I have multiple surgeries in the last 11 years and each time I wake up from the anesthesia I suffer from migraines and tend to be verbally abusive and combative (not normal for me at all). Is this a common side effect in patients or just a strange reaction I seem to suffer from? 

First, the migraine headaches. There are a variety of triggers of migraine headaches, including foods and food additives, starvation, psychological stress, medications, weather changes, smells and odors, and strong lights. Any one of those factors could potentially have helped set off your migraine in hospital after surgery. If you are susceptible to migraines it might be worth taking some medication before your next operation, and to attend to any other known factors that trigger your migraines at other times. Check with your anesthesiologist. The verbal abuse and combativeness are not completely out of the ordinary, and are part of what is known as emergence delirium. Similar behavior can occasionally been seen at induction - that is when anesthesia is first administered. I've had patients who, just before they become unconscious, change from being polite, dignified, soft-spoken, librarians and schoolteachers into foul-mouthed, semi-crazed gangsters. The same behavior occurs even more typically after awakening (emerging) from general anesthesia. It takes a lot to shock most doctors and nurses in busy hospitals - we've seen it all. So don't worry about the effect of your behavior on us. In these situations the priority is to prevent you from harming yourself. Chemical or physical restraints are occasionally necessary to ensure your safety but usually the only danger is to your dignity. During the subsequent recovery most patients return over time to their normal mental state, though complete recovery depends obviously on the healing from surgery, the effects of pain medications, and so on. 

I`m a post-menopausal 57 year old woman in generally excellent health who takes no drugs on a regular basis. I recently had a lithotripsy, where I received lidocaine, zofran, decadron, propofol and fentanyl. For the week following the procedure I had sweats or hot flashes and severe sleep disturbance. As I got more and more sleep deprived, I also experienced dramatic mood swings. Can you tell me which of the drugs is likely to have caused the side effects so that I can avoid it in the future? 

ﾠSleep disturbance after major surgery is pretty common. There are changes in sleep pattern that affect the amount of REM (Rapid Eye Movement) sleep (the phase in which dreaming occurs), as well as the amount of slow wave sleep (SWS). REM sleep decreases initially, then rebounds. From days 3 to 7 of postoperative recovery there may be more REM sleep than normal. One of the interesting findings that emerges from the limited amount of research in this area is that the form of anesthesia (regional vs general) does not seem to make much of a difference. This suggests that other factors are involved. Likely factors affecting sleep after major surgery include the stress response to surgery (hormones, inflammatory compounds), pain and pain medications, starvation, psychological factors, environmental factors such as noise, temperature and light, nursing observations, etc. Lithotripsy can't be considered major surgery. Nevertheless it is a procedure associated with some tissue injury from which the body must heal, so perhaps some of the factors mentioned above are relevant. The anesthetic you received sounds like a standard mix of agents. I wish I could tell you that the unpleasant symptoms you're experiencing are due to one specific drug or set of drugs. Unfortunately there isn't any scientific evidence to support that. Happily, these things are usually self-limiting. Hopefully you're out of the woods by now and your sleep and mood are restored to normal. 

85 yr.old male, open heart valve replacment. Was doing well day one. Now is very confused and makes no sense...like he was driving a car last night... and there`s a man in the corner of the room (no one there). Now he has a bowel infection w/ diarrhea, is being treated today with antibiotics. Will he come back around or will these effects stay? What causes this reaction? Please, any info would be greatly appreciated! 

Confusion after surgery and anesthesia fits into the general condition known as delirium. There is a large variety of possible causes including pain killer medicines, side effects of other medications, stroke, psychological reactions, sleep-wake cycle disturbance, effects of being on the heart-lung machine, electrolyte disorders, inadequate oxygen, pre-existing brain disorders, kidney or liver disease - the list goes on. The risk of delirium after surgery increases with age, and in an 85-year old who has had heart valve surgery is quite significant. The treatment, and the prognosis, depend on the diagnosis. So please check with the doctors involved with his care. 

I am a happy, well-adjusted, optimistic, and positive person. But when I have surgery w/ a general anesthetic, I always wake up in the PACU in tears. Last week I had a successful lumbar laminectomy for excision of a benign tumor (I had constant unrelenting sciatica pain for 6 weeks prior) so I was so relieved...yet I was weeping! All thru the night, as nurses checked on me, I continued to cry periodically. I had plenty of pain relief options, which I used, but the tears continued to flow. Even today, 4 days later, I cried a few times. Is this "normal"?! I must add that I`m a very physically sensitive, very empathetic, person. Could my unconscious mind/physical body be remembering events (while I was anesthetized) from the whole surgical experience and my only way to deal with that "unknown" feedback is to weep? Or....?! Thanks for any insight! 

To be honest, as an anesthesiologist I have spent the vast majority of my professional time in the operating room or its environs. I seldom see my patients 4 days after their surgery so I cannot say whether your experience is "normal", nor does the scientific literature in my field have much comment on this! 

If you want my entirely unscientific opinion, I would say that tearfulness after a major operation, which was accompanied quite possibly by fear of cancer and fear of dying, is probably a healthy psychological response. You reflect on your joy at being given a "good" diagnosis, and the prospect for a continued happy life, as well as relief of your sciatica pain. 

I have noticed that many patients who are anxious or upset preoperatively tend to be tearful or upset when they wake up. I do not know of any pharmacologic effects of anesthetic drugs that would increase tearing or crying, although some drugs tend to have a disinhibiting effect, perhaps making it easier on an emotional level to "let go." 

If you are concerned that you were at some other level awake or aware of your surgery during the actual procedure we can of course speculate but have no way of knowing until such time as we fully understand consciousness and how it arises in the brain. In the meantime I would accept the tears and reflect on your good fortune to have received good medical care and a new lease on life. 

My father had surgery a few years back to remove a cancerous para-thyroid, he was under for 8 hours. Since then he experiences horrific, (what his doctor told him are) "night terrors." He sleeps constantly, having very low energy since the surgery, and during sleep, he will be woken with what he says physically feels like "extreme fear" except that he has no conscious thoughts of fear nor does he recall dreaming, nor had any stress in his life during that period of time. They had averaged about 3 a year but he had one last month and one yesterday. His doctor said that it is a "chemical/physical" result of the long surgery and having taken in so much anaesthesia during that time (and not stress induced.) He was given drugs to combat the condition, which he does not want to take and he just called asking for my help, but I cannot find any holistic remedies. I am an herbalist myself, but I know of nothing that might help him...he won`t take the drugs, so can you please tell me if you feel that it IS the residual effects of the anaesthesia and IF there is a more natural / organic approach that we can take to correct this condition or remove these toxins from his system? Thank you. 

Several years after your father's surgery there will be not a trace of anesthetic drugs, or what you call "toxins" in his system. Iﾒm afraid I canﾒt think of a natural or organic approach to correct the condition you describe. It is interesting that his trouble has occurred without other apparent stresses in his life, and began around the time of his cancer surgery. He is not the first patient Iﾒve been told about whose problems have been attributed to a recent anesthetic. In my profession weﾒve had the belief for a long time that if all goes well during a general anesthetic the drugs are metabolized and excreted within hours or days and there should be no long-lasting effects. This notion has recently been challenged by one or two studies that show longer term effects on cognition in the elderly after general anesthesia. However the scientific evidence is not all that strong, and it is hard to separate out the effects of the surgery (also prolonged in your fatherﾒs case) and the disease (cancer) for which patients have their surgery in the first place. Itﾒs a tough question to answer because nobody today is likely to volunteer to have surgery without anesthesia! Clearly your father is having a difficult time. I am no psychiatrist, but much of what you describe could easily be attributed to depression. Has he been seen by a mental health professional? I would recommend one with special experience treating the elderly. 

Are there any procedures/medications that can lesson the effects of PTSD, flashbacks, memories, etc. that arise after general anesthetic in persons with severe Dissociative Disorders (Multiple Personality Disorder). With each surgery I have had, the negative "recovery" experiences have increased in severity/intensity...recently, even though all of the hospital staff that was assigned to my case were made aware of previous problems, I had extreme terror, "reliving" of traumatic events as though they were happening in "real" time, and so forth, to the degree that my husband was brought into the recovery room to "talk me down" because no one on staff knew what to do. 

I`m ready to simply refuse surgery in the future, rather than put myself and my husband through this again. I have had many yrs of therapy and now manage my disorder with lifestyle changes and medication. Rarely do I dissociate anymore, unless under extreme stress or as mentioned above, when it is drug induced. Pls shed some light on this for me, if you can. Thank you. 

Thank you for your question. Your problem is certainly an unusual one, and there is little I could find in the research literature that addresses it. I personally do not have any experience taking care of a patient with Dissociative Disorder. I can only offer the following observations and opinions which I hope are helpful to you. 

If you believe that general anesthesia is responsible for the unpleasant experience you describe, a regional anesthetic, that is, anesthesia in which numbing medication is used, may be your best choice. Regional anesthetics, such as spinal anesthesia, epidural anesthesia, brachial plexus blocks, and peripheral nerve blocks, are standard techniques for most operations on the extremities (arms and legs) and pelvic area. Sometimes a regional anesthetic is possible for abdominal surgery. Operations on the brain and the heart or lungs usually require a general anesthetic. 

Although in most cases we administer sedative medication along with a regional anesthetic, a successful regional anesthetic can permit the anesthesiologist to entirely avoid administering sedative drugs to you. If a general anesthetic is needed, there are certain drugs that are more closely associated with negative psychological effects during recovery. Ketamine is one of those drugs. Ketamine in fact causes a kind of dissociative state, so your anesthesiologist should be sure to avoid it in your case. Other drugs, such as benzodiazepines, which are intended to reduce anxiety, may help in your case, or might make you feel worse. 

Of course it is possible that the anesthetic itself has had little to do with your unpleasant recovery. The whole experience of surgery and hospitalization in itself may be enough to trigger a bad reaction. So, altering the anesthetic in different ways might not guarantee you any better outcome the next time around. 

Keep in mind that the anesthesiologist`s main goal is to keep you safe. It may not be wise to "experiment" with unusual techniques in order to avoid a short lived reaction if this jeopardizes your physical safety. 

Another suggestion is to ask your physicians whether they can plan your recovery in a quiet room, such as an isolation room, away from the general hubbub. In such a room there can be a minimum of activity, and perhaps even some familiar personal objects and people, including your husband, to lessen the overall stress. 

Finally, be sure to discuss your problem with your anesthesiologist well ahead of the next planned surgery. Your psychiatrist should also be involved. Try to keep a record of all the anesthetics you have had - it is your right, and this information will help those who take care of you next time to make the best decisions about your care. 

I have had 2 major surgeries on my arm. i was under general anesthesia for both. The first time I woke up disoriented, nauseated and crying. The surgery lasted 2 hours. The second surgery i woke up hypoxic, nauseated, disoriented and crying. This surgery last 4 hours. Is it that i have a reaction to the anesthesia or is it that they are giving me too much? Both times I had to be admitted to the hospital and had to stay 2 days each and had the same anesthesiologist also. 

ﾠThanks for your question. I am sorry you have had such unpleasant recovery experiences after surgery. It is hard to know exactly what caused your symptoms without more information about your medical history, the anesthesia you received, and the course of the surgery itself. I can offer you only a few general comments and suggestions. Firstly, you could ask to meet with your anesthesiologist to discuss what happened to you. Try to obtain the records of your anesthesia from the hospital so that they can be reviewed by any anesthesiologist who takes care of you in future. If you are to have further surgery on your arm, regional anesthesia (anesthesia that numbs the arm only) might be a better option for you than general anesthesia. The type of reaction that you have described is not necessarily due to "too much" anesthesia. For instance, nausea occurs anywhere from 20 to 80% of the time after a general anesthetic. There are medications and anesthetic agents that can decrease the risk of this happening to you. Hypoxia (lack of oxygen) is potentially a very serious problem that could have been caused by many different anesthetic factors or by medical problems you might have that could be worsened by anesthesia or surgery. This is a strong reason why you should request an interview with your anesthesiologist ahead of any future surgery so that a safe anesthetic can be planned for you. 

Two days ago I underwent a colonoscopy under sedation. I woke up during the procedure and was aware that I was in extreme pain, although I didnot actually feel this pain, which was a very weird experience. They gave me some more painkillers and I cannot remember anything of the rest of the procedure nor for 3 hours afterwards. But when I went to sleep the night after the colonoscopy I relived this waking up experience over and over again and now I could feel the pain as well, or so I imagined. And what`s more I cannot seem to stop crying. For two days I have been doing nothing but cry. Is this normal? Is this a side-effect of the sedation and how long will this last? 

Awareness of pain, while not actually feeling it, is something termed "dissociative" anesthesia.ﾠ There is a combination of drugs, once commonly used (but now muchﾠless so), which can produce this type of experience.ﾠ This combination of drugs - usually a medication called droperidol,ﾠplus a pain relieving (narcotic) medication (such as fentanyl) -ﾠis less popular now because many people, although able to undergo the procedure without apparent problems, find it overall to be unpleasant. I suggest that you contact the anesthesiologist, or other doctorﾠ responsible for giving you the sedation.ﾠ You should try to find out whatﾠyou were given, and also to explain in more detail how you are feeling.ﾠ Your doctor may then be able to offer you a better explanation.ﾠ Assuming there is not thought to be a physical reason forﾠany ongoing pain (and it would be very important to check that out) it might even be helpful to refer you to someone for counseling. Keep in mind that a colonoscopy does not usually require general anesthesia.ﾠ That is, one should not expect to be completely unconscious during the procedure, and there may unfortunately be periods when discomfort is experienced. 

Recently, my aunt had surgery to remove spots on her lungs. She was given an epidural for anesthesia. Things went well until they removed the epidural approx. 24-36 hours after the surgery. After it was removed my aunt became severely paranoid. She thought that the doctors and nurses were "out to get her" and even though it is now a couple weeks after surgery and she is home, she still thinks that the people in the hospital were out `to get her". Is there any literature on this topic that I could read? Is this a common occurence of epidural anesthesia, or at least IS it a side effect? I was told that people who are alcoholics sometimes have adverse affects from an epidural..my aunt isn`t a full time drinker, but she`s a once a week drinker...does this maybe have something to do with it? I also know that the doctors gave her something for pain after removing the epidural, but I`m not sure what it was, and they themselves didn`t think it had anything to do with her paranoia. Any information you can give me about this would be greatly appreciated. 

I don't believe that your aunt's psychiatric symptoms have anything at all to do with the epidural anesthesia or analgesia. In fact, a regional technique like epidural or spinal anesthesia is often the best choice for patients with brain syndromes because it avoids or at least minimizes the amount of sedative and anesthetic drugs needed. These are the drugs which definitely do act on the brain and can sometimes worsen the condition of patients with dementia or delirium. Similarly, there is no connection that I am aware of between alcoholism and any side-effects of epidural anesthesia. There is a tendency to blame the anesthesia for a variety of side-effects or problems after surgery. These suggestions must be treated with caution. The recovery from surgery (a major, controlled injury) may include tissue breakdown and wound healing, inflammation, nutritional stress, pain and pain medications, infectious challenges, fever, immobility, change of environment, and drug or alcohol withdrawal. It is hardly surprising therefore that the mental state of patients during this time is not always normal. 

I`ve had two surgeries this year, and in the recovery room I acted like a lunatic. Why did I act this way? It was totally out of character for me. 

Iﾒm not sure exactly what you mean by acting ﾓlike a lunaticﾔ! Itﾒs a very descriptive term, but I canﾒt be sure what it is that you actually did! My guess is that your behavior would have fallen in the category of ﾓpostoperative agitationﾔ. Sometimes an otherwise normal person, during emergence from anesthesia, will become physically combative, uncooperative, and unable to comprehend where they are, or what has happened to them. Such patients may prevent the staff in the recovery room from taking proper care of them, possibly endangering themselves or others in their immediate environment. Why would you act in this way? There are a variety of possible causes for this kind of agitation. The staff in the recovery room will first look for life-threatening causes, such as inadequate breathing, or circulation. A more common cause is simply pain, usually from the site of the surgery. Another frequent cause is a full bladder causing a desperate but unexpressed need to urinate! Trained staff will also look for other problems that might have to do with fever or low body temperature, metabolic problems, drug withdrawal (the stopping of prescription drugs or alcohol) or drug interactions (the effects of different drugs or medications taken together). Sometimes there is no apparent cause for this type of behavior, and it may be due to the lingering effects of any of the several different drugs that are given during a typical general anesthetic. Some people do seem to be particularly susceptible to postoperative agitation. We can speculate that a personﾒs emotional state before the surgery may have an effect on recovery. Anesthesia drugs can cause ﾓdisinhibitionﾔ, in other words they remove the usual restraints on behavior. A patient with unusually high levels of emotional distress or anxiety before surgery may be prone to agitated behavior during recovery. Interestingly, most patients seem to have little or no recollection of what occurred.