily released me into the care of a relative or a mate that's arrived to drive me home.

Once home, I've then usually stuffed my face with food because I was starving from fasting the night before the op (mmmm, fooood...) - and then I've just carried on as normal, doing stuff...and apart from the big bandage on my knee, I can honestly say that it felt like nothing had really happened, and I was feeling like I always do. No headache, no drowsiness, no groggy feelings, no haziness - nothing. Just...normal?


I'm now a student Paramedic, and I have asked other clinical staff about this - although as of yet, I haven't run into an anesthetist in any of the A&E departments I've been to, in order to ask them.

So far, I've been told a range of things from 'some people always recover well from a GA, others do not...' to 'you've just been lucky each time and have had a really good anesthetist...' right up to 'you probably didn't receive enough anesthetic - can you remember being in the operating theatre at any time at all?'

The answer to the last question by the way is - no - I cannot remember a single thing at all, from the moment I went under to the nurse waking me up. And anyway, from what I have been learning so far, it's next to impossible for someone to 'wake up' during an op, despite some scare stories in the Daily Fail



So - any anesthetists or clinical ODP's who can tell me why I get over a GA within minutes so well?

TIA...

[dave_s13]

Sorry, not able to answer but my experience of GA was watching my Mrs come round from having an emergency C-Section.

She was off her head for hours and talking some right nonsnese. One of the first things she proclaimed to the consultant was "I've got a vagina like a clam!". In reference to baby getting a bit stuck She wouldn't normally make such a satement, so loudly, with a pissed up slur to her voice.

Anyway it took her a good 36hours to fully come round.

It's likely a function of how well your body processes and excretes the drug through your systems. Your liver and kidneys must be on the ball.

Do paramedics ever use LA? If so I'm sure there will be some learning around maximum safe dosages and how the body deals with the toxins. Biochemistry/pharmacology can be supremely difficult to understand fully though. I've got my LA certification for numbing toes, it's been a while and I honestly can't remember how it works on a chemical level (something to do with sodium channels). I just know that A). It does work and B). What to do if there's a bad reaction.

[ChasW]

I had my first ever op in August. It was minor but under GA. I was dreading the post op but it was fine. I woke up and within about 20 minutes ready to order my meal as I was starving. It was a private hospital so the chef prepared what precisely what I wanted. I left about three hours after coming round. I would have liked to have stayed longer for another meal and some TV and reading in relaxed surroundings. Apparently the GAs they use these days have far fewer after effects. I thought I'd be throwing up.

[ucb]

Post-operative recovery is determined by 3 factors: surgical, anaesthetic, and patient factors.
I know it sounds blatantly obvious, but I would expect someone waking up from a daycase arthroscopy to feel pretty good/fine. You shouldn't need long-acting painkillers, you don't have a particularly long anaesthetic time, and the operation does minimal disruption to the way your body works.

Compare with the GA section, which requires strong long-acting painkillers post-op, and the operation itself involves significant disruption to the abdomen and internal organs (repaired naturally), although overall the anaesthetic time is roughly similar to an arthroscopy.

How each person reacts to a given anaesthetic or operation is impossible to predict.

[Ruskie]

Can't answer the question but having spent my time in theatre (as a student paramedic) it would have serious issues having an op with GA. When you come round and have the ET tube or LMA in there would be too much!

[Chicken]

Ruskie said:

Can't answer the question but having spent my time in theatre (as a student paramedic) it would have serious issues having an op with GA. When you come round and have the ET tube or LMA in there would be too much!

Massively off topic, but, does anyone still use LMAs? I thought everyone was on iGels now.
PS Ray, do you know which station you'll be observing at yet?

[numtumfutunch]

Chicken said:

Massively off topic, but, does anyone still use LMAs? I thought everyone was on iGels now.
PS Ray, do you know which station you'll be observing at yet?

I was told that igels are only popular because they sound like Apple make them and that they are easier for the non skilled to use

[Chicken]

numtumfutunch said:

Chicken said:

Massively off topic, but, does anyone still use LMAs? I thought everyone was on iGels now.
PS Ray, do you know which station you'll be observing at yet?

I was told that igels are only popular because they sound like Apple make them and that they are easier for the non skilled to use

And they look comically phallic as well

[Ray Luxury-Yacht]

Chicken said:

Ruskie said:

Can't answer the question but having spent my time in theatre (as a student paramedic) it would have serious issues having an op with GA. When you come round and have the ET tube or LMA in there would be too much!

Massively off topic, but, does anyone still use LMAs? I thought everyone was on iGels now.
PS Ray, do you know which station you'll be observing at yet?

Yes, our trust, at least, is all iGels now.

Yes, started on placement last week - 'observing' might not be the right way to describe it though - 'in at the bloody deep end' is more like it, if being involved in a full-on resus on my second ever day is anything to go by

Won't write on here any details about stations and placements for obvious reasons - drop us a PM though, would be good to chat!

[Mabbs9]

I woke after an arthroscopy and still had the tube down my throat. A nurse attended in moments, she just said 'breathe out gently' and pulled the tube out.

It was something i used to fear, having experienced it I realise it's no big deal.

[Ruskie]

Ray Luxury-Yacht said:

Chicken said:

Ruskie said:

Can't answer the question but having spent my time in theatre (as a student paramedic) it would have serious issues having an op with GA. When you come round and have the ET tube or LMA in there would be too much!

Massively off topic, but, does anyone still use LMAs? I thought everyone was on iGels now.
PS Ray, do you know which station you'll be observing at yet?

Yes, our trust, at least, is all iGels now.

Yes, started on placement last week - 'observing' might not be the right way to describe it though - 'in at the bloody deep end' is more like it, if being involved in a full-on resus on my second ever day is anything to go by

Won't write on here any details about stations and placements for obvious reasons - drop us a PM though, would be good to chat!

We are still on LMA but have had iGel on trial about a year ago. If you need any advice or help with the student paramedic thing drop me a PM. I went through that route 6 years ago.

[Silent1]

Ruskie said:

Ray Luxury-Yacht said:

Chicken said:

Ruskie said:

Can't answer the question but having spent my time in theatre (as a student paramedic) it would have serious issues having an op with GA. When you come round and have the ET tube or LMA in there would be too much!

Massively off topic, but, does anyone still use LMAs? I thought everyone was on iGels now.
PS Ray, do you know which station you'll be observing at yet?

Yes, our trust, at least, is all iGels now.

Yes, started on placement last week - 'observing' might not be the right way to describe it though - 'in at the bloody deep end' is more like it, if being involved in a full-on resus on my second ever day is anything to go by

Won't write on here any details about stations and placements for obvious reasons - drop us a PM though, would be good to chat!

We are still on LMA but have had iGel on trial about a year ago. If you need any advice or help with the student paramedic thing drop me a PM. I went through that route 6 years ago.

Looking at the trials of LMAs vs iGels it seems iGels can be inserted quicker, have less incidence of blood and easier insertion of gastric tubes but the sealing pressure is significantly lower than an LMA.

[Ruskie]

Silent1 said:

Ruskie said:

Ray Luxury-Yacht said:

Chicken said:

Ruskie said:

Can't answer the question but having spent my time in theatre (as a student paramedic) it would have serious issues having an op with GA. When you come round and have the ET tube or LMA in there would be too much!

Massively off topic, but, does anyone still use LMAs? I thought everyone was on iGels now.
PS Ray, do you know which station you'll be observing at yet?

Yes, our trust, at least, is all iGels now.

Yes, started on placement last week - 'observing' might not be the right way to describe it though - 'in at the bloody deep end' is more like it, if being involved in a full-on resus on my second ever day is anything to go by

Won't write on here any details about stations and placements for obvious reasons - drop us a PM though, would be good to chat!

We are still on LMA but have had iGel on trial about a year ago. If you need any advice or help with the student paramedic thing drop me a PM. I went through that route 6 years ago.

Looking at the trials of LMAs vs iGels it seems iGels can be inserted quicker, have less incidence of blood and easier insertion of gastric tubes but the sealing pressure is significantly lower than an LMA.

I'm not a fan to be honest. Without trying to sound arrogant I have never had a problem intubating quickly and more importantly in the right place! Sighting the cords, cricoid pressure (useful in my experience as people can often feel the tube going in) fogging on the tube, auscultation and capnography plus bougie if needed means unless its a difficult grade there are no excuses in my opinion. I realise I am in the minority and that research shows ALS with a paramedic v non paramedic BLS the non paramedic has a better ROSC.

[numtumfutunch]

Ruskie said:

Without trying to sound arrogant I have never had a problem intubating quickly and more importantly in the right place!

Interesting

I hear that the incidence of failed intubation amongst trained anaesthetists is as much as 1 in 200

How many tubes do you do per year?

[mybrainhurts]

Ray Luxury-Yacht said:

One of my favourite things in life is sleep - I love it so I always rationalise the GA as another opportunity to sleep! It always intrigues me, and weirdly I enjoy the feeling of the anesthetic being injected into the cannula, the coldness of it running up my arm -

I'll have you know you put ME to sleep on Friday when I read that and I've just woken up...
I want my weekend back, you bastid....

[dudleybloke]

i dont know what ga they used on me when they operated on my arm but when i came round i was bright eyed and bushy tailed within a min or 2.

[Ray Luxury-Yacht]

mybrainhurts said:

Ray Luxury-Yacht said:

One of my favourite things in life is sleep - I love it so I always rationalise the GA as another opportunity to sleep! It always intrigues me, and weirdly I enjoy the feeling of the anesthetic being injected into the cannula, the coldness of it running up my arm -

I'll have you know you put ME to sleep on Friday when I read that and I've just woken up...
I want my weekend back, you bastid....

The clue's in the thread title...

Can't offer you back 48 hours of your life, sorry. But I have got a photograph of a piece of cheese - will that do?

[mybrainhurts]

Ray Luxury-Yacht said:

mybrainhurts said:

Ray Luxury-Yacht said:

One of my favourite things in life is sleep - I love it so I always rationalise the GA as another opportunity to sleep! It always intrigues me, and weirdly I enjoy the feeling of the anesthetic being injected into the cannula, the coldness of it running up my arm -

I'll have you know you put ME to sleep on Friday when I read that and I've just woken up...
I want my weekend back, you bastid....

The clue's in the thread title...

Can't offer you back 48 hours of your life, sorry. But I have got a photograph of a piece of cheese - will that do?

I'll chew on it...

[Ruskie]

numtumfutunch said:

Ruskie said:

Without trying to sound arrogant I have never had a problem intubating quickly and more importantly in the right place!

Interesting

I hear that the incidence of failed intubation amongst trained anaesthetists is as much as 1 in 200

How many tubes do you do per year?

Rightly so. It's their day job and they are very good at it. Why is that relevant to paramedic practise? How many times a year do anaesthetists put in an I/O or cannulate the jugular vein? What percentage of airways are compromised, that they deal with? What percentage are intubated on their knees?

Don't get me wrong I have immense respect for anaesthetists but I am tired of paramedics not getting the credit where it is due. In situations where someone is leading a cardiac arrest as the senior clinician there is a hell of a lot to think about, let alone dealing with upset family/trying to get a history/instruction junior members whilst attempting to secure an airway.

How many tubes a year? Between 10-25 I would estimate but that will differ paramedic to paramedic. Rural to urban.

[turbolucie]

Mabbs9 said:

I woke after an arthroscopy and still had the tube down my throat. A nurse attended in moments, she just said 'breathe out gently' and pulled the tube out.

It was something i used to fear, having experienced it I realise it's no big deal.

One of my senior colleagues talked me into having an LMA inserted awake, just for fun. It wasn't fun!

You have to be awake enough for it to be safe to take the tube out anyway, so you can maintain your own airway, so some people are bound to remember it.