I read the panic attack questions. I had similar reaction but not sure what it was. Upon waking, my heart rate went high, felt like it was jumping out of my chest, they hooked up EKG, told me to "bear down", asked if I`d had heart problems before, first administered one drug 6cc of? No change in heart rate, administered 12cc. No change. Then they administered Versed and the heart rate finally started to decrease. Gave me potassium pills, released. What happened, did I have tacychardia or panic attack. Going in for new surgery, very scared. Someone suggested TIVA instead, perhaps better results with this kind of anesthesia. Any help to not be so scared of going under? I don`t even care about the hip surgery, it`s being put under that has me worried. 

ﾠTachycardia is what you had. The word means rapid heart rate. Tachycardia has many causes. One cause is indeed a panic attack, although that would seldom be the first diagnosis in the setting you describe - during recovery from a general anesthetic. Your doctors would want to make sure that nothing life-threatening was the cause before concluding that anxiety alone was responsible. The drug you were given was probably adenosine. It is one treatment for supraventricular tachycardia (SVT) - a rapid heart rate caused by a conduction abnormality in the top part of the heart (the atria). The usual first dose is 6 milligrams which, if unsuccessful, is repeated with double the dose (12 mg). Unsuccessful results with adenosine, and a lack of a previous history of this sort of problem, suggests that you did not have SVT. Other causes of tachycardia include ventricular tachycardia (a sign of serious heart disease), medications, drug interactions, various metabolic, hormonal and electrolyte disorders, lack of oxygen, pain, fever, inadequate return of muscle function, etc. You need to chat with your anesthesiologist before you have your next procedure. Your anesthesiologist should be given the records of your previous anesthesia and recovery so that a reasonably informed assessment of what happened to you can be made. If it is felt that you had a panic attack, then reassurance from your care team and relaxation techniques combined with appropriate sedative or anti-anxiety medications may help. TIVA (total intravenous anesthesia) is not likely to have any different results for you than any other mix of agents for general anesthesia. Regional anesthesia is usually an option for hip surgery but you might get even more anxious. Please discuss with your doctors. 

My mother had knee replacement surgery 3 weeks ago. She is 79. Since the surgery, she has become prone to panic attacks, especially when she has to get up and walk with a walker and perform her exercises, she is afraid when left alone, and is regressing rather than improving from day to day. We`ve been told that these mental incidents could be attributed to the general anesthesia, but if that is the case, why is she getting worse instead of better? She`s had other major surgeries where she`s improved normally. Could it be a side effect of the midazolam? Or should we be thinking in the direction of early dementia or Alzheimer`s? 

While there is increasing research and clinical interest in the possibility that anesthesia may have long term cognitive effects in the elderly, the jury is still out on this. In your case, dwelling on that possibility is not very productive. The anesthetic is over, and there are no specific remedies available for postoperative cognitive dysfunction (POCD). In particular, the idea that benzodiazepine drugs, like midazolam, are especially bad, does not have foundation. Benzodiazepines work on GABA receptors in the brain, but so do many other anesthetic drugs. (I assume that your mother is not taking midazolam currently). Rehabilitation after knee replacement surgery is a challenge, even for healthy younger people. It is substantially more difficult for elderly people because of general lack of conditioning, medical illnesses, etc - and I'm afraid 79 is elderly. If you think about it, panic attacks and anxiety seem an entirely appropriate response! You're trying to walk on a new, artificial knee joint, with weakened muscles, and are alone at home with the realistic fear of falling and doing yourself a severe injury. Hopefully there are some options available to you in the form of home visits by nurses, or day patient visits to rehabilitation facilities. In the mean time, it would be wise to have your mother assessed by your family physician, internist or geriatrician who can do a proper mental state and physical exam to establish whether there is something else going on, like Alzheimer's or some other form of dementia, or a treatable anxiety disorder or depression. 

I was awakened after surgery and saw paper floating over me. Dosed off and woke up and it disappeared but pain level was high. Suddenly I could not breathe (worse than an asthma attack). I was terrified. The post op staff and anesthesiologist took care of me, I began breathing and fell asleep. When I woke up the nurse told my husband that they had given me three things but they felt that I was allergic to the Morphine and needed to tell doctor in the future. 

The problem occurred after I talked to my surgeon on follow-up. He got a little mad and said he did not know what I was talking about that I needed to call anesthesia at the hospital. I did call them and told them for the 5 days following surgery I was waking up in the night with panic attacks about not breathing. I asked if he could explain what happened and how I can prevent it for the next surgery. (This was all on answering machine except for the first call where the man said he would have him call me by noon the next day). 

Anyway- with lack of sleep and running a design firm I needed answers because I figured that would solve the problem for me. No call back at all- I left three messages for three days. Went ahead and got the surgical and anesthesia records and notes thought I could figure it out or maybe the next anesthesiologist could. The record shows they did not give me morphine but dilaudid. Would this be the problem or should I ask more questions. Are morphine and dilauded related so she was right to tell us that ???? Confused and need a hysterectomy but terrified. The anesthesia that he gave me really did the trick as I usually get very very sick but did not at all. Please tell me that it was not what ever drug he gave me to not get sick!! Can I get an epidural for hysterectomy? Help! 

It's important that you have this problem reviewed by the anesthesiologist who took care of you, or at least one of his/her associates in the same facility. If you're not getting anyﾠresults from the anesthesiology department or groupﾠyou might call the hospital directly and tell them about your problems. Many hospitals have a patient advocate or other staff member assigned to help patients with such issues or complaints. 

Dilaudid (hydromorphone) and morphine are related. They are both "opioids" with almost identical properties. However, some people seem to do better, from a pain treatment point of view, with one or the other drug. That is, fewer side effects, or more relief of pain. 

A hysterectomy certainly can be done with epidural (or spinal) anesthesia. This technique avoids intubation (breathing tube), unconsciousness (although sedative medication can, and usually are, given), and nausea. This might be a good option for you. 

It's not clear what caused your breathing problems after surgery. An allergic reaction? Partial paralysis from muscle relaxant medications? Laryngospasm? Secretions? Anxiety or a panic attack? (This is why you need to chat to the anesthesiologist). 

I suppose that an unpleasant, scary reaction like your recovery from anesthesia could predispose you to recurrent pain attacks or nightmares. Professional counseling may help, along with a full explanation of what happened, and a plan for avoiding such problems in the future. Good luck! 

I`ve been searching the web for this phenomenon and have found very few references to it - one of which is on this site. A woman asked you recently whether or not it was normal to suffer a panic attack while coming out of anasthesia. Unfortunately, you did not have enough information to answer the question. Recently, I had a simple procedure done for a stubborn kidney stone and was placed under general anesthesia. I`ve only been under general anesthesia once before - when I was very young, for a tonsilectomy. While I was a bit anxious before my recent surgery, I certainly wasn`t in anyway fearful for my life or well-being. I joked easily with the nurses and doctor during pre-op and had no qualms about "going under." I remember the nurse anasthetist putting the mask over my face. The next thing I remember is waking up in post-op and into a full-blown panic attack. I knew where I was, why I was there, and I knew I was safe. But I found myself hyperventilating and crying out my sister`s name. The nurses seem startled and frustrated - as though they had never seen this phenomenon. They certainly didn`t handle it well. As soon as I was wheeled into my room, my mother was able to calm me with a few words. My main question is whether or not this happens frequently - a panic attack when coming out of anasthesia. 

I don't know whether what you are describing is a panic attack, but I suppose that is as good a term for it as any. There aren't any studies that I am aware of on panic attack as a psychological phenomenon after emergence from anesthesia. In anesthesiology the tendency, rightly, is to focus on measurable physiology. If someone were to exhibit "panicky" behavior during their recovery from anesthesia the most appropriate response would be to seek physical causes for this, some of which are life-threatening and must be treated immediately. The causes include such problems as hypoxia (low oxygen), pain, bleeding, low blood pressure, inadequate breathing, partial paralysis, a full bladder, and the side-effects of certain antinausea drugs. It is unlikely that your family member was with you during the episode you describe. So I assume your description is based on your recollection. A recollection through the "haze" of anesthetic drug intoxication might not be the most reliable with regard to the facts. It is possible that the nurses dealt with your response appropriately. That is, they looked for the really important causes mentioned above, and then, in their absence, simply tried to reassure you, perhaps unsuccessfully. If you are really concerned about what happened and what was done for you, remember that you have the legal right to view your hospital records. My final observation is that some anesthetic drugs are disinhibiting, like alcohol. But this disinhibition takes different forms with different people. Some patients become reckless and angry, others mournful and weepy. Why this is so in individual cases is hard to know but is no doubt a potential subject for study. 

I had a section of my colon removed in 2004. I spent 5 days in the hospital. When I woke from the anesthesia I was in alot of pain and was given morphine and delodin (spelling?). I woke with the feeling doom and fear of going to sleep to by the fifth day think there were people trying to kill me and pulling tubes out of my body. It was explained to me that I had probably received to much delodin and it caused me to hallucinate. Between the time of the surgery and the intial onset of the colon issue I had been in the hospital 7 times on all kinds of pain meds and antibiotics. 6 monthes ago I had an angiogram go bad and it required me to have my femoral artery repaired. 1 night in the hospital I thought people were trying to get me again. I asked that I just receive vicoden for pain. Last week I went into surgery to repair a hernia from the colon surgery and repair a leak from the femoral artery surgery. I refused pain meds after the surgery but can`t speak to what was given to me during. I wake up at night hallucinating, sweating, and feel as if death is coming, then I snap out of it. In the first 2 cases I went back to normal in 2-3 weeks. I am not a person that takes meds for being crazy or sees fuzzy pink elephants when all is normal. It seems that my body no longer accepts this drug or combination of drugs. I have taken pain killers within these time frames without any side effect but when mixed with anesthesia or anesthesia on its own I have these mental meltdowns and my cognitive function seems to have been affected also. I am a 37 yr old male with diverticulitis and slightly high blood pressure (the reason for the angiogram of the kidney. They found one to be slightly smaller then the other) Any info would be great. I have gotten to the place that I would rather not fix something when it needs to be fixed. 

Thanks for your question. You certainly have had a rough time and I can appreciate your fear and frustration. You are very young to have had such serious problems from a condition like diverticulitis. I am not a psychiatrist but the symptoms you describe might indeed fall into the category of panic disorder. One suggestion is that you might ask to see a psychiatrist with an interest in this type of disorder. Psychiatrists who do so-called "consultation-liaison" psychiatry specialize in the problems of patients with medical diseases that produce psychologic symptoms, especially when they are acutely ill. That sort of expert might be able to sort out whether what you have is a pure psychiatric problem that is only triggered in certain hospital settings, a psychiatric problem that is triggered by certain drugs (and which ones), or just an unusual reaction to pain-killers and/or anesthetic drugs without any underlying psychiatric disorder at all. Having said that, the pattern does seem strongly related to the use of pain-killers. The obvious advice, or strategy, would be to avoid the pain-killers that are members of the opiate family - morphine, hydromorphone ("Dilaudid"), and meperidine (Demerol). As you know, these drugs are almost invariably prescribed for the relief of pain after major surgery, so it is pretty hard to get away from them. The alternative drugs are less potent, but are nevertheless effective. These include medicines in the NSAID (aspirin-like) category and acetaminophen and they should be included in any future pain management approach for future surgery, unless you have a medical or surgical reason to avoid them, such as allergy or bleeding. For many surgical procedures, a very effective way to manage pain is to use local anesthetics. After an abdominal operation like a cesarean section, or colon removal, an epidural catheter can be used to deliver local anesthetics. Special catheters can be placed alongside major nerves or groups of nerves with similar good effect. I would suggest that before any future surgery you consult with your surgeon and anesthesiologist to figure out a way to give you pain relief in this fashion so as to entirely, or almost entirely, avoid opioids. Although this cannot be guaranteed to solve your problem it will at least tell you whether your post-surgery problems are related to these drugs or not. Although opiate drugs are a standard part of most general anesthetics they are not essential and so your anesthesiologist can also attempt to avoid them for this "experiment". Good luck! 

I have had two general anesthesias in the past six months and each one has been followed by a panic/anxiety attack, one in the waking room (1st anesthesia) and one in my hospital room, 12hrs after surgery (2nd anesthesia). I have also had a high level of anxiety for the next couple of days after those two surgeries. Could these be caused by a reaction to one of the drugs given during the anesthesia? It`s worth noting that I didn`t have any anxiety before both surgeries and I never have panic attacks in everyday life. Thank you. 

Thanks for your interesting question. I plan to search the literature systematically for an answer to your question. In the mean time, let me offer the following remarks. Anesthesiologists are experts in applied human physiology, and are accustomed to explaining events in terms of observable, measurable phenomena. Parodoxically, however, we also interact with patients experiencing one of the most stressful events in their lives - undergoing surgery and anesthesia. So, although few of us have a psychologic "bent" most develop a real appreciation of the impact of anxiety and can diagnose its acute form in all its various manifestations. But before we would label anything, I repeat anything, during postoperative recovery, as "anxiety" or "panic attack", we would make sure that we were not dealing with something that had serious, even life-threatening, consequences. In this category we put hypoxia (low oxygen) and hypercarbia (impaired ability to breathe and get rid of carbon dioxide), hypotension or hypertension (low or high blood pressure), allergic reactions, stroke, hypoglycemia (low blood sugar). Also, pain itself can make people restless and anxious. You have not given me enough information to discover whether you would have been at risk for any of these events. And you have not described exactly what you mean by "panic attack". What exactly did you feel? Let us assume however that none of the above-named important, and treatable things occurred during your recovery from general anesthesia. It may well be that the stress of surgery and anesthesia was enough to trigger a panic attack, even though you've never had one before.ﾠEven if this is the case itﾠwould be wise though for the next anesthesiologist who takes care of you to examine the records of your anesthetics, and the recovery period, to figure out whether anything treatable may have occurred or whether, as you suggest, some of the drugs given during or after the anesthetic may have residual effects that caused your distress. One possibility is that you may have been given an antiemetic (anti-nausea) medication, such as droperidol or metoclopramide, that can occasionally produce strange symptoms of "dissociation" - that is the outward appearance of calm accompanied by inner anxiety and unease. Another possibility, that would account for your problems in the recovery room, but not 12 hours after surgery, is that the muscle relaxant that was given to you during your anesthetic had not entirely worn off. This is probably more common than is generally thought, and can lead patients to feel very uncomfortable, and in extreme circumstances unable to breathe properly or cough effectively. This again is something your anesthesiologist might be able to ascertain by reviewing your records or even talking to the anesthesiologists who took care of you previously. 

I have an interesting short story that might link to an allergic reaction to anesthesia....About five years ago I had a plastic surgery procedure done. I did the surgery without telling anyone, therefore, no one was there to be of assistance after the surgery. The surgery went well physically (liposuction done) but I was told I had a slight problem with the anesthesia and that I didn`t wake up for about 4hours. Even though I was told I would be ok, I remember feeling violently lightheaded and sick to the stomach (throwing up). After a few days being on percs to ease the pain, I experienced a strange bodily reaction that was sort of like an out of body experience. The symptoms I had from then on were very mentally disturbing because I constantly felt anxious/paranoid, I had chills, left-hand numbness, neck numbness, and very disoriented (racing thoughts, dizzy, confused). I began to feel that way after the surgery for about 8 months until I was told it was anxiety and that I need to be on a mood stabilizer called zyprexa. The drug did help a bit but I still to this day experience these same symptoms even being skimmed off zyprexa........I was hoping you can help me evaluate what I am experiencing day in and day out? I have seen therapist, a neurologist that told me everything looked physically fine, and a primary doctor that said things looked normal. Do you think that the surgery I had under general anesthesia played a role in these symptoms I get everyday almost constantly? In other words, do you think it could of done something "chemically" to my brain? If not, any other suggestions? I know it started a few days after the surgery and I do have a family history of allergic reactions to anesthesia. Please any suggestions would be very helpful in determining where to take my next steps. Thank you. 

Thanks for your question. Unfortunately it isn't enough to know that there was "a slight problem" with the anesthesia. What actually happened? Are you even sure that anything untoward happened, given that none of your friends or family were there to report this back to you? Again, reporting an "allergic" reaction to anesthesia is not enough information. Allergic reactions range from hives to anaphylaxis and don't include long term psychological and neurological symptoms. Light-headedness, nausea and vomiting are relatively common after-effects seen with general anesthesia, particularly in young women having outpatient surgery. Your account of not waking up for 4 hours can't be taken too literally - it is very unlikely that you were completely unconscious for 4 hours after the surgery. It's just that many patients are quite drowsy and take a while to fully regain their faculties to the point where they can attend normally to the world. During that time your short-term memory may not be fully functional. Narcotic medications like Percocet can also be associated with unusual psychological symptoms and it sounds like you were taking those for some time. An anxiety disorder could account for some of your symptoms. But as you have had numbness it would be important to rule out any neurological (nerve) disorder. I would stay in touch with your doctors including your neurologist to monitor these. The bottom line is we don't have any scientific evidence that anesthesia causes long term chemical alterations in the brains of healthy people that would produce your symptoms. 

I have to go in for a minor dental procedure which requires the use of a local anesthetic. I am also taking Zoloft and Ativan for anxiety and to block panic attacks. Do these drugs interfere or cause problems with any local anesthetic that the dentist might use? 

As you have noted, Zoloft is a commonly prescribed antidepressant medication that is also used to treat anxiety disorders. Ativan is a benzodiazepine, (in the same group as Valium) and is another drug that is effective for anxiety. Please be assured that neither of these drugs should interfere in any significant way with the actions of local anesthetics. 

If you are afraid that your dental procedure might trigger anxiety or even a panic attack it would be particularly important to take your medications on the day of the procedure. 

I would advise you to call your dentist to discuss your concerns. Many dentists are trained and licensed to administer sedative and anesthetic drugs, which might make the whole experience easier for you. 

What of the side effects of anesthesia? Is it possible to cause anxiety or nervousness after having 2 surgeries in a 6 month period? 

It is unlikely that anxiety or nervousness would be due to any lingering effects of anesthesia. In other words, the medications used in anesthesia do not persist very long in the body and are usually almost undetectable within 24 hours. The psychological effects of both anesthesia and surgery, like any stressful experience, can, on the other hand, have prolonged effects. This would be especially true if either the anesthesia or the surgery itself did not go well. Did you experience any complications? Anxiety, nervousness and stress are common in our society and have many causes, both biological, psychological, and social. If your symptoms are severe, I would advise you to consult your family physician to look into this as soon as possible. However, I would also reassure you once again that the anesthesia is very unlikely to have any persisting effect to explain the feelings you describe.