I’m going under general for the first time in two weeks for a brain biopsy.
Explain it and how it’s safe.
I’m not scared of the biopsy, just the general.
Is that normal?
In: 90
Lots of people have explained the technical side so I’ll do the basics from my own experience.
They’ll give you a hospital gown to change into and maybe some flimsy underwear and socks.
They come in and ask you questions about your height, weight, and medical history (Allergies, surgeries, family issues, diabetes, smoking, etc).
They’ll then do a basic checkup and take your blood pressure.
After, the anaesthetist will come in, ask you to confirm your answers, and take you the prep-area.
They’ll give you an injection in your arm, it may feel cold, and either talk to you or ask you to count.
You’ll then awake in the recovery ward to make sure you’re ok, you’ll still be a but loopy, and then they’ll take you to your bed where you will come out of it.
Most of the time people only remember having the injection and then waking up in their bed.
Feel free to shoot me a message if you have any specific questions, but lots of very qualified people have given you great answers already.
I’ve had general anesthetic 10+ times. I still get nervous but very much look forward to those few seconds before you drift off.
Pro tip: try to stay away as long as you can and look around. The walls melting gets me everytime.
Copy/paste from a long response I made in another ELI5 about anesthesia.
It gives you something to do while allowing the doc to watch the medications take effect.
Induction for surgery differs a bit from what we do in the field but the concept is similar.
We start with an induction agent. This is designed to put you to sleep. It often has amnesia inducing effects which makes you stop making memories.
Then once you’re asleep, we give a paralytic. This paralyzes your muscles so that we aren’t fighting against you. It gives us more control. It also prevents your digestive muscles from relaxing and spilling gastric contents into your airway. This is also why they tell you not to eat or drink after midnight. You can’t spill what’s not there.
You’re intubated, which involves using a curved tongue depressor looking object with a handle (and often a camera) to manipulate the tongue / airway structure and putting a tube into your trachea. This gives us a tube that we can use to breathe for you while your muscles are paralyzed (this means the muscles you use for breathing are also paralyzed, which means you’re not breathing during this).
We take over your breathing with a machine. This is a ventilator, but can often be referred to as “life support.”
We give you additional medications to keep you asleep. Depending on what medication we gave for induction, it may be the same, or it may be different. Similar but different.
Now in the surgical world, they also worry about waking you up and all that. We don’t in the field. If we put you to sleep, weren’t not the ones waking you up.
Back to your original question. The easiest way to see how your induction medication is working is to just talk to the patient. Have them count out loud and you know they’re asleep when they stop counting. This isn’t always feasible for us.
If we are intubating in the field, they’re usually really sick / hurt and they may not be able to talk. As such, I’ll poke the forehead and brush the eyelashes to determine whether our meds have kicked in. Each of those will elicit a response that will disappear with paralysis. Once your paralyzed, we intubate quickly and start breathing for the patient before they physiologically realize they aren’t breathing and start to respond accordingly.
Edit: Really long winded way of saying no, it doesn’t matter what order you count in. Once meds are pushed, everyone is just waiting for you to fall asleep. You can count forwards, backwards, sideways, list colors, or name the states in alphabetical order. No matter, once meds are pushed, you’ve got 10-20 seconds before you get sent to the best nap you’ve ever taken.
Edit 2: getting a lot of repeat questions.
Why doesn’t the paralytic stop the heart?
The paralytics we use target a specific receptor pathway / system that isn’t present in heart cells. Imagine of the medicine paralyzes everything in the body colored blue, but the heart is red.
Did I have this with X procedure?
Depends. Maybe. Maybe not. But probably. If you woke up with a cough or a sore throat, there’s a good chance you had something there.
If you are (or were) a natural redhead, **mention this** to your anæsthetist when they stop by to introduce themselves. Something in our DNA affects our reaction, and it will be useful to them to know this.
Have a look at Max Feinstein on YouTube, he’s an anaesthesiologist who makes videos explaining all aspects.
when i was 13 i got into a car accident that resulted in 9 fractures (the car got hit by a train). as a result i had probably at least 5 surgeries that required general anesthesia (most likely more) and by the second or third time, whenever doctors would ask me how i’m feeling about my upcoming surgery, i would say “fine, if anything it’s just a few extra hours of sleep.”
don’t stress it! it’ll be absolutely fine. good luck!
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