What methods are available to help eliminate the anesthesia given during surgery from your body? How long does "general" anesthesia remain in your system after a 4 hour surgery? 

Nothing that I know of speeds the elimination of anesthesia from the body, other than general good health, and good genes. The elimination of anesthesia drugs from the body require your heart and lungs to function well, and your kidneys and liver to break down and excrete the medicines. We don't have any magic for any of those things. "Antidotes" for certain drugs do exist, but they often cause more harm than benefit. 

The duration that drugs remain in your "system" depends on your system and on the drugs - there are many different ones in use. If you measure the common ones in blood or tissues, it is hard to find much around after about 24 hours or so, but that doesn't mean you are instantly back to normal. Surgery is trauma and your body takes time to heal. 

I have a fear of being put to sleep. I remember on two occasions where I have been put under general anesthesia and I didn`t wake up until several hours later (I slept for over 10 hours after the surgery). The one case I remember to most clearly was when I had an obdominal circlage. My doctor at the time was one of the only doctors who performed that kind of abdominal procedure. I remember that I had to be in the hospital at 7am. The procedure, I was told, was going to take aprox. 2-3 hours becauseﾠat the time I was already pregnant (only weeks if I remember correctly)ﾠand they were trying to make sure that my body didn`t abort this pregnancy like it had in the past due to an incompetant cervix. I remember going into surgery around 9-10 am but something happened during surgery.ﾠI didn`t wake up until a little before midnight the same day. 

My doctor told me he had never been so scared because I was young, and healthy but my pressure dropped.ﾠI had to be put on a breathing machine because I stopped breathing on my own. He was baffled. He and the head of anesthesiology who also was present during my surgery said they had to figure out what happened. The next day the head of anesthesology visited me in my hospital room and told me the name of my problem/allergy if I can call it that... it was a long name but I can`t remember exactly what it was other than it start with a "d" and have like 10 -12 letters in it. I know it was a very long word I`m thinkingﾠof because I`ve always remembered something with a "d" and being long. He said he would e-mail it to me so that I would always know but he didn`t. 

I came home from the hospital and didn't check my e-mail for weeks since I was put on bed rest with my pregnancy. My pregnancy was a success (after the cerclage) and I kinda forgotten about it until recently while watching Oprah andﾠa well know doctor on the panelﾠstated all women need to know their medical history. The doctor who performed my procedure has since left the hospital. The name of this condition isﾠnowhere in my medical file because my obgyn has been the same for several years. He was the one who referred me to the doctor to perform the cervix surgery. No one knows what I`m talking about and the people that were in the room I can`t contact them.ﾠEven if I could its been 6 1/2 years and I know they have had 100s or 1000s of patients since me.ﾠI need to know what it was during the anesthesia that I was allergic too. Have you heard of such a thing... 

Oprah, as always, is right! It's very important to keep your own records of your medical history. Hospitals do keep their records for a number of years - they are obliged to do so by law. So you may still be able to get the information you need from hospital records of the anesthesia, surgery and postoperative care. My best guess is that you have a condition called pseudocholinesterase deficiency. This is an uncommon, but well known genetic condition in which the enzyme that breaks down a drug called succinylcholine is either absent or decreased in amount or activity. The drug therefore lasts a long time. 

The effect is that the patient is paralyzed, for up to several hours. The treatment is "supportive"- in other words, we breathe for you with a ventilator (breathing machine). Because you are paralyzed and unable to move or breathe you are given sedation for comfort and amnesia. Eventually you recover from the drug-induced paralysis - and wonder what on earth happened! 

Pseudocholinesterase deficiency is not associated with low blood pressure, so that unfortunately does not fit the picture. This condition can be detected with a blood test - ask your doctor, or better still contact the hospital where you had your procedure and ask for the head of the department of anesthesiology. Pseudocholinesterase deficiency is something that gets anesthesiologists quite excited so I'm sure he or she will be happy to take your query. By the way , the surgical procedure you had was a "cerclage" - a treatment, as you indicated, for an incompetent cervix (the cervix opens during pregnancy, resulting in miscarriage). 

My sister had a brain biopsy to rule out a tumor, she has hepatitis C (from a blood transfusion in 1960) and is on the liver transplant list. It is 5 days and she has not regained consciousness yet. I know her liver is not filtering out the anesthesia properly. How long should we expect her out? It has now been 4 days. 

I'm afraid it's impossible for me to say how long it will take for your sister to recover. Anyone who is on the liver transplant list is really sick. The anesthesia may have contributed to her failure to regain consciousness but as you know it's not the only factor. Persons with liver failure that is untreated will eventually become comatose as part of what is known as hepatic encephalopathy. The liver processes many substances in the bloodstream that, unprocessed, depress the function of the brain. 

What was the result of the brain biopsy? That might shed some light on the cause of your sister's coma. Is there an infection of some sort - bacterial or viral meningitis or encephalitis? Electrolyte disorders, like a low sodium level, or low glucose, can also affect brain function and are common in patients with poor liver function. Drugs beside anesthetic agents can affect the brain too, including sedatives, antibiotics. There are also causes like strokes, or seizures which the doctors may be considering in view of the delayed recovery. 

The best thing to do is to talk with your sister's doctors. Tell them your concerns and ask for a few minutes with them to discuss what they think is going on, and what their plans are for diagnosis and treatment. I hope she recovers soon. 

I hope I am wording this question the correct way. I have a reaction to general anaesthesia. It sounds like it`s normal but I don`t think so. When I go "under" we are never sure when I will wake up. When I had my tubes tied, a surgery that should have taken a 1/2 hour (according to my OBGYN) lasted A LOT longer! After 3 1/2 hours the doctor came out and told my husband that they were trying to, but could not, wake me. This also happened when I was in the 5th grade, after a bladder surgery. My uncle also has this condition, but he had flatlined. He now wears a medical ID bracelet. I know there is a test that can be done to see what causes this, and I also know there is a name for this condition. Could you please give me the name of the blood test so that I can tell my doctor and have it done? And the name of the condition? Thank you. 

A patient who does not wake up after general anesthesia has to be carefully assessed for a variety of problems, some of which must be urgently treated. 

Preoperative intoxication with drugs or alcohol can cause delayed awakening. 

The commonest cause of delayed awakening is the effect of anesthetic drugs or sedatives which remain in the body. The effects of some drugs can be reversed with "antidotes" such as flumazenil, physostigmine, or naloxone. 

Very low body temperature (<33ﾰC) can produce unconsciousness, as can abnormalities in blood glucose, electrolytes, oxygen deficiency or carbon dioxide excess. 

Serious problems in the brain itself, such as stroke or bleeding, can cause delayed awakening. 

So, most causes for delayed awakening are not inherited and are usually associated with obvious medical conditions or with an equally obvious catastrophe that occurs during the operation. 

If you are an otherwise healthy person, one possibility is that you have a plasma cholinesterase deficiency. This makes it difficult for your body to break down a muscle relaxant drug called succinylcholine. This drug in normal people lasts only a few minutes. If you cannot break it down you cannot "wake up" (in fact it is not awakening that is the problem, it is prolonged paralysis). Your anesthesiologist will keep you asleep until the succinylcholine finally wears off. This may take hours. There is a blood test that can be done to measure cholinesterase activity. 

You should not have to guess at what is causing your problem. You should contact the anesthesiologist who took care of you, who may have a perfectly reasonable explanation, and also ask for a copy of your records that can then be reviewed by other doctors. 

Your uncle "flatlined" but this does not sound like what happened to you. The most likely explanation is that you have an unusual sensitivity to standard anesthetic medications, but this cannot be ascertained without a full history, physical examination and possibly laboratory tests. 

The next time you have an anesthetic your options including asking for a regional anesthetic instead of a general, and suggesting that your anesthesiologist use a brain monitoring technology such as the Bispectral Index monitor to try to minimize the amount of medication you receive. 

Hello, I am 18 years old and I am getting breast implants in two weeks. Now I am scared of general anesthesia, and I am afraid I won`t wake up. What`s the chance of that? I am 5`7, 100 lbs. I don`t have any health problems yet or anything. I guess I am scared because of stories I hear. So please help me out. Thank you. 

Thanks for asking this question. Before you go into surgery, your anesthesiologist will explain the risks of anesthesia. Some of these are serious, but if you are young and healthy with no medical problems, there is almost no chance of you "not waking up." This is mostly a myth regarding anesthesia. All patients deserve to know the risks of any procedure, so that is why we explain them. However, it is statistically probably more risky for a young, healthy person to drive to the hospital than to undergo anesthesia at the hospital. Before your surgery, your anesthesiologist will be able to give you some relaxing medicine to help if you are nervous. Best of luck! 

I had difficulties awakening from anesthesia after my 4th jaw surgery. I, along with a couple doctors, am still researching what happened. You mentioned in your past response the possibility of rare disorders, and as I was researching, I ran across a disorder called proximal myotonic myopathy. There does not seem to be much known about this condition and I was wondering if you had any knowledge of it and if it can cause such reactions like I had to anesthesia. 

A proximal myotonia seems unlikely without some other symptoms, cramping at least, myotonic episodes at most. During a myotonic episode the affected muscles undergo prolonged contraction. There are hints of CNS (brain or spinal cord) effects with certain myotonias, especially the chloride channel ones (DM1 and DM2) but this is a relatively minor component. It is still unclear from your story whether you actually lose consciousness, it sounds like you are periodically paralyzed. "Periodic Paralysis," which involves potassium channels, is another condition that might be responsible, brought on by electrolyte imbalance for example. You really need to be seen by a geneticist with a special knowledge of muscle disease. 

What is the name of the disorder that causes a patient to not wake up from anesthesia? 

There are several possible causes for delayed "emergence" - the technical term for waking up - but no specific, single disorder that would cause a patient not to wake up at all after anesthesia. The failure to wake up would be called coma, and in fact general anesthesia is nothing other than a highly controlled form of chemically-induced coma. 

Any severe disruption of the supply of oxygen-carrying blood to the brain can damage it permanently. The oxygen-deprived brain cannot survive intact for more than 5 or 6 minutes. There are a variety of anesthetic and surgical "disasters" that can produce this result, for example major bleeding. Fortunately this outcome is rare. 

The brain also needs fuel - particularly glucose - so a very low glucose level can delay emergence or even cause permanent coma. 

There are disorders in which the brain is injured - such as strokes, or bleeding into the brain. 

The brain also needs to have normal chemistry, such as a normal level of sodium in the blood, in order to function normally. 

Delayed emergence can of course be a result of delay in getting rid of anesthetic or sedative drugs. This can happen when large doses are given, in the elderly, and in those with liver or kidney function that is not normal and the drugs cannot be metabolized or excreted. 

A low body temperature, whether deliberately induced, or occurring accidentally, can slow emergence a lot. I hope this gives you an idea of the possible causes of a fortunately very rare occurrence. 

My child who is 9 is going in for an MRI and will be under general anesthesia. She had an MRI when she was 4 and they put her to sleep in the morning and it took her a long time to come out of it. That night she still needed assistance walking. Did they give her too much or is she real sensitive or what? Really worried. Is this normal? 

I almost always advise people who write in with their concerns to speak with their anesthesiologist and this case is no different. For your anesthesiologist to determine whether your child might be at extra risk from anesthesia will require more information. This information can come from a review of your daughter's medical records, from talking with you or her other doctors about her medical history, and from examining your daughter. 

It sounds like your daughter had a prolonged recovery from the anesthetic so it would be useful to know what anesthetic medications she was given, and whether anything untoward happened during the procedure or immediately thereafter. This information is found in the anesthetic record which is normally stored in the medical record. Do you have this available, or can you retrieve it somehow? 

Secondly, does your daughter have a known medical condition that might influence the recovery from a general anesthetic? Why is she having the MRI? Is she in good general health? You can be reassured by the fact that in the hands of competent professionals anesthesia is very safe even in small children and with modern agents recovery is usually quite rapid. Please talk with your doctor and ask for time to speak with your anesthesiologist to allay your concerns. 

My mother suffered a subarachnoid haemorrhage in the left side of her brain. As a consequence she developed pulmonary oedema and needed to be fully ventilated with inotropic support and sedation. The pulmonary oedema is improving. The inotropes and sedation were switched off over a week ago but she hasn`t regained conciousness. She is moving her arms and legs but ? involuntarily. What reasons could there be for her not waking up? She is 65, and a smoker with previously no major health problems. 

I am terribly sorry about your mother. As I am sure you are aware, subarachnoid hemorrhage can cause serious injury to the brain. Many patients die. I assume you have sent me your question because you are concerned that the sedation your mother has received is responsible for her not waking up. This is most unlikely to be the case. The hemorrhage may have caused ischemia (lack of oxygen) or even death of brain tissue. Another possibility is that of vascular spasm (constriction of blood vessels supplying the brain) that occurs characteristically a few days to a week after the initial event. This so-called vasospasm is difficult to treat. 

Last time I went under I had a hard time waking up, and wanted to fall back asleep. The Nurse did not want this to happen. Why? 

I imagine the nurse wanted to get both of you home. 

My brother`s body kept jerking after coming out of heart surgery... so much so that he had to be put back on the ventilator and restrained so that he wouldn`t damage stitches. He has been heavily sedated, and it has now been 48 hours after surgery. What is going on? 

Jerking movements can be caused by many different problems in the brain, the metabolic system, or the muscles, for example seizures (convulsions), agitation (delirium), hypoxia (low oxygen), drug interactions or drug or alcohol withdrawal. I am sorry I cannot give you any more definitive information. You should be discussing this with the doctors who are taking care of your brother. 

My husband had surgery on his sinuses last year. He was given anesthesia, the nurses had a hard time waking him when it was over, when they finally awaken him, he became nausea and starting vomiting. My husband is about to have his wisdom teeth pulled, i`m afraid what may happen this time. What is your advice? 

My first piece of advice, as always, is for your husband to talk about his previous experience with the anesthesiologist who is going to take care of him. The anesthesiologist is likely to tell you that sinus surgery is associated with a higher incidence of nausea and vomiting than most other surgical procedures. One reason for this is that blood from the site of the surgery can drip down or be swallowed into the stomach and trigger the nausea. By comparison, dental extractions are relatively minor procedures, usually with less nausea, and more rapid recovery. Although nausea and vomiting may occur after dental surgery done under general anesthesia, there are several things that can be done to improve the odds in your favor. These include the use of anti-nausea medications, the selection of certain anesthesia drugs less likely to cause nausea, keeping well hydrated, and effectively treating pain. For individuals at high risk of nausea, there is even a special battery powered bracelet that works on acupuncture principles that is effective in preventing this troublesome problem. Recovery time from anesthesia is related to several things that include the duration of the anesthetic, the medications that are given, non-anesthetic medications being taken by the patient, other medical conditions that the patient may have, as well as individual susceptibility to anesthetic medications, some of which is probably genetic. So, anesthetic technique plays a part in shortening recovery time, but we cannot accurately predict how an individual patient will respond. Once again, make sure to mention your concerns to the anesthesiologist. With attention to the factors that can be controlled your husband will hopefully have a less upsetting experience with his forthcoming surgery. 

My fiance underwent a heart valve replacement. He remained unconcious for nearly 12 hours AFTER surgery. I`ve heard that there are effects to the body after anesthesia used during surgery. What are they? And what can we expect in the way of physical or psychological effects of this, if any? 

Thanks for your question. Until a few years ago, it was common practice to deliberately keep patients unconscious at least until the day after open heart surgery. Today, it is usual to try to minimize this time during which the patient is kept heavily sedated and on a ventilator (breathing machine). Even so, most patients who undergo open heart surgery will be sedated, or even unconscious, for a period of hours after the surgery. So the fact that your fiance was in this state does not necessarily indicate that there was a problem with the surgery or during the recovery period. Sedation is used to buy time needed for recovery and stabilization of various body systems - lungs, heart, kidneys and brain - and for the elimination of anesthetic drugs. 

We think that a prolonged anesthetic in itself rarely produces any long term physical or psychological problems. However, there is a limited amount of evidence emerging that suggests that elderly patients may have more cognitive difficulties after general anesthesia than younger patients. It is not clear whether these changes are sustained. 

The problem is the difficulty of distinguishing between the effects of the surgery and the effects of the anesthesia - the two go together. We cannot study the effects of the surgery alone because few patients would volunteer to undergo surgery without anesthesia! Many of the problems attributed to the anesthetic may in fact be due to the stress of the surgical procedure and the recovery from it. 

You should know also that heart surgery, and especially heart valve surgery, is a special case in that most patients will go on cardiopulmonary bypass (heart lung machine). The effects of the bypass machine on blood and oxygen supply to the brain may themselves lead to psychological problems, including memory loss and difficulty with thinking. Recent evidence suggests that the dislodgement of small particles of plaque from the walls of the aorta into blood vessels that supply the brain may be more of a culprit for these changes than the bypass machine, or, for that matter, the anesthetic drugs.ﾠ 

My wife recently received general anesthesia for breast reduction surgery. She also has low blood pressure. We`ve heard from some sources that people with low blood pressure will take a "long time" to get rid of the anesthesia in their system. Is this true? What would be considered an appropriate time when she wouldn`t be feeling the effects of it? She`s still feeling "tired" after 3 weeks. 

Thank your for your question. I would be interested to know your sources for the idea that low blood pressure causes prolonged recovery from anesthesia. To the best of my knowledge, there is no link that I am aware of between the two. This assumes, of course, that your wife is otherwise healthy, and the low blood pressure is not a sign of some other medical condition. Your wife`s sense of tiredness 3 weeks after her surgery is unlikely to have anything to do with the anesthesia. Modern anesthetic agents are almost entirely cleared from the body within hours, although small amounts may persist for a day or two. Your wife has had a fairly major surgical procedure and the body does take some time to fully recover from that kind of "trauma". The process of healing is not instantaneous. Please note that it is important for your wife to consult with her regular physician if she continues to feel unwell. There are many other possible reasons why she might be feeling fatigued. These include anemia (was a lot of blood lost during the surgery?), infection, depression, or some other illness completely unrelated to her surgery.ﾠ 

Following a cholecystectomy a few years ago it took me five tries, hours apart, to walk into the bathroom. The problem was wobbly legs. I was finally able to get in there and void after 17 hours. The nurses ascribed my delayed ambulation to the anesthesia, not the surgery, per se. Pentothal, ethrane, and succinylcholine were used. Now I`m going to have arthroscopy to repair a torn meniscus. My doctor set me up for same-day surgery, but I`m very skeptical. I`m having GA, but I don`t know what agents will be used. In view of my previous GA experience, is same-day surgery likely to succeed for me? My doctor is unaware of my previous delayed ambulation after GA. Should I tell him so that he may reconsider his plan and admit me instead for "regular" surgery? 

Seventeen hours of difficulty with walking after a routine gall bladder operation would certainly be unusual! But it is hard to know what caused you to have ﾓwobbly legsﾔ for such a prolonged period. Some degree of unsteadiness is fairly common after general anesthesia, typically lasting anywhere from minutes to a few hours, and is usually accompanied by sensations of grogginess or dizziness. Wobbliness caused by the prolonged effects of anesthetic drugs might be related to delayed elimination of drugs from your body, to an unusual susceptibility to the effects of the drugs, or to having been given an unusually large amount. Another cause might be lowered blood pressure, from the effects of dehydration and the anesthetic agents. Of course, some people are wobbly on their legs due to chronic illness, weakness, or deconditioning, as well as rarer brain, nerve and muscle diseases, but I will assume that you are generally in good health. If you experienced muscle weakness without any real effect on your level of consciousness, another possibility to consider is the unusually prolonged effect of muscle relaxants that you were given as part of the general anesthetic. Succinylcholine is one such agent and some individuals have an inherited (genetic) inability to break down and eliminate this drug from the body. I would advise you to meet with your anesthesiologists ahead of your forthcoming surgery to discuss these possibilities and to plan your anesthetic. It would be very useful if you could obtain the records of the anesthetic, and any other pertinent hospital records that document what happened to you. Your anesthesiologist might discuss options other than general anesthesia, such as spinal or epidural anesthesia. These techniques do cause intentional, but time-limited leg weakness, but would minimize the possibility of a recurrence of some side-effect of the general anesthetic drugs which may have caused your problems. It is also worth mentioning this problem to your surgeon, who should be able to make arrangements for you to stay overnight in the surgical facility if it should happen again. 

Has there ever been any cases where someone didn`t wake up after having anesthesia? 

ﾠModern anesthesia administered by competent professionals rarely causes serious, permanent complications. The chances of a serious complication depends on the medical condition of the patient, and the type of surgery, as well as the conduct of the anesthetic itself. While this is very rare, there are several problems that could prevent a patient from waking up after a general anesthetic. Many of these are not directly related to the anesthesia itself. A comatose patient could have a serious metabolic problem, such as an electrolyte disorder, liver or kidney failure. Respiratory (lung) failure is another potential cause. A lack of oxygen to the body can cause permanent brain injury and coma. There may be a problem with inadequate blood flow to the brain, a blood clot or bleeding into the brain (stroke). In a few patients, for a variety of reasons, there may be slowed elimination of drugs from the body, and therefore delayed recovery from anesthesia. In time these patients will usually wake up fully, unlike the person who has had a permanent injury to the brain. 

I had a colonoscopy on Monday morning at 8am. I was given Versed and Fentanyl for the conscious sedation. I "woke up" a couple of times in severe pain. I was told after that I required a lot of one or both of the drugs. I slept the rest of the day. Next morning, I was still very weak and dizzy, unable to go to work. I also proceeded to get a migraine. My BP is in the normal range, but low by 15points for me. I also began crying uncontrollably Tues morning. Dr. thinks it is the anesthetics... It`s now Tues night and getting a little better, but I`m still not myself. Any ideas? I was told I`d be fine right after the procedure. I could hardly sit up to get in the wheelchair to leave! 

This is not a diagnostic service, so my comments are general. If your weakness, dizziness or headache persists you should see your doctor. It's true that colonoscopy is usually advertised as an easy, "drive-through" sort of procedure. Sometimes it just isn't that way. You're not the only one! In a certain number of patients, pain is experienced during colonoscopy despite "usual" doses of midazolam (Versed) and fentanyl. Individualized sedation - a little for some, more for the people who need more, is the ideal. Many anesthesiologists prefer the use of a sedative/anesthetic like propofol, but propofol can cause significant decreases in blood pressure and breathing. (There is controversy over whether non-anesthesia providers, like surgeons or gastroenterologist, should be allowed to administer propofol). You might have a received fairly large amount of midazolam. Although this is a fairly short-acting drug, you can expect some hangover effect with large doses. This should go away within hours to days. Anesthetic and sedatives are often blamed for almost all of the after-effects of surgery. The truth is we don't know exactly what the contribution is of surgery and the accompanying stress of manipulating and/or cutting tissues, versus the effects of the anesthesia. It is likely in most cases to be a combination of both factors. And let's not forget the psychological stress of undergoing a medical procedure, with uncertain outcome and associated worry. That form of stress will surely contribute to feelings of physical unwellness. 

I was diagnosed with Pseudocholinesterase Deficiency at age 10 after having a tonsillectomy and not waking from the anesthesia for 3 hours. I am now 28 years old and am pregnant with my first child. I am due in March and have been wondering about what type of pain management I will use during labor. I am very worried about having any type of anesthesia due to my condition. Is there any risk to having an epidural during labor with Pseudocholinesterase deficiency? 

Thanks for your question. Don't worry. Your risks from an epidural are no different to any other normal healthy patient's risk. You should be offered the same pain management options as anybody else. Pseudocholinesterase deficiency is only a problem if you are given the muscle relaxant drug succinylcholine. If you needed a general anesthetic to get your baby out in a hurry this is the drug that the anesthesiologist would use. However there are alternatives, so all you need to do is make sure that your enzyme deficiency is well documented in your doctor's and hospital's records. Also, if you are planning to get an epidural, this makes the likelihood of needing a general anesthetic for a cesarean or any other obstetrical surgery rather small. You should also consider getting and wearing a Medic-Alert bracelet with the information about your pseudocholinesterase deficiency on it.