During my last 3 surgeries, all with general anesthesia, I had the same episode of difficulty breathing immediately upon awakening in recovery. I`d become aware of where I was, and try to breathe but couldn`t get air to go into my lungs, like my chest was paralyzed. Then I panicked and thrashed around, and the last 2 times something was put into my IV and there was immediate relief. I wonder if I`m sensitive to some of the drugs used and if it`s likely to occur with future surgeries? It was extremely scary. My mother also had a similar episode during a surgery about 15 yrs. ago. Could this be a hereditary thing? 

ﾠYour description really does sound like the experience of being partially paralyzed. Very scary for you (and probably for those taking care of you). This certainly could be hereditary. There is a condition called pseudocholinesterase deficiency in which the metabolism of a common muscle relaxant called succinylcholine is slowed. There are also a variety of hereditary nerve and muscle conditions which would make you more susceptible to the effects of almost all the muscle relaxants. Some patients cannot metabolize muscle relaxants effectively because of problems with kidney or liver function. In other people, there is an interaction between muscle relaxants and other drugs they may be taking. Another possibility is a panic attack. Are you susceptible at other times to such feelings? A final possible diagnosis is laryngospasm, in which a part of the throat constricts, sometimes in response to secretions retained in the throat during the period of recovery from anesthesia. Your repeated problems certainly warrant a trip to your local hospital and a meeting with a senior anesthesiologist who might be willing to sit down with you, review any hospital records available, and try to come up with a reasonable diagnosis and a plan to avoid these kinds of difficulties the next time you have surgery. Good luck! 

Anesthesia on Thursday.......today is Tuesday & I`m still having difficulty breathing...........I`m in excellent shape (5 miler) but cannot go from bed to bathroom without breathing difficulty.ﾠ Are these effects normal? 

ﾠDefinitely not normal. This is not a diagnostic service nor is it an emergency service but  I must tell you that the best course of action is to contact your doctor as a matter of urgency to be properly assessed. 

I recently had a laporoscopic cholecystecomy and immediately I came round after the anasthetic I struggled to breathe. I was trying to speak but could hardly speak and felt as though my lungs would just not work. The nurse said my oxygen sats were 98% so I should be ok but I started thrashing around. I heard the doctor say he`d given me something and put an oxygen mask on my face. I then started shaking uncontrollably and it was so scary. When I got my breath they said I`d had a panic attack. I worry in case it was related to the anasthetic as I have read in apnoea the oxygen stats are normal until it`s too late. The doctor kept shouting to me to look into his eyes and asking me how many fingers he was holding up. Please could you advise as I may need another operation soon for something else. Thanks 

Clearly you have had a very upsetting experience. I hope this does not happen to you again. It's always difficult, in fact unwise, to attempt to make diagnoses based on limited information that might not even be accurate. You must recognize that what you remember from the period of recovery from a general anesthetic might not be entirely correct. I always advise patients to check with the anesthesiologist for a fuller assessment, conducted in the light of the real facts. With those caveats, I will offer you one or two possibilities to consider. One possibility is that during your awakening from the anesthetic you were suffering from muscle weakness. Muscle relaxants are intravenous paralyzing agents which make it possible to insert airways into unconsciousﾠpatients and to relax muscles sufficiently to allow surgery to proceed effectively. Relaxants are usually reversed with special medicines also given intravenously. Occasionally a patient will awaken without full recovery of muscle function. Even though breathing and oxygenation may be adequate, there is a very distressing feeling that accompanies this partial paralysis. Another possibility is that you had a reaction to one of the medicines used to prevent nausea, such as metoclopramide or droperidol. This can also be an uncomfortable, anxiety-provoking feeling. Finally, there is a condition called laryngospasm, in which the structures in or near the voice box (larynx) close off, or partially close off, making it difficult to breath properly. This can occur when there are secretions irritating the vocal cords, or sometimes for no apparent reason. Fortunately this condition is usually easy to treat with oxygen and air pressure applied with an oxygen mask. What you have said about apnea (apnoea) is not entirely correct. It is true that if you stop breathing it may take some time for oxygen levels to drop, but that does not mean it is "too late". It's just that a low oxygen level can be a relatively late sign that someone has stopped breathing, especially if they were breathing extra oxygen before the breathing stopped. Except under unusual circumstances, there is plenty of time to help the person with breathing and restore oxygen levels to normal.ﾠ 

I am terrified to have general anesthesia after the past two surgeries I have had. Immediately upon waking up from the first surgery I started coughing uncontrollably and could not get my breath. The attendents in recovery immediately must have known what the problem was and gave some type of injection and immediately I stopped coughing and could breath. This was terrifying and I honestly thought I was going to die. I was told that when they removed the tube this caused spasms in my throat and if I ever had surgery again to always tell the anesthesiologist so that they could be prepare for this. The next surgery I had I did tell the anesthesiologist but when I awoke from this surgery I had the same problem but this time no-one immediately came to my aid until some time later...a panic attack does not describe this terror. I need two surgeries - my thyroid removed and a surgery on my knee for a torn cartilage (meniscus). The thyroid surgery I have avoided for years due to my experience and now I cannot walk due to the torn cartilage. What can I do to prevent this problem so that I can have these surgeries? Or will I always have this problem..so what can I say to the anesthesiologist so that they will be more alert to this possible problem. Please assist me if you can...I cannot keep avoiding these surgeries not due to being afraid of the surgery but due to waking up after the surgery. Your answer would be greatly appreciated! 

You must discuss your problem with your surgeon and with the anesthesiologist who will take care of you. Many larger hospitals, especially academic medical centers, have pre-anesthesia clinics in which such difficulties can be explored, diagnosed, and appropriate plans made for future surgical procedures. You should try to obtain your hospital records so that the episode you describe can be fully reviewed by your doctors. You may have a condition known under many terms, such as vocal cord dysfunction, or paradoxical vocal cord motion, but commonly referred to by anesthesiologists as laryngospasm. The site of trouble is the upper airway - at or above the larynx, or voice box. The vocal cords come together to narrow or close off the airway. These terms may in fact encompass a variety of different conditions of different causes. This suggests the conditions are not that well understood. Before your next surgery you should consider being referred to an ENT doctor who can actually examine the voice box directly just to make sure there is nothing wrong with the anatomy. Assuming there is nothing wrong with the structure of your larynx, and there are no serious medical conditions like tumors or infection, the condition you seem to be describing is not life-threatening, but obviously very scary. There may or may not be a psychological aspect to this condition. Sometimes coughing or panting can break the spasm and relieve the obstruction. Acute, severe episodes can be treated with oxygen, or Heliox (80 percent helium/20 percent oxygen) which flows more easily through a narrowed airway. Sedation is another treatment for this condition - you may have been given intravenous sedative to relieve the problem last time. Intermittent, positive pressure also can resolve an attack. That means applying pressure to the airway using a mask placed tightly over the nose and mouth and a flow of oxygen. Lidocaine, a local anesthetic, applied to the larynx by the anesthesiologist just before the end of the surgical procedure and before the airway (breathing tube) is removed might be useful in prevention. The anesthesiologist can also make sure that the airway is cleared of any secretions that might irritate the larynx to cause spasm before you wake up. I hope these suggestions help. 

I have a neuromuscular disease with proximal muscle weakness and respiratory muscle weakness. My PFT`s show a restrictive process with the MIP-25% (should be 150) and MEP-21% (should be 87). I use a BIPAP at night to help rest the respiratory muscles. I am worried if I ever have to have surgery with gen. anesthesia that I could have problems being extubated due to the weakness. In the future if I have to have surgery, should I mention this to the anesthesia doc? Is this significant that I should be worried about this? Are there things that could be done preventively while under anesthesia to help with this problem? Thank you for your help. 

I think you know the answer to your first question. Your neuromuscular disease is something that your anesthesiologist should be fully informed about. 

Everything you have mentioned is important but in addition your anesthesiologist will need a much fuller medical history and willﾠprobably want a discussion with and/or a report from the doctor(s) who take care of you for this set of problems. 

Any anesthesia-related risk will depend on a variety of factors including your exact diagnosis, the severity and stability of the disease, the medications you take, the surgical procedure, and the type of anesthesia. 

Based on those test results your condition sounds moderately severe. If you need to be intubatedﾠfor, let's say, an abdominal operation, then your concerns about extubation (breathing tube removal) are appropriate. This will have to be approached with caution. Patients with severe neuromuscular disease sometimes require a period of hours or days to recover their breathing function and so must be cared for in intensive care unit. 

The avoidance of muscle relaxant drugs may help maintain enough breathing muscle function to allow extubation at the end of the surgery, but these kinds of decisions must be made by your anesthesiologist, fully informed about the factors I've mentioned above. 

For other kinds of surgery, regional anesthesia (nerve blocks, spinal or epidural) may be an option which will sometimes, but not always, help avoid the problems of worsening the respiratory muscle condition. Again this needs to be individualized.ﾠA good plan, considering all the options,ﾠmust be made with your anesthesiologist. 

I was 48 hour post general anesthesia. I felt short of breath but could quite say I was having trouble breathing. I was a little anxious about it and just didn`t feel right. I felt better sitting up than laying down. At one point in time, I yawned deeply, and felt immediate relief. I have not felt short of breath since. Should I worry about this and what do you think took place? I am not planning on contacting my doctor about this tomorrow because I am not sure it is something I need to bother him about. 

It's not possible for me to give you diagnostic or treatment advice, I can only provide general information. Shortness of breath after a surgical procedure can have a variety of causes, some serious and some innocent. To determine what is causing, or has caused, your shortness of breath would require a full history, including knowledge of the surgical procedure you had, a physical examination and possibly some tests. Among the more dangerous possible causes of breathlessness are pulmonary embolus (blood clot in the lungs), heart failure, heart ischemia (lack of oxygen to heart muscle), pneumonia, and lung collapse. At the other end of the spectrum are simple anxiety, and viral infection. The fact that you do not feel short of breath now is somewhat reassuring. One possibility is that perhaps you had a small amount of atelectasis (closure of a section of the lung) which is now gone. For the reasons stated above please consult with your doctor as soon as possible. 

I am a long term smoker over 50yrs. I will be having a inguinal hernia repair in about 2 weeks. I have been told that my lungs may get worse before they get better if I quit smoking now and it may interfere with my breathing during my anesthetic and after surgery. Is this true? What do you suggest? 

The bottom line is - quit smoking now! Your surgery represents a golden opportunity to do so. There is evidence that smokers who quit at or before surgery experience fewer symptoms of nicotine withdrawal and are more likely to succeed in their attempt to stop smoking long term. Although it may take 3 - 6 weeks for the lungs to recover from some of the effects of smoking, and you have only 2 weeks to go, there is still, on balance, benefit to you if you stop. As always, you have to look at the benefits and the risks. During the first few days after stopping, some people will experience an increase in mucus production in the air passages of the lungs. Some people think this might increase the possibility of a lung complication but there is no published evidence that this is true. On the other hand, the risks of a lung complication after a relatively minor operation such as inguinal hernia repair are rather low anyway. This is an operation that can be done without general anesthesia and intubation, which are associated with the lung complications you want to avoid. And there are also immediate physiologic benefits from stopping smoking, such as increased oxygen carried in the blood, and improvement in wound healing. Some authorities believe that this is an important public health issue. There is a new American Society of Anesthesiologists task force which is looking at how to help people quit smoking at the time of surgery. It's hard to do it on your own entirely, and the use of nicotine replacement therapy (NRT) - that is the nicotine patch or gum - can definitely help keep you off the cigarettes. NRT is safe, and probably effective for people trying to stop smoking around the time of surgery. Ask your primary care doctor to assist you with this. 

Over the past 8 months, I have had 4 surgeries on my jaw. During the first under sedation, I had no problems waking up afterwards. During my 2nd surgery under general anesthesia, I had to stay overnight in the hospital becuase I would not wake up. My 3rd surgery was again under sedation and I took a couple hours to wake up and then came in and out of conciousness during the next 4 days. My most recent surgery was under general anesthesia and I had a severe reaction. I stopped breathing the night after my surgery in the recovery room and had to be on a ventilator. I was unable to breathe on my own for the next 3 days and did not "wake up" from the surgery until a week afterwards. What I mean was I was aware of what was going on around me, but I could not move at all and could not open my eyes or talk. 

I am fine now, but my doctors still do not know what happened. I am 18 yrs old and am healthy other than the fact that because of the jaw injury, I have been on a liquid diet for all 7 months. I am wondering if nutrition played a role in this. I know my nutrition level was down from not being able to eat properly and the fact that I had a worse reaction after every surgery seems to go along with my decreasing nutritional level. 

My doctors say I had a reaction to morphine, but are not exactly sure. What do you think caused this reaction? Like I said, I am only 18 and in good health other than not being able to chew foods. 

I'm sorry you've had such a rough time with your recent surgeries. Although you've given quite a good description of what happened it's difficult to speculate on the cause without reviewing your medical records in detail, including the drugs you were given before and after your surgery. That is one of the reasons why we do not offer a diagnostic service. 

Nutrition certainly affects how the body handles medication, including anesthetic drugs, and painkillers like morphine. For instance, the level in the blood of a protein called albumin, which can drop in severe malnutrition or other illnesses, can have an impact on the effects of certain drugs. Albumin binds to drugs, and it is only the free, or unbound, drug, that is active. If your protein and albumin levels are low, you may have more free or active drug circulating in your body, and therefore a greater effect from a particular drug. 

It is actually possible to measure your level of nutrition, not only by looking at your weight and general appearance, but with blood tests. Interestingly, albumin level turns out to be a good predictor of how well patients recover from major surgery. Pre-albumin is another substance in the blood whose amount reflects overall nutrition levels. Deficiency of certain electrolytes, like calcium, magnesium and potassium can affect the function of nerves and muscles. These electrolytes are all easily measured. However, you have to be pretty severely malnourished or have some other disorder, along with not eating properly, to get to the point where your electrolytes are abnormal enough to affect your nerves or muscles. 

I wonder how long you were not breathing for after your most recent surgery? As you know, brain damage occurs after more than a few minutes completely without oxygen. This might result in coma although not usually the kind of distressing "paralyzed but awake" state that you describe. Morphine, the standard medication for major pain, is a respiratory depressant. In other words, it slows breathing, and can even stop breathing entirely. One of the problems is that there is quite a wide variation between individuals in the amount of morphine needed to control pain. Size and age are a guide, but even when one takes into account these differences, it's still hard to predict how much a person will need. Hence the usefulness of methods like PCA (patient controlled analgesia) in which the patient decides how much pain medication he or she needs. It is possible for a person's sensitivity to morphine to be abnormally high, resulting in the slow awakening from your surgery and subsequent breathing problems after an operation. 

If your doctors are puzzled or uncertain about what caused your problems, it may be time to look for unusual disorders. Although you say you are in good health, there are certain metabolic disorders, and disorders of nerve and muscle, that could possibly have contributed to your problems, with few signs to point to them until you encounter an anesthetic, the stress of surgery, and all the medications used after surgery. Porphyria is one such disorder. There are also a variety of rare muscle diseases, such as mitochondrial myopathies that can cause problems with anesthesia. These require an expert, such as a geneticist, for proper diagnosis and treatment. 

I will be having General Anesthesia soon for repair of a labral hip tear and reshaping of the femur head (about 1.5 hrs surgery). The biggest fear I have is the anesthesia. Not waking up, etc. 

Many years ago I heard horror stories about anesthesia and it`s definitely hard to just relax and trust in this very strange situation of being `put out`. I have had `Twilight Cocktail` two times previously for eye and wrist surgery with no complications, with one just a year ago after I started having trouble with asthma. No issues. I am very healthy - 40 yr old female. 

Other than recent panic attacks in the last few years, I have had a type of asthma ever since I had whooping cough 4 years ago. I always had a very quiet asthma that only occurred when exercising in very cold weather and it only happened once or twice a year and was never, ever a problem. Now, if the air gets cold or warm or I get a chest cold, I have a hard time breathing and no type of asthma medicine or inhaler helps at all. Tried many. They actually seem to make it worse. Humidifiers help and sometimes just relaxing but it can takes weeks, particularly after a cold, for things to stabilize. And any throat irritation can initiate a strong need to throw up also and for some reason it also affects my lungs. I think it`s my lungs being very weak as well as a nervous reaction. 

I have read about asthma being a potential complication but my doctor doesnt seem too worried about me. And this tube down the throat concerns me since my gag reflex...well, you get the picture. 

At what point is Asthma an issue and does adjusting the type of anesthetic drug used minimize risk? 

I agree it is difficult to get comfortable with the idea of getting "put out" and I have a few comments to make in response to your question. 

First, asthma that doesn't respond to asthma medicine is not likely to be asthma! So my first piece of advice is to check with your family physician or a pulmonary specialist on that. 

Second, a person with panic attacks is often going to be much more worried about anesthesia than the next person. The most helpful thing may be to ask to talk with, or actually meet with your anesthesiologist, or a representative of the anesthesiologist group at the hospital where you will have your surgery. They will probably be able to reassure you and give you more information about the anesthetic choices. You may be offered sedative or anxiety-relieving medication to take at home before you arrive at the hospital, or even to take the night before, when anxiety may be at its worst. The anesthesiologist will definitely be interested in your asthma "story", and may even ask for a report on this from your family doctor or lung specialist, or to request that some tests be done on your lungs, such as a chest x-ray, lung function tests, or pulse oximetry. 

Among the anesthetic choices that you may be offered is spinal or epidural anesthesia, also known as "regional" anesthesia. In many hospitals, these techniques are the preferred form of anesthesia for hip or knee surgery. If you have a spinal or epidural anesthetic there will be no need to put a breathing tube in your throat or to interfere with your lungs or your breathing. Along with the spinal or epidural you can receive an intravenous infusion of sedative drugs - the "twilight cocktail" that you refer to, which will keep you calm and snoozing happily. With your history, this technique might be the way to go. But, as I said, you should consult with the anesthesiologist so you can have this discussion with a professional who has all the medical information, can do the necessary physical examination, can take your wishes and concerns into account, and then come up with the best possible plan of action. 

I am thinking of undergoing an elective cosmetic surgery. However, a year ago I had my gallbladder removed laparoscopically. In waking from the surgery, I was gasping for air and felt I could not breathe. My anesthesia had to be reversed 3 times and I remember them putting something on my arm that felt like a shocking device. I had to have oxygen and was vomiting. I have a copy of the records from that date b/c this has bothered me so much. Can you tell me what could have happened? Is it normal to have to have anesthesia reversed 3 times? 

ﾠThe best person to discuss this problem with you is the anesthesiologist who took care of you when you had your gall bladder surgery. I suggest you give that person a call. Without access to the records and talking to the people who were there, it is difficult to know exactly what happened. Having said that, my best guess is that the muscle relaxant medication, which is given routinely during anesthesia for this type of surgery, had not entirely worn off when you awoke from the surgery. This, as you described, can be a very unpleasant experience. The muscle relaxant medications used in anesthesia differ from those prescribed for use at home, for example to treat various kinds of pain. Muscle relaxants used in anesthesia are in fact paralyzing drugs. A full dose causes complete paralysis. These drugs are used to make it easier to pass a breathing tube, and also to relax the muscles enough to allow the surgery to take place. At the end of the surgery it is usually not the anesthesia that has to be ﾓreversedﾔ but the muscle relaxant. In the United States there are two drugs commonly used, in combination, to reverse muscle relaxants ﾖ neostigmine and glycopyrrolate. It sounds as though you were given two additional doses of reversal ﾖ one dose is the usual. The ﾓshocking deviceﾔ that you recall was probably a device called a nerve stimulator, which administers a small electric shock to a nerve in the arm or the face. The shock causes the muscles in that area to twitch, and is an indication of whether the muscle relaxant has worn off. It is normally used on patients who are unconscious. There are many reasons why you might not have recovered fully from the muscle relaxant when you woke up. The reasons include having a lower level of the enzyme that breaks down the relaxant, the presence of other drugs that interfere with recovery, low body temperature, inadequate dose of reversal medicine, or simply not waiting long enough for the muscle relaxant to wear off on its own. The administration of oxygen after general anesthesia is routine and that in itself is not anything that points to a major problem. Nausea and vomiting are unfortunately problems that still occur relatively frequently after anesthesia. Certain individuals, such as younger women, those with a history of motion sickness, those receiving narcotic pain medicines, are more at risk of this happening. There are medications and techniques that make it less likely to get nausea and vomiting but this not an entirely preventable problem. Please be sure to bring these concerns to your anesthesiologist before you undergo your planned surgery, and remember to bring the old medical records with you. With a good understanding of what happened to you it is very likely that your unhappy experience will be repeated again.ﾠ 

I am 39 years old and had asthma as a baby. I have not been treated for asthma since then. I smoked for about 20 years (on & off) but stopped the day before major surgery on January 11th. I have had problems getting a deep breath for about a week now. It has been over 2 months since my surgery. Can anesthesia cause asthma to act up after so long? Should I call my surgeon or just go and see an asthma/allergy doctor for evaluation? 

Thanks for your question. You do not say what type of surgery you had, nor whether you made a good initial recovery from the surgery and anesthesia. Nevertheless, if you are feeling breathless 2 months after your surgery, this is extremely unlikely to have anything to do with the anesthesia you received at that time. 

It is not possible to make a diagnosis with the information you have given me. Diagnosis is not in any case a service we offer. Typical symptoms of acute asthma include breathlessness, a tight feeling in the chest, and wheezing. I must urge you to see a physician as soon as possible to investigate and treat your symptoms. If your surgeon already knows you quite well, you may choose to see him or her; alternatively you should consider calling your family physician or even going to an emergency room, particularly if your condition is worsening. You may have something as common and benign as an upper respiratory infection, or as serious as a blood clot in the lungs. 

I had a hysterectomy a year ago. After surgery when the tube was taken out of my throat I guess my throat closed up and I was unable to breathe for awhile but they got that under control soon enough but than my blood oxidation level dropped to 50 and they had a hard time getting it back to normal. I was given many breathing tx`s.My question is What could have happened to cause this? I am 47 and in good general health. Please let me know cause I am scared if I have to have another operation I will die. It was not a pulmonary embolism. 

ﾠI recommend that you meet with your anesthesiologist before any future surgery to discuss what happened to you. It would be extremely helpful if you could get copies of your hospital records so these can be thoroughly reviewed. You should also try to get the name of the anesthesiologist who took care of you so that you, and you physicians, can get their opinion about what caused your breathing problems. There are several possible causes for breathing difficulties after surgery. I will mention just a few likely factors. Muscle relaxants are paralyzing drugs used routinely during anesthesia. Incomplete reversal of muscle relaxant effect at the end of surgery, when the breathing tube is removed, can cause the breathing passages to close off. In this circumstance the patient may be awake but too weak to breathe properly. Patients who are too deeply asleep (anesthetized) after the breathing tube is removed may also be unable to keeping their breathing passages open. Residual anesthetic medications, including painkillers (narcotics) may be responsible for this effect. Sometimes, when partial airway obstruction happens, extra fluid enters the lower airway passages immediately afterward. This is known as negative pressure pulmonary edema. The fluid in the lungs causes the blood oxygen level to decrease. Aspiration is another cause of breathing problems. This is when stomach contents come up the esophagus (food pipe) and enter the lungs. This can occur any time during an anesthetic when a breathing tube does not protect the airway. Finally, as you mention, a pulmonary embolism can cause severe breathing difficulties. This is when a blood clot lodges in the blood vessels supplying the lungs. You do not indicate how you know that the events you describe was not an embolism. Your physicians should review the evidence for or against this possibility. If, as you say, you are in good general health, it is unlikely that the events you describe will occur again during a well-conducted general anesthetic. 

Back in 1962 I had an operation for a torn meniscus. The doc gave me a spinal, and after a few minutes, I felt that I couldn`t breathe and started panicking and then the docs put me out under general anesthesia. Now, I am scheduled to have a TURP, and the doc wants to give me a spinal again as the doc says she needs to be able to talk to me during the procedure. I am deathly afraid of getting the "not being able to breathe" problem again. I suppose the problem stems from the fact that I couldn`t move my lower adominal muscles during the procedure in 1962, which caused me to feel like I couldn`t breathe. Have things improved since 1962 as far as spinals go, or do I stand a chance of having the same problem again? If so, is there anything I can do to avoid the problem? 

Although it's 44 years ago this unpleasant experience is still vivid in your mind. In 1962 I was still in diapers. You were probably a young, active person and injured your knee playing hockey, skiing or on the football field. I would like to tell you that spinal anesthesia has changed radically since then. But it hasn't changed all that much. We still "stick" a needle (gently, of course) in your lower back and inject a small quantity of local anesthetic. Most of the local anesthetics we use today (lidocaine, bupivacaine) have been around for a good 30 to 40 years. 

What has changed is the size of the needle - much more delicate, narrow gauge needles are used today which minimize the risk of a postoperative headache. Monitoring has greatly improved, along with awareness of potential complications, allowing their prevention and/or early detection and treatment. 

What may be more important is that you have changed. You are older, probably wiser, and I would imagine a bit calmer in the face of adversity. As a more mature person you will probably be able to tolerate the unusual sensation of spinal blockade without panicking. If you are still extremely nervous, your anesthesia practitioner can offer you intravenous sedation along with the spinal. The sedative drugs available today have improved since 1962. They can provide you with a pleasant and tolerable experience. 

Finally, although spinal anesthesia is commonly used for TURP procedures it is not considered essential under normal circumstances. If you cannot face the prospect, please chat with your surgeon and your anesthesiologist ahead of time to make this clear to them and to allow consideration of the safe alternative - general anesthesia. 

After knee replacement surgery, I was placed on a PCA morphine pump. While using the PCA, I stopped breathing and had to be coded, fortunately with no lasting ill effect. I has been on a morphine PCA for a prior surgery a year before with no problem. I am 71 with controlled hypertension and diabetes 2 but otherwise in good health. How could this have happened? I thought the PCA was calibrated and only allowed a safe dose with lock out periods so that the patient didn`t get too much morphine. The doctor said I overdosed. If I ever need surgery again, should I say that I am allergic to morphine? Is the PCA dangerous? I am ready to have my other knee replaced and I am nervous about it. 

Those are very good questions. In order to avoid a similar outcome the next time you need a surgical procedure it's extremely important that you have a good understanding of what happened. You are fortunate that you were rescued and have suffered no ill effect. The first thing to do would be to get accurate, written records of your previous hospitalization, including the misadventure with Patient Controlled Analgesia (PCA). Perhaps your doctor could arrange for a brief summary of events, in the form of a letter, to be written by the appropriate physician - for example the doctor in charge of the intensive care unit where presumably you were cared for. Without such a record it is impossible to say exactly what happened and how a future event should be prevented. If you are having your surgery in the same hospital, the doctors should have ready access to the records, but you should make sure the records are retrieved and reviewed before your surgery. It is very unlikely that you are "allergic" to morphine. Allergy to morphine does occur but is quite rare. The more likely explanation, as you have said, is that you received too much, or at least too much for YOU. Morphine, and all the other strong, "opioid" pain relievers have the unfortunate side-effect of decreasing your breathing. However, the dose of morphine that one person needs for pain relief can be enough to stop another person from breathing. There is a large amount of individual variation in the "tolerance" for morphine, even in persons of the same age and weight. When delivered by PCA machine drugs like morphine are quite safe, because sedation usually precedes severe respiratory depression. When you become sedated you are unlikely to press the button to give yourself more morphine, so the system has built-in safety. The sedation, and the pain relief, must wear off before you are awake enough to press the button again. But, like everything else in medicine there are no absolute guarantees of safety, or effectiveness. The PCA machine can be programmed incorrectly. Someone else might have pressed the button. The wrong concentration of drug might have been put in the machine. The machine might have been programmed to give you a continuous infusion of morphine - this bypasses a safety element but is nevertheless one of the conventional methods of administering PCA. So, there are many possibilities, and it's not possible for me to say what happened to you. A potentially fatal adverse event of this nature demands a full explanation and I'm sure you'll get it from your doctors and your hospital. With this information your doctors can devise a treatment plan that should make it be possible for you to have a safe and comfortable postoperative recovery from your next surgery, with or without PCA analgesia.