Wow! Everyone that you so much!
Bill that you for the very informative post. One thing I still do not understand. If by sedation they mean just taking the edge off, I was completely out last year during my surgery. So could that still be considered sedation?
I did ask my surgeon the week before surgery if I was going to be sedated with an ankle block or have a general, he said sedated.
Last year I had a osteotomy done for my foot. Next month I am getting my hip scoped.
Thank you again!
Right, it's just a bit more than taking the edge off, but I didn't say the part that explains why you were "completely out" until the very end. "Technically, sedation just means taking the edge off, removing your anxiety and probably also reducing pain, and usually also amnesia
". It's that amnesia part that might apply to you thinking you were out. Even if they gave you nothing more than 1 or 2 mg of Versed( Vitamin V)- which does not even really reduce pain and most likely will not produce unconsciousness- it would seem to you like you were out. Because you will probably have total amnesia until the Versed starts wearing off. You might be able to carry on a conversation the whole time, but you probably won't remember any of it. Which is why I said it would probably all be the same to you, it seems like you are out.
Then again, you might indeed have been out. Especially if anesthesia folks are involved, they are pretty quick to be giving you propofol( aka Milk of Amnesia) in the 1st place(with or without versed/fentanyl) and quick to give you a little MORE if needed for you to hold still, so you lapse right on over from the technically sedated state into the general anesthesia state, even if only for a couple of minutes.
You mentioned "sedation with an ankle block". Another very common routine is called deep sedation(which may actually be a 2 minute general) with various blocks. The blocks can be quite unpleasant, and just a little bit of sedation only removes inhibitions so the patient can become very uncooperative and moving around, making it hard to safely inject the block and hit the target. So the norm is some drug pusher(also aka gas passer) like me hits you with a good size single dose of Propofol, and you lay perfectly still for the injection, you are out. Then we just let it wear off in about
10 mins, and then you are wide awake, able to cooperate, have a good airway, and numb as a post with zero pain. But if you have also had some Versed, you might not even remember going in the room or being awake after the block or anything until you are in recovery room.
But here is a funny story related to that. Some folks come in and they agree with the surgeon for sedation only(plus local anesthesia) for cataract removal , because it is explained to them that they are not going to feel a thing- no pain due to the local anesthesia in the eye, and that the only thing unpleasant will be the eye block and they will actually be out briefly for that. But some of us will accept nothing else than being OUT, even if it means we will struggle with their airway(= more risk) or that they can not obey commands to be still while the surgeon works on their eye, etc. A full general is pretty much out of the question for a lot of these sick folks, just TOO much unneeded risk. Much safer just to deeply sedate just long enough for the block. So they agree to the "sedation" for all of these good reasons, plus that is the only way their surgeon will do the case. Then I give them a good dose of propofol, they go out(actually going very briefly into general anes) to the extent that I'm having to lift up very hard on their jaw to keep their airway
open, then the surgeon or someone like me injects local anesthesia behind their eyeball (retro-bulbar block look it up ouch) and they don't even move, then I am still having to struggle to keep their airway
open while the nurse does the eye prep, etc. Finally, about
the time the surgeon is sitting down maybe 10 minutes later, they wake up and breath good on their own. Surgeon says "are you comfy, every thing OK, let us know if you hurt, etc" and "move your head to the left or right, take a deep breath, " etc, and all seems great. But then maybe 1 out of 20 patients, when we are going to the RR, seems a little grumpy or outright PO'ed. I'll ask "didn't hurt did it?". "No, but I never did go to sleep" and they are not happy about
that. No amount of reasoning will convince them that they went to "sleep", because it just seems like a split second from the time I said" good night" until the time the surgeon is doing his work and talking to them. They sometimes refuse to believe I put them out even for a few minutes until I finally ask them ( if they really seem mad that they never went to sleep) something like "well, do you remember us sticking the needle behind your eye, and me jacking up on your jaw trying to keep your airway
open, and pounding on your shoulder while I yelled at you to breath?". Then finally they will reluctantly admit that maybe they had been asleep for a little while.
Those are the pros/cons of pure Propofol VS Pro + Versed- or Versed + narcotics alone, for sedation. You can get all the sedation possibly needed and more- even to general anes, with Propofol all by itself. And it has less nausea(actually has anti-nausea properties) than anything else and when the case is done wears off faster than anything else when used by itself. But if Versed is added to the mix, or used without Propofol, you probably won't be aware of anything until sometime in the recovery room. Amnesia without being unconscious! Might not be good enough for the surgeon to do his work, but all seems great to you!
20 years ago, had a healthy young lady come in for a tubal ligation. I could not get her breathing tube in and neither could anyone else. Since it was an elective case, we wanted to avoid any trauma so we woke her up, explained the problem, and arraigned for her to come back. Then we would keep her awake, so we could take our time while she breathed on her own, sedate her, numb her throat, and tube her awake. If all else failed, we would place an epidural and do the case that way. ( since the patient would be almost on her head for the surgery, every one preferred general with a breathing tube in) So I give her some Versed to calm her, she stays wide awake while I get her to gargle anesthesia plus spray her throat with it. Then I go down her throat with my laryngoscope, still can't see a thing. Several other very experienced folks try, can't see a thing. And she is awake and coughing and gagging a whole bunch, looks BAD. If it was life or death or she HAD to have surgery that could not be done without an ET tube, we would have got it in ONE WAY OR ANOTHER, by probing blind or even if we had to cut a hole. And today, we have better scopes (Glidescope etc) that allow us to see around the curve and could get it done, but not back then. But in this case we gave up after maybe 30 minutes, I rolled her over and put an epidural in her lower back, which took maybe 10 or 15 mins, get her back on her back, takes maybe another 15-30 mins until she is good and numb, and we do the case, which takes about
another 15 mins or so. about
the end of the case I ask her if she is doing OK, and she says " I'm fine, but when are you going to take a look and try to put that tube down my throat?"!
Now that, Ladies and Gentlemen, is what you call AMNESIA. Not asleep at all, and no doubt quite uncomfortable, but she probably told folks afterwards " Oh I don't know what they did because they just put me out right before I went in the OR".
Was that long-winded enough for you? I've got a million of them, including one about
me during my RP. But I will spare you for the moment! LOL!
Post Edited (BillyBob@388) : 8/18/2014 12:05:39 PM (GMT-6)