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 than 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 came 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 preformed 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 "jolting" you'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's thermostat, in a part of the body called the hypothalamus, resets itself to a wider range. This means that your body'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 being unclothed) 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 - 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 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 came 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 preformed 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 done 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's thermostat, in a part of the body called the hypothalamus, resets itself to a wider range. This means that your body'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 being unclothed) 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: 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) or pethidine. 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. 

After general anesthesia and recently after a twilight sedation, I shake uncontrollably and my blood pressure drops. Is there a way to determine if this is due to an allergic reaction? 

Decreasing blood pressure is one sign of a severe allergic reaction, also called anaphylaxis. The other main features of anaphylaxis are breathing difficulty and skin rash. Anaphylaxis can be fatal if untreated. Because you are writing to me from your computer, and do not describe intensive emergency treatment from your doctors I deduce that you did not have anaphylaxis! Instead it is more likely that you were shivering (common) and had a minor decrease in blood pressure (a bit less common - people are more likely to have higher blood pressure when they awaken, because of pain and discomfort). Shivering occurs because operating rooms are cold, because in them you lose your normal protective responses to cold (putting on clothes, reflex constriction of blood vessels) and because anesthesia resets your body thermostat. When you awaken, you shiver which generates core heat in an attempt to restore your body temperature. Sometimes patients shiver even when their body temperature is normal after anesthesia. The shivering can be unpleasant but is fairly easily treated with blankets and with medications called meperidine (Demerol) and clonidine. If this reaction occurs every time you receive general anesthesia or sedation, remember to tell your anesthesiologist beforehand. Measure that could be taken include keeping you as warm as possible during the procedure (warm operating room, forced air warming blanket, warmed intravenous fluids) and giving you one of the medications I mentioned prophylactically (before you awaken). 

I had a hysterectomy 4 months ago and I will be having surgery next month. When I had my last surgery the Dr. told me that I was shaking uncontrollably and it was very traumatic when I was coming out of the anesthesia. He accused me of being on drugs which I am not. He then said it could be from all of the ibuprofen I had taken for my severe cramps. What do you think caused this and should I be concerned about my next surgery. 

ﾠIt is hard to provide a good answer about what happened to you without more information about your general health, the medications you take, and the anesthesia that you were given. Iﾒm going to assume that you are generally healthy, and not taking any medication apart from ibuprofen, which is a very commonly used, over-the-counter, pain and anti-inflammatory medication. Many patients experience some shivering after a general anesthetic. This can also occur with epidural anesthesia. Occasionally the shivering is quite severe, with shaking movements. It cannot be controlled by voluntary effort and is obviously rather uncomfortable. The reason shivering occurs after general anesthesia has to do with loss of body heat that occurs in a cold operating room, but is also related to resetting of the bodyﾒs thermostat which happens during anesthesia. Interestingly, shivering can occur after surgery even if your body temperature is normal. The risk of shivering can be reduced (but not eliminated) by maintaining body temperature while you are in surgery. There are several ways to do this, including special warming blankets, heating the intravenous fluids, and keeping the operating room at a higher temperature (surgeons do not enjoy this!) A particular pain medication called meperidine (Demerol) has been shown to effectively control, or perhaps even prevent postoperative shivering, and your anesthesiologist might consider using this drug when you have your next surgery. Donﾒt forget to mention this problem to your anesthesiologist before you have your surgery. It would be helpful if you could obtain the records of your previous anesthetic for his or her review.