Does diprivan, halothane or succinylcholine inhibit the body`s ability to regenerate heat? 

Your body temperature is normally tightly controlled around a set point near 37 degrees centrigrade. Anesthetic agents (e.g. halothane, Diprivan) affect body temperature in one of two ways. 

• First, they affect the body's thermostat, which is in the hypothalamus, a part of the brain. The effect of anesthetics is to widen the range of temperature that the hypothalamus allows. 
• Second, anesthetics cause vasodilatation (widening of blood vessels) which causes heat to be redistributed from the "core" to the surface. Vasodilation causes a net heat loss from the body, and a decrease in core body temperature. The hypothalamus allows this drop in temperature. 

Succinylcholine is a muscle relaxant that does not affect heat balance. However all muscle relaxants inhibit shivering, which is one of the compensatory mechanisms that your body uses when it becomes cold. Shivering generates heat through muscle contraction. 

Various warming measures are used before, during and after anesthesia to try to maintain body temperature at or above 36 degrees centigrade. These include keeping the operating room as warm as tolerable, forced air warming blankets, warmed intravenous fluids, and so on. 

I`m having two screws removed from a bunionectomy done several years ago. I don`t want to be `under`, but I don`t want the initial pain of the needle numbing my foot. What drug would you suggest I request that would put me out for a few minutes? Thank you. 

Thanks for your question. 

I think you will find that even something that sounds as simple as "removing two screws" inevitably takes longer than 40 seconds or "a few minutes". If it didn't, then your surgeon might do the procedure in his office. 

The ideas of being "out" but not "under," and that either of these states involves simply the selection of a single drug - those are two misconceptions. Either you need an anesthetic for this procedure or you don't. If you do, the options are local, regional or general anesthesia. General anesthesia is unfortunately more complicated than simply selecting and administering a particular drug. If it weren't, we would all be doing this ourselves in the comfort and privacy of our own living rooms. Please browse other responses on this site for more explanation of the three options listed above. 

For foot surgery, local and regional anesthesia are both feasible, popular options. Local anesthesia,without sedation, does, as you've realized, mean that you get an initial injection that is associated with some discomfort. Nerve blocks can be done (that is one of the regional anesthesia choices). Spinal anesthesia is another option - the legs and feet will become totally numb. The good news is that the discomfort of a needle can be reduced or even eliminated through the administration of intravenous sedation, but you still need a needle (the IV) to get the benefit of that approach. 

A discussion with your anesthesiologist will reveal the options available to you in the facility where you will have the procedure, taking into account the exact nature of the operation and any medical conditions that might also influence the decision. 

I had dental surgery a year ago with general anesthesia. I was told that I was very difficult to intubate and was given a letter concerning this. I am scheduled for a double mastectomy with reconstruction in a week. I am petrified because the anesthesiologist has informed me that I will have to be awake (semiconscious) during the intubation. Will I feel the tube placement and be aware of its insertion/removal? 

"Awake intubation" is an important safety measure when a person needing general anesthesia is known to be difficult to intubate. One can understand why you would not be looking forward to this! 

The good news however is that in the hands of a competent anesthesiologist you are likely to have no more discomfort (and possibly quite a bit less) than the average person scheduled for an endoscopic examination of the stomach - a gastroscopy. This is a very common procedure done in doctor's offices and outpatient centers. Hundreds of thousands of people undergo this type of procedure every year without a huge amount of discomfort. 

A variety of drugs may be used to keep you comfortable during the intubation, while breathing adequately (the breathing part is the key). Also, local anesthetic is applied to your airway (throat and lower airway) to make the passage of the tube easier to handle, suppressing the gag reflex. Once the tube has been inserted, you will immediately be given additional anesthesia so that you quickly become unconscious, as with any other general anesthetic. At the end of the procedure, the anesthetic is lightened and as soon as you are awake enough and strong enough to breath on your own and keep your airway open, the tube will be removed. Most people have no recollection of this part of the procedure. 

During minor throat surgeryﾠI developed a fever which my doctor thought could be infection setting in soﾠI stayed there for two days.ﾠI always thought the anesthesia caused this. CouldﾠI be correct? 

It is true that a mild fever is common in the first 24 hours after surgery. There is no evidence that fever is caused by anesthesia. The most cautious approach to a postoperative fever is to keep the patient in hospital and look for serious causes like infection. Infectious causes of fever include pneumonia, urinary tract infection, infection of intravenous line sites, and surgical site infection. Other non-infectious causes of fever are pulmonary aspiration, pulmonary embolism, (blood clot), drug fever, and blood product reaction. 

A condition called atelectasis, which is where parts of the lungs are "collapsed" (the small airways are closed and air cannot get in or out of that area of lung), has traditionally been thought to cause fever. Perhaps this is because atelectasis is common, and fever is common! But again there is no hard evidence that atelectasis causes fever. 

When these other causes are ruled out fever is most likely to due to the release of various molecules, called cytokines, in response to tissue injury (surgery). The fever is self-limiting (goes away without treatment) and benign (harmless). 

I had outpatient surgery today under general anesthesia. The Dr told my husband it was enough to knock out an elephant before I finally was out and following the surgery, the nurses gave me alot of fentanyl, phenergan, patch for nausea and 10 times they put benadryl in the IV. I never went to sleep and the nurse was in awe that I was talking and making sense. It is almost midnite and I woke at 8:00 am for surgery at 12:00. Left hospital at 4:00pm when the itching seemed to be at its lowest point. I have never used illegal drugs and have been taking hydrocodone for the pain and not as often as I should. Is there a reason I was not affected by the meds as "normal" people do. I weigh 100 lbs, 5 ft 5 inches and I am 49 years old. Thanks 

Oxycodone is an opioid pain-reliever. As you take more of this drug and for longer periods, you develop tolerance, which means you need more drug to get the same effect. This might explain why you could be given a lot of fentanyl, a drug which is also an opioid, and still be wide awake after your procedure. But it would not explain why you had to be given a lot of medication to go to sleep for your procedure. 

The science of pharmacogenetics - the study of how genetics affect the body's handling of drugs - is still in its infancy. This is the science that is beginning to explain differences in how people respond to drugs, whether those drugs are antibiotics, anesthetics, cancer drugs, or others. In fact anesthesiology has made significant contributions to pharmacogenetics by showing, for instance, that some individuals cannot metabolise a commonly used muscle relaxant called succinylcholine. Similarly, there may be a certain genetic makeup that is associated with either increased rate of redistribution or breakdown of certain anesthetic drugs, (that is a pharmacokinetic explanation) or are "resistant" to the effects of the drug at normal doses (a pharmacodynamic explanation). (Apologies for the technical language). 

I don't know of any cases in which a person could not be anesthetised at all with any of the commonly used anesthetic drugs. It's simply a matter of being given enough. I'm sure the hospital won't run out! 

For you, the toughest part may be convincing another anesthesiologist that you need more than the average amount of anesthetic medication. Especially as you are apparently not elephant-sized! Many of us are just born sceptics. You might want to consider getting a copy of your anesthetic record as proof and keeping that with the rest of your personal records. 

Is a urinary catheter needed for small outpatient procedures(<1 hr) requiring anesthesia? Is there a time limit where one can go without one? 

A urinary catheter is not usually needed for procedures lasting less than an hour. Unless the surgery involves the urogenital system. There is no absolute time limit, but for procedures lasting more than about 3-4 hours we would normally put in a urinary catheter. As always, there are benefits and risks to placing a urinary catheter. Among the benefits: the bladder does not become distended (which may interfere with surgery in some cases,ﾠ creates discomfort, and even increases in heart rate and blood pressure) and the amount of urine produced can be monitored. Among the drawbacks: an increased risk of bladder or urine infection, and catheter-related discomfort when the person awakens from the anesthesia. The need for a urinary catheter can be limited by giving less fluid during the case, but this is not always possible. In many cases, the urinary catheter can be withdrawn very soon after the end of the procedure. If you have particular concerns about this, please discuss with your anesthesiologist and surgeon. 

I have had 2 knee replacement surgeries within a year. How does the anesthesia from that affect my overall health as far as having energy and not being tired all the time? Thank You 

There is no doubt that having two major surgeries in one year can really take a toll on you. Contrary to what seems to be common belief, the anesthesia is not entirely responsible, because the drugs are cleared almost completely from your body within 24 - 48 hours. A major factor is that your body's resources become depleted by the repair of tissue injury from surgery. Surgery is a form of controlled trauma and it sets up major local and systemic inflammation responses, and uses body protein for repair. You also have to deal with pain, especially the pain associated with moving the knee. Without this work on your part the new knee cannot give you the renewed mobility that you expect, but it is tiring to put in the necessary effort. Although we believe that anesthesia does not significantly contribute to the prolonged fatigue you describe, it is possible that certain anesthetic techniques might be associated with an improved recovery profile. So, for example, regional anesthesia with local anesthetics can reduce pain in the short term and even perhaps weeks or months afterward, anti-inflammatory medicine can modulate the inflammation process, and certain intravenous fluids might help at a cellular level. Much work remains to be done to figure out how to optimize long term recovery through interventions during and immediately after surgery. 

What explains the hearing of phantom music after anesthesia? 

Phantom music after anesthesia is not something I have ever encountered. Music is often played in the operating room. The choice of music reflects the tastes of the providerﾠ- many doctors bring their iPods into the operating room and connect it to the stereo system. Perhaps you woke up and heard the stereo - loud, energeticﾠmusic is sometimes played at the end of the surgical procedure to encourage everyone to pick up the pace! An alternative explanation is that you experienced an auditory hallucination. It is possible that some drugs used in sedation or anesthesia, such as propofol, midazolam and ketamine may produce hallucinations. These are not always unpleasant, and in fact propofol in particular is associated with erotic dreams. 

Todays date 7/27/06 Difficulties after foot & ankle surgery 7/19/06. Was given general anesthesia. Normal blood pressure readings & EKG prior to surgery, but pressure rose to 160/110 within minutes after surgery. Pulse rose to 118. Temerature normally 97.8. Dropped to 95, although felt like I was burning with fever. Normal blood sugar 94-96. Rose to 225. Extreme nausea & stomach cramping. Could hear but couldn`t talk for 2 hours after surgery. Symptoms lasted several days. Blood pressure & pulse still higher than normal 140/94. Pulse 108. Feel a little shakey. Doctor is puzzled. I have Hashimotos disease, fibromyalgia & osteo arthritis. Otherwise, very healthy & active 49 year old. 145 lbs - 5`5" Take all meds once daily: Synthroid 0.1 mcg. Cytomel 5 mg, & Imipram 25mg. Any suggestions? 

After surgery, a higher blood pressure and heart rate is very common. It is also common, unless special efforts are made, for body temperature to be lower than normal in the operating room and in the period just after surgery. Nausea occurs in up to 40% of patients after general anesthesia depending on the medications used, the type of surgery, and the individual's susceptibility. The inability to talk is a bit puzzling, however most patients are not very talkative during recovery - they are groggy. This normally wears off within hours. Your blood sugar may have risen if you were given glucose in your IV or because you are diabetic. The next time you have surgery you should consult with the anesthesiologist beforehand. Regional anesthesia (nerve blocks, spinal or epidural) may be a better option for you. Take the records of your anesthesia and recovery with you if possible. Good luck! 

The last time I had general anesthesia, the DR. told me that he had to insert an NG tube because of all of the stomach acid that was coming up (I have GERD). I am scheduled to have a hysterectomy next week and I am also having severe gastritis (ulcer?) for the past several weeks. Do you think the gastritis will add to the complication of the GERD. I had to cancel the GI tests for next week due to the hysterectomy. 

Gastritisﾠsimply meansﾠinflammation of the stomach and can be due to a variety of causes. If the hysterectomy is elective - that is, not an emergency - and you are feeling unwell because of the gastritis, then it may be wise to delay the surgery until you are feeling better. This is a decision that should be made by you andﾠyour gynecologist, possibly with input from your anesthesiologist. 

GERD is very common in the United States and patients with GERD are able to receive anesthesia safely. Certain precautions may be necessary. For instance, patients should continue to take their antacid or H2 blocker medicines (e.g. Zantac, Prevacid, etc) before their surgery and on the day of their surgery. During the induction of anesthesia ("going to sleep") certain actions may be taken to help prevent acid from coming up out of your stomach and into your lungs. 

If you are having gastritis on top of your GERD the prevention measures I have described would be especially important. 

I recently had a TAH/BSO 6 weeks ago. After a hard two week recovery we discovered I had appendicitis so an appendectomy was done. I had no muscle or joint complications after the first surgery and am in very good physical condition at 37. About 36 hours after the appendectomy I woke up unable to move. The pressure in my joints and stiffness was incredible. Several calls were placed and I was told by my surgeon that several of his patients has a "virus" post-surgery in the same time period. I have since seen a rheumatologist and was told that I might have "inflammatory arthritis". I am very confused and would like your opinion on whether this is a very lingering viral infection such as parvovirus or if it is a lingering effect to an anesthetic I was given in the second surgery or if at 37 years old and with no family history of arthritis if it is possible at all that I could develop it so suddenly. Lab work revealed a 5.85 marker for IgG in Parvovirus but a normal IgM,also all other "arthritis markers" were normal, however SED rate was increased as well as C-reactive protein. Any help, advice, or referral would be greatly appreciated. Thank you 

The only condition that there is even a small chance of being caused by your anesthesia is the syndrome of postoperative myalgia (muscle pain) associated with the muscle relaxant (paralyzing drug) called succinylcholine. If you had emergency surgery for appendicitis it is very possible that this otherwise excellent muscle relaxing agent was used to allow the breathing tube to be placed. The muscle pain you get from this drug occurs most often in young women undergoing outpatient surgery. It is self-limited - that is, it goes away without specific treatment over a two to three days. In some cases it may last as long as a week. It is difficult for me to offer any additional explanations over the ones you have so far been given. I think it is safe to say however that if your problems are persistent they are not due to the two anesthetics you received. Your sed rate would not be elevated. I hope that you recover soon. 

My father-in-law had two lymph nodes removed from his abdomen on 3/27/06. He has been diagnosed with Non-Hodgkins lymphoma. He started to get terrible itchiness (without any rash) in his lower back area about a week after surgery. He still has it on and off, and is very uncomfortable. Two doctors (one from Sloan Kettering) have said it is a reaction from the anesthesia. How long can we expect this to last? Over the counter Benedryl initially helped, but is no longer effective. 

Itching is well known to be associated with Hodgkin's lymphoma but I don't think it goes with the Non-Hodgkin's Lymphoma which your father-in-law has. Diffuse (all over the body) itching is a symptom with many causes, including allergy, drugs (especially pain-killers like morphine), kidney or liver disease. Itching in a particular area must draw attention to the possiblity of skin diseases of various kinds, including chicken pox, which can itch before the rash is obvious. A general anesthetic involves the administration of several different drugs, so to call this a reaction "from the anesthesia" really doesn't have much meaning. I can't think of any commonly used anesthetic agent which would cause a localized itch one week after surgery. Please ask for an internist or dermatologist to see your father-in-law if the itching continues to be troublesome. 

My 82 year old Aunt had triple by pass surgery second week in December. Very active prior to surgery. After surgery has had problems with swallowing. They put her on a feeding tube. Had barium swallow test and the ENT told her it was due to moisture on left vocal chord from eating/drinking going into her lungs. Speech is normal. Mobility is normal. She has a rehab speech therapist. Had MRI - no stroke. Do you have info on this? Thank you. 

Problems with swallowing occur in 3-4% of patients who have had heart surgery. Quite often no specific cause is found. Patients with diabetes, heart failure, or poor kidney function before their surgery are more likely to develop this problem. Subtle neurologic problems are surprisingly common after heart surgery, this is thought to have something to do with the use of the heart-lung (bypass) machine. So, problems swallowing (ﾓdysphagiaﾔ) may actually result from a minor brain injury that does not show up on MRI. Having a breathing tube (endotracheal tube) in place for a long time after the surgery may also contribute. It is important to recognize swallowing problems early because patients who cannot swallow properly are prone to aspiration, that is the passage of food content into the lungs. This leads to pneumonia which can be very serious or even fatal. The appropriate treatment is speech therapy and the insertion of a feeding tube. Most patients will recover their ability to swallow but it may take as long as 6 months. 

I know this sounds crazy but....I was put to sleep about 2 months ago and ever since my skin has been very oily! My skin has never been like this ever. And it all started after I was put to sleep.I have heard of other similar effects but just wondered if that is possible and if so will it ever go back to normal??? Please let me know. 

Over the years I have received a number of questions about strange phenomena that people have attributed to their exposure to anesthesia. These include getting sadder, getting happier, and getting more energetic; losing energy; losing sleep and having nightmares; loss of hair, gaining hair, and gaining curly hair; loss of taste; icy sensations in the chest. And now, oily skin. 

The conventional answer is that the effects of anesthesia (and surgery) are fairly short-lived, that anesthetic drugs are eliminated from the body in a short period of time, and that these unusual symptoms are merely coincidental, or, possibly, related to the trauma of surgery and the recovery from it. 

When it comes to skin and hair problems, I don't know of any biological explanation or connection between anesthesia and such unusual findings. My hunch is that these associations, if we can call them that, are statistically inevitable. Let's look at the numbers. About 1 in 7 people have anesthesia in America each year (40 million out of 280 million). Suddenly developing oily skin must be a rare event - let's say 1 in 10,000 people experience this each year, for reasons unrelated to anesthesia. You can calculate that a fair number of people (over 350 in fact) will have both anesthesia and oily skin in America each month, and at least some of those will put two and two together. That is they will attribute their oily skin to the anesthesia which they just happen to have had within the same month. Your oily skin after anesthesia is probably just another example of the effects of randomness on our daily lives. 

I have a history of reactions to anesthesia. I am a 27 year old female. When I was 20 I had a GA to have my tonsils removed. When I come out of the anesthesia I couldn`t breathe, this was very scary. I was given oxygen and injected with something! This fixed it, although I was very short of breath for a few hours afterwards, and my oxygen saturation levels were very low. When I was 24 and 27 I had a right and a left hip arthroscopy under GA. I informed them of my previous experience and they said they thought they knew why and would use something different (this was at a different hospital to the previous surgery). I could breathe fine when I came out, but both time experienced uncontrollable shaking, to the point of pain. I was put into a "bear hug" machine, and again injected with something and this seemed to help. After each arthroscopy, they kept me in hospital over night for monitoring, rather then release me the same day as other patients, because of my past GA experience. In the last few months I have had 2 Medial Branch Blocks in my bilateral sacro-iliac joints and dorsal sacro-iliac ligaments on both my left and my right side, using a iodine contrast and 1.5ml Marcain 0.5% and 0.25ml Celestone. Both times a twighlight sedation was used. The first block a few months ago, when I cam to I experienced uncontrollable body jolting. Almost like I was having a fit or a seizure. I had to be restrained by 4 nurses. I could hear them talking to me, but I couldn`t respond in any way, and I couldn`t control the movement. After about 30 mins it settled down, but I was very weak and hung over for the next 24 hours. Yesterday I had my second Medial Branch block and experienced the same thing. This time they gave me a shot of Dextrose. The operating nurse also informed me that I had woken up during the twighlight sedation, lifted my head off the operating table and looked around the room. I have no recollection of this. They said I had already had a lot of anesthetic, but had to give me more. I again experienced the unpleasant jolting on waking. Both branch blocks where preformed in a day surgery clinic. I need to go back in a month or so and have a Radiofrequency Denervation performed in the same area, at the day clinic. This will be done under GA. After my experiences, I`m nervous about having a GA in a day surgery environment. Should I be pushing to have it down in hospital and stay overnight? Are these reactions I`m having normal? Thanks for your help. 

The unpleasant ﾓjoltingﾔ youﾒve experienced while awakening from general anesthesia is most likely a form of violent shivering that is sometimes seen during the early part of recovery. You may shiver under these circumstances despite having a normal, or close to normal body temperature. During general anesthesia, your bodyﾒs thermostat, in a part of the body called the hypothalamus, resets itself to a wider range. This means that your bodyﾒs control mechanism for temperature now accepts both lower and higher temperatures than usual. During general anesthesia your body loses heat (dilated blood vessels, the cold operating room, plus nakedness) unless active measures are taken to avoid this (warm operating room, warm IV fluids, Bair Hugger (air warming blanket), etc). Even with active measures, your body temperature may drop slightly especially if the surgery is a large abdominal operation and lots of body fluids are lost. When you awaken, and the thermostat returns to its normal settings, your body temperature may now be outside its accepted range. This triggers one of the responses which raise your core body temperature ﾖ shivering. Shivering is the repeated contraction of your skeletal muscles. Post-anesthetic shivering is treated with small doses of a pain-killer drug called meperidine (Demerol). It is not clear how it works, but it does. Another drug which works is called clonidine, usually used to treat high blood pressure. If your doctors agree that this was shivering and not some other unusual neurologic problem, they might consider giving you a bit of meperidine just before you wake up, which could prevent rather than treat the problem. Good luck with your procedure. 

I have a relative that has Fructosemia and is having surgery for a septal defect. She is concerned about the glucose or anaesthesia that may be used to put her under. What might a Dr. give her instead? 

Fructosemia, also known as hereditary fructose intolerance, is a rare inherited disease. Because of the rarity of this disease, it is unlikely that your anesthesiologist will have had any previous experience taking care of a patient who has fructosemia. It would be wise therefore for your relative to contact the anesthesiologist and arrange a pre-surgery evaluation. Records of previous care, lab results, hospitalizations and other surgical procedures will obviously be helpful. The anesthesiologist will also be likely to want to discuss your relative`s condition with the physician who takes care of her - I suspect this might be a geneticist, a liver specialists or perhaps a general internist or pediatrician. From what I have learned researching this condition (see "Anesthesia & Uncommon Diseases" 4th Edition, 1998, by Jonathan Benumof) the main issue is to avoid giving sucrose or fructose to patients with fructosemia. Neither sucrose nor fructose are given routinely as part of anesthesia. Intravenous glucose-containing solutions are sometime used during and after surgery. These should not be a problem, but you should confirm this with her doctors. If your relative has liver or kidney damage as a result of the fructosemia this can have implications for the anesthetic drugs that are used, which again should be discussed with the anesthesiologists prior to the surgical procedure.ﾠ 

About 4 years ago, I had my wisdom teeth pulled. I was put out for about an hour or so. When I came to, I felt sick like many people do afterwards. Well, weeks, & now years have went by and I`m still sick. I have this constant motion sickness feeling (mild to moderate dizzines and some nausea), plus my ears ring all of the time. I felt fine before the operation. I found out about a year ago that I have an atrial tachycardia. Could the operation have made me feel like this or have affected/worsened some underlying problem (such as the tachycardia or something else) that I don`t know I have? 

ﾠAssuming that there were no complications during your dental surgery, it is unlikely that anesthesia caused the problems you describe. General anesthesia certainly can lead to nausea and even vomiting, but most anesthetic drugs are cleared from the body within hours, and the symptoms rarely last longer than 24 hours. Ringing noise (tinnitus) with dizziness and nausea are symptoms of middle ear disease and you should consider consulting an ENT doctor. 

How long does it take to get rid of local anesthesia in our system? 

ﾠThe answer is, it depends! It depends on what type of local anesthetic is used, the dose administered, where it is injected, what additives are put in the mix, and the body's processes of drug distribution, metabolism and excretion. Those processes depend on blood flow and on the efficiency of your liver and kidneys. An injection of the local anesthetic lidocaine for dental anesthesia or a peripheral nerve block might last only 30-60 minutes. An interscalene block with bupivacaine plus epinephrine and some steroid can last as long as 24 hours. 

Iﾠknow local anesthesia will be used to remove a wart from the side of my foot, but what is the drug used, how long does it take to set up, and how is it administered? 

I am going to assume that your wart is rather small and that your doctor is going to remove it in her office. If this is the case, then your doctor will have a choice of a few different local anesthetics. In the United States, the most commonly used short-acting local anesthetic is called lidocaine. Other local anesthetics include procaine, mepivacaine, ropivacaine, and bupivacaine. As you might have guessed, cocaine is also a local anesthetic but not used for this purpose. Your doctor will probably inject the local anesthetic under and around the wart, using a syringe which contains the anesthetic, and a needle. The injection will sting, but the discomfort does not last long, and the effect is almost instantaneous. 

I am a 38 year old woman, and had a root canal at my dentist`s office two weeks ago. I was given an anesthetic containing epinephrine, and just after it was administered, I got extremely light-headed and my arms suddenly felt like lead weights. After a while, the feeling subsided for the most part, but now I am left with weakness in my arms and a feeling like I`m trembly, not unlike after an adrenaline rush. I am concerned that it has not gone away. . .could this be permanent? Could this be an indication of an underlying problem that was just exacerbated by the medicine? Thanks for your help. 

Thanks for your question. The injection administered by your dentist would have contained an anesthetic - probably lignocaine or procaine - and adrenaline. The purpose of the adrenaline additive is to reduce the absorption of the anesthetic into the bloodstream. Absorption into the bloodstream reduces the duration of action of the anesthetic, which might mean that you would need more injections to keep the anesthetic going. 

Some patients have symptoms similar to those you describe when the injection is administered. These symptoms may be due either to the anesthetic or the adrenaline. Light-headedness or dizziness, palpitations, metallic taste in the mouth or jitteriness are among those symptoms. Usually these symptoms are short-lived and don't require treatment. 

Sometimes patients are told, mistakenly, or assume, mistakenly, that they are allergic to the local anesthetic. While allergies to local anesthetics do occur, in most cases they do not present in this way. It is certainly unusual for these possible side-effects to linger for two weeks. Even if a substantial amount of these drugs in absorbed into the blood, the body metabolizes and excretes them within minutes to hours. 

So, although I am not at all sure what your persisting weakness and trembling is due to, I think its unlikely to be a direct result of the dental anesthetic. If your symptoms do not go away, please be sure to consult your physician. 

I had elbow surgery yesterday and had nerve block how long does it take for it to wear off? 

It depends! It depends on the kind of nerve block, and the kind of local anesthetic that was used. Long acting local anesthetics, such as bupivacaine and ropivacaine, might last up to 12 hours or so. There are certain additives, such as clonidine, epinephrine (adrenaline), and corticosteroids that help to prolong the effect. The effects on movement ("motor effects") wear off more quickly than the the effects on feeling ("sensory effects"). If you had a single injection of local anesthetic and the effects have not worn off by the following day you should give your surgeon or anesthesiologist a call. 

I recently had rotator cuff surgery and a local block was performed. Can this type of anesthesia cause me to have severe sweating? I have the constant smell like diesel fuel is on everything I have changed bedding daily and the smell will not go away. I took very little pain medication. How do I get this out of my system? Thank you! 

Your anesthesia was probably some form of brachial plexus block. Typically this block causes decreased sweating through its effects on the sympathetic nervous system. Your unusual symptoms don't sound like they have anything to do with anesthesia or pain medication. 

I recently had arthroscopic surgery for torn rotator cuff. During the nerve block procedure some anesthetic got into a vein. Do I need to be concerned about any permanent damage or complications? 

Thanks for your question. You probably had a brachial plexus block. The brachial plexus is a grouping of nerves coming from the cervical (neck) portion of the spinal cord. These nerves can be blocked by injecting local anesthetic in the neck area, or above or below the clavicle (collar bone). The injection has to be very precise to achieve the desired effect, and also to avoid injecting the anesthetic medication into the wrong structures. 

One of the structures in the neck to avoid injecting into is the vertebral artery. There are also veins in this area. If anesthetic is unintentionally injected into a blood vessel, the consequences range from none to serious. Mild symptoms can occur (ringing in the ears, dizziness, numbness around the mouth, metallic taste) for a minute or two. If enough anesthetic gets into the blood stream however, especially if injected into the vertebral artery, seizures (convulsions) and unconsciousness can occur. If seizures occur, these can be fairly easily managed with normal resuscitation measures and they stop within minutes as the anesthetic is processed by your body. Finally, if enough anesthetic of a particular kind (such as the commonly used bupivacaine) gets in, heart disturbances, and even cardiac arrest can occur. This is very rare but of course very serious, and also much harder to treat successfully. 

To avoid such rare but awful consequences a great deal of care is taken. Various methods are available to make sure the needle is in the right place (e.g. nerve stimulators, ultrasound) Before any significant amount of anesthetic is injected, the doctor will be draw back on the syringe (aspirate) to make sure there is no blood. A small amount of anesthetic may be administered initially and then there is a pause to ensure there are no problems. Then the rest of the dose is administered slowly and carefully, making sure the position of the needle does not change. 

If you're writing and asking me about this, you survived the injection of anesthetic into a vein. In this type of case there are usually no known long term problems of the kinds you mention. 

I recently had Novocain when I had 2 wisdom teeth pulled. Does Novocain have any impact on the effectiveness of birth control pills? 

Novocain is the brand name for the local anesthetic procaine. Procaine was the first injectable local anesthetic, developed in 1905. Procaine is no longer commonly used, having been replaced by other local anesthetics such as lidocaine. I searched two different drug formularies and could find nothing to suggest an interaction between either lidocaineﾠor procaine, and birth control pills. This seems particularly unlikely to occur after a single dose of local anesthetic for tooth extraction. 

I had 4 wisdom teeth out this morning with local anesthesia. It`s been almost 12 hours and my lower lip and chin is still numb. How soon should this wear off if it is just the normal effects of the anesthesia, and when should I start worrying that the nerve was damaged, causing this numbness? 

I certainly hope the numbness has worn off by the time you read this response! Please understand that this is not a source of emergency care and is not a substitute for care from your phyician or other provider. 

The duration of anesthesia depends on the type of local anesthetic used, as well as the presence of additives such as epinephrine which prolong the numbness. There can also be quite a bit of variability from person to person even when given the same amount and type of anesthetic. Twelve hours is probably at the outside limit of most dental anesthesia, so it may be advisable to contact your dentist if you are still numb after this time has elapsed. 

I had a colonoscopy done on 9/19/06, all was well, no polpys, no cancer, etc. However the doc discovered 3 large hemorrhoids which he banded.ﾠ Since 9/20 /06 I have a loose bowel movement, EVERY HOUR ON THE HOUR. I am at my wits end and cannot take my stool sample to the lab until 9/25/06. Could I have a reaction to the anesthesia? 

You had a procedure done on your bowel and now you have a bowel-related symptom - diarrhea. It is interesting that you would think that the anesthetic, rather than the procedure, would somehow be responsible for the diarrhea! Please contact your gastroenterologist for advice. I don't think the anesthetic has anything to do with your current problem. I wonder whether the bowel preparation medicines you might have received prior to the colonoscopy may be causing the loose stools. 

I`ve raised, and notice many other questions, regarding problems with IV sedation. We`re always told the phlebitis, blood clots and bruising are "rare" -- obviously this is not the case. What is the most constructive way to get our care providers to listen to our concerns? I don`t want to be confrontational, but I`m too often made to feel like I`m a nuisance if I ask for anything outside of "this is the way we always do it." Do you have any thoughts on how we can best be partners in our health care? And thank you for your service to this site. 

That is an excellent question! I've learned that problems and concerns about IV sedation are more common than I thought. Exactly how common is not clear. Obviously, the people who write in are a self-selected group and I only hear from the ones with concerns and problems related to their anesthesia care or health care in general. What is the denominator? I think there are a lot of satisfied customers out there too! Part of the problem may be a lack of data on actual outcomes, as we anesthesiologists are often guilty of not following up on what exactly happens to our patients. Of course, the fact that a complication is "rare" is not helpful if you are the one who experiences it. Also, the acceptability of a particular complication rate varies widely among different people. Appreciating that involves having long discussions with each patient. And time is often short. The culture of health care is changing and definitely becoming more responsive to the types of concerns you bring. But culture takes a long time to change. In many settings, the old paternalistic, doctor-knows-best, approach reigns. That is certainly true of many countries outside the United States. I assume you are based in the US. You would be even more disappointed I suspect were you to be a patient somewhere else where physician autonomy is still very strong and patient empowerment correspondingly low (although they are not always inversely correlated!). One suggestion is that you always try to keep the big picture in mind. The big picture is - your best shot at getting better from your illness, or surgery, is by creating the conditions for your medical team to do their best for you. Accept they have limitations and that treatment methods are not perfect. Try not to be hostile, even though your anger may be justified based on your previous experiences. Also accept that perfect outcomes are not always possible, that complications do occur even in the best hands. Try to have an extra pair of eyes and ears with you - a family member - because errors do occur. When you see a problem or a potential problem, an error in the making, you need either the right kind of doctor who can respond appropriately to your directives or preferences, or to evoke your most profound emotional intelligence, on a case-by-case basis in your interactions with less than responsive caretakers. Take your medical records everywhere with you - physicians like data. If you've had complications before, have the documentation with you to avoid getting labelled as simply a neurotic or troublesome patient. Find out whether your hospital has a patient advocate or ombudsman - these people are not emotionally invested in your care the same way the doctors and nurses are, and can often help if they are good at their jobs and not perceived by doctors are being on "the other side". I hope these few ideas help! 

I`m scheduled for a colonoscopy (no problems, just a routine screening) and I don`t want to be sedated as I have never been sedated for anything including two chilbirths (for which I also did not receive pain medication) and I don`t want an IV. My Mother and both sisters had a lot of bruising and pain at their injection sites that lasted for weeks and I refuse to go through that. I want to be aware of what is happening to my body through the entire procedure and be able to convey to the doctor if I want to stop the procedure. I can`t do that if I`m sedated. I also want to be able to leave the hospital afterwards without any residual medication affecting me. In other words I don`t want to leave in a drugged stupor as my husband did after his procedure. If I go through the procedure the way the doctors have outlined it to me then they will be taking all of the decisions about what happens to me out of my hands. I am trying to retain as much of my dignity as I can in this wholely undignified experience. So the question is, is it possible to have a colonoscopy done with no IV or sedation? 

ﾠDuring the Civil War, men had their limbs amputated without anesthesia. As you've mentioned, women may endure childbirth without medication. I am sure it is possible to have a colonoscopy without sedation. I guess it is your right as an autonomous patient to request this. Before you make your request, you should consider these questions: - Why are you having the colonoscopy? - What are the rights of the physician? These are my suggested answers: You are having a colonoscopy to screen for asymptomatic abnormalities. Such abnormalities can be polyps or even cancer. You want the physician to have the best possible chance of detecting these because their detection could save your life. You give the physician the best chance at detecting abnormalities by lying absolutely still so she can concentrate on finding abnormalities. If you are not sedated you are likely to have significant discomfort, with which the physician will be concerned, and find difficulty being immobile. Your physician may be distracted by your discomfort and be pushed into completing the procedure as quickly as possible. As a result the abnormality may be missed. This would be a very unfortunate outcome for both you and the physician. I imagine that in the US it might even be grounds for a lawsuit against the physician! Your dignity is important. How important is your life? Your dignity may be best safeguarded by not having to endure a procedure that is difficult for both you and the physician to complete. An IV doesn't have to result in prolonged bruising and discomfort. Ask for someone who has had lots of experience putting them in. I suggest you discuss this issue with your physician, and the sedation with the anesthesia provider, who may or may not be an anesthesiologist. I suspect that both will be willing to give it a try without sedation provided you agree they can step in and provide this if necessary to ensure a good outcome. 

I`ve beenﾠdelaying a colonoscopy due to previous complications from IV sedation (blood clots, painful arm swelling, waking up in pain and paralyzed during the procedure.) What are alternative pain control options? 

Colonoscopy without sedation can be a rather uncomfortable procedure. Colonoscopy therefore is generally performed with moderate to deep intravenous sedation, but not general anesthesia. 

Do you know what kind of anesthesia it was intended that you receive? If you really were paralyzed and unable to move during the procedure this would suggest that you received a general anesthetic, with a breathing tube in your trachea (windpipe). This is unusual but occasionally necessary. 

If you need to have a general anesthetic again you should talk with your anesthesiologist before the procedure, have her review the records of your previous procedure to help identify what happened, and make a suitable plan to avoid a repetition of your unpleasant experience. 

If you were intended to get moderate to deep sedation you should have been told that some degree of "awareness" is expected during certain parts of the procedure, although perhaps the majority of patients remember little to nothing of their experience afterward. 

Because colonoscopy does not involve cutting tissue, except of parts of the bowel (biopsies) which do not have pain receptors, there is usually not much, if any pain, during recovery. However there may be a certain amount of discomfort resulting from the blowing of air into the bowel to improve the ability to see inside the bowel. Where is the pain you have had? Did you have this pain before the procedure? In future you may have to ask your doctors to give you some strong pain-killer medication along with your sedation. 

Blood clots and a swollen arm are definitely unexpected! It sounds like you may have had a venous phlebitis or thrombophlebitis. Please browse my previously answered questions on this topic. This is a known, occasional, complication of your IV which hopefully will not happen again. 

After a colonoscopy procedure during which I was diagnosed with colon cancer I began sneezing in recovery and am still doing it hours later after antihistimines. Is this normal? What can I do to avoid this during my surgery in the coming weeks? 

It does sound as though you may have reacted to something in the environment. I think it's unlikely to be the anesthetic medications though. For a colonoscopy, in the United States, the most common medicines used are propofol, fentanyl, and midazolam. These drugs very seldom cause allergic reactions but when they do the reaction may include a rash, swelling, difficulty breathing, and low blood pressure. Sneezing is not typical. Another possibility is that you are allergic to latex and have responded to rubber gloves, or some other latex-containing medical item that you came into contact with. Individuals with latex allergy often have a background of other allergic conditions, such as asthma or hay fever, and of previous exposure to latex in the workplace (gloves, usually). There is a blood test for latex allergy available. A final possibility is that your symptoms are completely unrelated to the colonoscopy procedure and you came into contact with something outside, or were just in the early stages of a respiratory infection. In any case, I think you are unlikely to have similar problems during your forthcoming procedure. It's a good idea to tell your anesthesiologist about your experience too she can be on the lookout for allergy-related problems during and after the surgery. 

I am soon to undergo surgery and understand I will be under twilight anesthesia for about 30 minutes. First, is this the same as MAC? Also, Do patients ever "talk in their sleep" while under this and/or say/do things that could be embarassing to them after coming out of this state of sedation? The amnesia that occurs from this is a bit disconcerting . 

Thanks for your questions about sedation and its effects. There are several terms used to describe the anesthetic "state" in which the patient is sedated but not under general anesthesia. Among the most commonly used terms are the ones you've mentioned. "MAC" or Monitored Anesthesia Care is "a specific anesthesia service in which an anesthesiologist has been requested to participate in the care of a patient undergoing a diagnostic or therapeutic procedure." A rather vague definition. In fact, MAC is often used to describe a state of "moderate" or "deep" sedation (more on that later). "Twilight" anesthesia has no official definition that I am aware of but is often used to describe the same type of sedative or anesthetic state that "falls short" of general anesthesia. The official terms and definitions, developed by the American Society of Anesthesiologists, and adopted by other national organizations, involves a "continuum" of sedation. The continuum starts with "minimal" sedation, and moves through to moderate and deep sedation, and, finally, general anesthesia. Along the continuum, with increasing doses of sedative or anesthetic drugs, a patient becomes less responsive, but also gradually loses the ability to keep the airway open, breathes less well, and experiences more depression of cardiovascular function. Moderate sedation is also known as "conscious sedation" - a bit of a misnomer really. There is a common misconception that sedation acts like a "truth serum" and that patients are compelled whilst in this twilight zone to divulge secret and embarrassing personal details. If only it were that exciting! In more than 15 years of anesthetic practice I have yet to take care of a patient who has revealed to me any juicy secrets! It is true however that sedated patients sometimes become a bit disinhibited, much as an inebriated person under the influence of alcohol might behave. This could be an embarrassing experience, however the amnesia effect means that you are unlikely to remember what you said. Whether this is a good or bad thing depends I suppose on your perspective. The goal of the anesthetic state is to allow the surgical procedure to be accomplished quickly, safely and effectively. A patient who is behaving in a disinhibited, drunken state will very quickly be given more anesthesia (or, sometimes, less) in order to create better conditions for the surgical procedure to take place. Unfortunately, the treatment of medical and surgical conditions sometimes involves the inevitable loss of one's physical dignity for a period of time. Hopefully the highest ethical standards surround the care we deliver. Let's recall that doctors and other healthcare providers are meant to observe the highest levels of respect for a patient's privacy. We all become patients at one time or another in our lives, and hopefully we learn to accept the occasional embarrassment or loss of physical dignity with humor, in return for the benefit of excellent and compassionate care. On a final note, I always encourage our readers to engage their anesthesiologist (and surgeon) in a discussion of risks, benefits and alternatives of anesthesia care. It is possible that the procedure you are about to undergo can be accomplished with minimal or even no sedation, using local or regional anesthesia techniques. This approach will help you to avoid the problems that you have raised in your question. 

After 24 hours I still have some vision distortion. Experienced Chills, sick to stomach/not vomiting, blurred vision, malaise after dental work. Is this considered allergic reaction? Does it affect the liver functions? 

The symptoms you are describing are not at all typical of an allergic reaction. I suggest that you seek attention from a physician as soon as possible, especially if your symptoms worsen. 

I am going to have a cyst removed from my flexor tendon sheath. They are going to use MAC sedation. I am extremely terrified of this. After reading several reviews on this type of sedation, I am now worried that I will be aware of what is going on, and if this happens, I know I will freak out. I want to tell the anestiageoligist (sp?) that I want him to knock me out before the surgeon even touches my hand. I am so scared. Can you tell me if he will do that. I just don`t think I can go through with this if he doesn`t. The cyst is so painful and restricting that I need to get it removed though. Any advice on this MAC would greatly be appreciated. If you could tell me around about way I will feel when I am on it. I know everyone is different. 

Clearly you are very frightened about your upcoming surgery. It's natural to be somewhat anxious but I do wonder what you've been reading and why you are so scared. I'm sure you realize that a cyst removal from your tendon sheath is a pretty minor procedure. If it's pain you are worried about you can be sure that the combined efforts of a competent surgeon and anesthesiologist together will ensure you are pain free during the procedure. If it's done under "MAC" - that is moderate or deep sedation - you may be "aware of what is going on" in that you may feel the surgeon touching, moving or applying pressure to your hand. You might be correct about that alone being enough to freak you out, but I doubt it because in my experience even the most anxious of patients manage just fine, given lots of reassurance and the correct amount of sedative medication. After discussing your anxiety with the anesthesiologist I'm sure he or she will give you some anxiety-relieving sedation - such as midazolam - before you reach the operating room. That will probably be enough to calm you down. During the procedure itself you will probably receive additional midazolam together with intravenous sedation - e.g. propofol. These drugs in high enough doses can produce general anesthesia - unconsciousness - but the aim is usually a state of sedation short of general anesthesia. If you are absolutely unwilling to have the procedure in the way it has been planned you should speak with your surgeon and anesthesiologist, preferably ahead of time. It is likely that they will be rather understanding of your fears, reassure you that all will go well, but offer you the option of general anesthesia if that is what you desire. A necessary condition however is that facility in which you are to have the procedure done must have the capability of providing general anesthesia including the appropriate after-care. There might be additional out-of-pocket cost to you. 

Is it dangerous to drink alcohol the same day I had twilight anesthesia? 

The standard advice is not to drink alcohol or take any other intoxicants for 24 hours after your anesthesia. Alcohol and other intoxicants can interact with anesthesia drugs to increase the effect of one or the other or both. If you've just had anesthesia, the effect of a drink of alcohol is likely to be greater than it would have been under normal circumstances. In other words you are more likely to become intoxicated. People who are intoxicated get into harm's way through impairment of judgment of normal motor function (movement) and other mental faculties. Extreme intoxication can affect breathing and even cause unconsciousness. Any medical facility that sent you home without the standard advice to avoid alcohol would be running a risk (medico-legal) for themselves and for you (health). The degree of impairment, and the resultant danger to you will depend on the amount of alcohol you have drunk, your individual susceptibility to the effects of alcohol, the amount of anesthesia you had, your individual susceptibility to its effects, the time that has elapsed since your anesthesia, and the effect of other medications you may be taking. There are many unpredictable factors involved here so perhaps you can understand why the standard advice is given. 

My doctor saysﾠI won`t be numb long from the spinal.ﾠI am hoping this is true becauseﾠI am scared of the numbing and afraidﾠI am gonna panic. Is this true about the numbing? 

The duration of a spinal anesthetic depends on which local anesthetic medication is used, and how much of it. At the one extreme, a spinal anesthetic with a small dose of a medicine called chloroprocaine may last for only 45 minutes or so. On the other hand, with a medicine called tetracaine, the anesthetic can last well over 4 hours. 

The duration that is needed obviously depends on the duration of the surgery. It is rather upsetting for all concerned if the surgery is still going on when the spinal is no longer working! Because surgery is not an assembly line process and has a certain degree of unpredictability, we prefer to err on the side of having the spinal anesthetic outlast the surgical procedure! In addition, this has the benefit that after the surgery is ended and you are taken to the recovery area, you are likely to be still quite comfortable. As the spinal gradually wears off, pain from the surgery can be treated with pain killers. 

Although the concept of being numbed, and in fact unable to move, is somewhat alarming, most people do very well with spinal anesthesia and I've never seen anyone get really panicky. That is because we won't administer this type of anesthetic to someone who is adamantly against having one, because we almost always administer sedative medicines along with the spinal anesthetic, and because spinals seem to have a kind of sedating effect of their own. 

You should express your concerns to your anesthesiologist who will discuss the benefits, risks and alternatives to spinal anesthesia and in all likelihood, if the spinal is chosen, will give you enough sedatives before and during the procedure to make you, at least temporarily, blissfully content with life. 

How do you test a patient to see if the epidural works before c-section? I recently had a c/section. I was told that the epidural failed so I had to have general anesthesia even though I had no feeling from the umbilicus. I did not have any pain from the contractions which I could not feel at all during labor or during pushings. In the OR the anesthesiologist used an object to touch my abdomen. I could not feel any thing at or below, but I can feel the touch above the umbilicus. And for that it was concluded the epidural failed. I had a ltcs, would the epidural be sufficent. The epidural site was at L3/4, so would it be expected that my skin above the umbilicus to be numbed while the dermatome of that region is supplied by lower thoracic branches. Thank you for your insights. 

To provide adequate anesthesia an epidural should produce a sensory level to approximately the T6 dermatome. That means sensation is blocked up to the area just beneath the breastbone. There are a variety of different methods of testing. Common methods include the use of an alcohol spray (very cold), or a pin (sharp). The idea is to stimulate a normal (unblocked) area of skin so the patient understands what the "normal" stimulation feels like, then try to define the area in which sensation is blocked. Blocked is actually a relative term. Most of the time, an epidural does not completely eliminate all forms of sensation, and pressure or movement are often still perceived. 

The umbilicus corresponds to a T10 level and may not be sufficient for a c-section. If you have a good T10 level, the block can almost always be extended by administering more anesthetic into the epidural catheter, and waiting a few minutes. 

The ultimate "test" of an epidural is whether the patient can tolerate the incision of the skin and the subsequent surgery. Most surgeons will do a final check by pinching the skin at the incision site with a surgical clamp. This would make anyone without a good anesthetic really jump! An epidural that works well during labor usually works well for a cesarian section. But not always! The catheter can become dislodged. 

I had a spinal block done when I had a c-section. I have been having dizzy spells off and on since then. Could this be a side effect of the spinal block? I didn`t have them beforehand. 

Spinal block has a number of potential side-effects but almost all are quite short-lived. The neurological (brain and nerve) side-effects include headache (1 or 2%), which can last several days, and certain cranial nerve problems (very rare) which can cause double-vision, and even hearing loss. If dizziness is your only symptom I think it is very unlikely to be caused by a spinal block more than 2 months ago. Dizziness is a very common symptom dealt with by family physicians and internists, with many possible causes. If the dizzy spells are not going away you should seek help from your doctor. 

Checking dermatome levels for epidural infusions : what should be used to test the sensory level? Touch, alcohol wipe or ice. Thanks. 

"Checking dermatome levels" usually refers to the technique used to estimate the extent of a spinal or epidural block. Dermatomes are the areas on the body surface associated with innervation, or supply by a particular nerve. 

An anesthesiologist will check the level of the block to make sure that anesthesia - the loss of pain sensation - is present in the area of the body where the surgery will take place. The level can be most easily checked using one of three different kinds of stimulation -light touch, cold or pinprick. These sensations are carried by three different types of nerve fiber. A beta fibers transmit touch, A delta fibers carry pinprick sensation, and C fibers are associated with the sensation of cold. Loss of tolerance of surgical anesthesia corresponds with the return of A beta function. This suggests that loss of light touch sensation may be the best indicator of surgical anesthesia in a particular dermatome. 

In the institution where I practice, dermatomal testing is usually done with an instrument that delivers a pricking sensation that does not penetrate the skin, such as the tip of a plastic needle, or, occasionally, with a disposable alcohol "wipe" or a piece of ice. Although this technique may not have the best scientific validation, in practice it works very well. 

I will be undergoing gallbladder removal. I have had a tonsilectomy, with no complications due to anesthesia except nausea. However when I had an epidural during childbirth, my pulse rate shot up, and the process was delayed a few minutes. Is that something that may happen with general anesthesia, or is that particular to an epidural? 

ﾠThanks for your question. Unfortunately it is not exactly clear from your description what happened to you when you received your epidural. Epidural analgesia for childbirth is not usually associated with an increased heart rate. One exception is when epidural medication, which may contain a small amount of epinephrine (adrenaline), is absorbed into the bloodstream from an epidural catheter whose tip is in or adjacent to an epidural vein. In that case the epidural catheter is usually removed and reinserted at another site. 

An increased pulse rate is, of course, very common during labor, because of pain and other factors. When an epidural is inserted your anesthesiologist monitors your heart rate and blood pressure more intensively than at other times. The heart rate increase may have had nothing at all to do with the epidural, which has an excellent safety record and is the most effective form of pain relief offered to women in childbirth. General anesthesia is an entirely different technique, using other drugs and equipment and associated with a different set of risks, including nausea. 

I`m having a tummy tuck in a week and I was wondering how and if smoking will affect the anesthesia. 

ﾠSmoking increases your risk of respiratory complications and your risk of wound infection. Your upcoming surgery represents a perfect opportunity to quit. Ideally you would stop 6 or more weeks before surgery to get maximum benefit, but the consensus is that any time before surgery is a good time to stop. Even if you stop for only 24 hours before the procedure this will increase the oxygen-carrying capacity of the blood. Smoking cessation programs are widely available in many places and your hospital or surgery center may be able to direct you to such programs. Smoking cessation aids like nicotine patches, gum, and drugs like buproprion can help you through it. 

Why do shorter women require less anesthesia than a taller woman? 

ﾠThe dose of an anesthetic agent is partly determined by weight. Taller women are likely to be heavier than shorter women. The same would apply to men! In the case of epidural anesthesia, the relation between dose and height is not quite as important as between dose and weight, but a short person will on average also require less. The volume of the epidural space, where the drugs are injected, is smaller. 

I have surgery in a few weeks and recently have been having low blood sugar in the morning (or during the night). One test said I may have nocturnal hypoglycemia. If my surgery is at 9am, and I haven't eaten, how do I overcome those low sugar feelings if I can't eat..and more importantly..what happens during the two hour procedure if its low or drops further? 

Are you diabetic? Low blood sugar typically, or hypoglycemia, occurs in people with diabetes who take sugar-lowering medication. If so, you should consult your personal physician about how to better manage your medication and diet. If you're not diabetic, low blood sugar is rather rare. You don't state what the sugar level was - it can easily be measured with devices for home use. Try not to confuse the "low sugar feelings" with actual low measured sugar (glucose) levels. Prolonged and very low levels can lead to such serious consequences as coma and brain damage. But low sugar feelings, at least in conventional medical thinking, probably represent hunger, fatigue or something else equally benign. If you are really worried about your sugar becoming low around the time of your surgery, when you are not permitted to eat, I would suggest you mention this to the doctors taking care of you. Most institutions will allow the consumption of clear fluids, which can contain sugar, up to 2-3 hours before anesthesia (check with the hospital, the surgeon, or the anesthesiologist). Your sugar (glucose) can be measured immediately before you go in for your operation, and can also be measured while you are under anesthesia. If the levels are low, you can be given sugar-containing solutions intravenously to raise and maintain your sugar at normal levels. 

My son in law had knee surgery a week ago and now has large blistering on his throat, very sore, sick to stomach, fever, aching - what do we do? 

I'm not sure whether those symptoms have anything to do with your son-in-law's anesthetic a week ago but you haven't given me any information that suggests that it does. A sore throat after general anesthesia is quite common but blistering is definitely not. There are many possible causes of the symptoms you have described including severe allergic reactions, infections and blood problems. You should advise your son-in-law to consult a physician as soon as possible. 

I was given anesthesia for a surgery and after I have been very itchy. Why is that? And will it stop? 

There are many causes for itchiness that include many different diseases of the skin as well as diseases originating in other parts of the body, such as allergy, infections, infestations, organ failure, and even cancer. There are also environmental causes such as excessive washing that depletes skin oils, compounded by the dehydrating effect of dry, climate-controlled air. A common reason for itching (pruritus) after surgery is the administration of opioids - that is pain killers like morphine or meperidine, especially if given via epidural or spinal anesthesia. The itchiness lasts roughly as long as the effect of the pain killer and probably is a "central" effect through the action of the drug on opioid receptors in the brain. 

How do you know how much medicine to put into a shot to give to a patient? 

ﾠThat is a very big question! Drug dosing depends on the effects of the drug on the body (the science of pharmacodynamics), and the effects of the body on the drug (pharmacokinetics). It`s what medical professionals go to school for a long time to learn. As far as anesthetic medications are concerned, keep in mind that these drugs are all "poisons" which can suppress vital functions of the body such as breathing and heart function. Don`t try this at home!!