# Anesthesia



## BRICKS (Sep 14, 2019)

After 23 years in practice I'm still amazed at all the nonsense people believe or have been told/read on the internet.  Post any questions you have about anesthesia and I will be happy to address them.


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## CJ (Sep 14, 2019)

Why are my pants always unbuttoned when I wake back up?


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## BRICKS (Sep 14, 2019)

CJ275 said:


> Why are my pants always unbuttoned when I wake back up?



That didn't take long.  That would be the nurses.  I don't ask.


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## notsoswoleCPA (Sep 14, 2019)

CJ275 said:


> Why are my pants always unbuttoned when I wake back up?



Lucky you...  I always wake up belly down with my bunghole feeling weird.

In all seriousness, I have a cousin that is a CRNA, and I thought I wanted to be like him while growing up...  After one nursing class in college, I realized that I did not have what it takes to be in the healthcare profession because I lacked empathy.  I literally got up, walked out of class, and changed my major that very day!


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## BRICKS (Sep 14, 2019)

Well, I can tell you that empathy gets slowly replaced over time with cynicism as you repeated see people who have no regard for there own health, as well as the stupid shit people do to themselves and each other.  If I'm being honest I'm not all that altruistic.


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## Bro Bundy (Sep 14, 2019)

I was on a small dose of test when i went under no problem at all..


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## BRICKS (Sep 14, 2019)

AAS are no problem if you're getting anesthesia.  Your anesthesia provider could not care less about this.


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## Straight30weight (Sep 14, 2019)

I’ve been under more times than I care to count. Occasionally I do not come out of it well, once, without me really knowing it, I had a very violent outburst after surgery. I don’t remember it but was told several times about it by several people. When I came to I was restrained to the bed. Wtf is that all about? 

I’ve had my throat stretched many time (**** I’m going to regret saying that), once I came to in the middle of it with this massive dildo thing jammed down my throat. That was pretty horrible. And no, it’s not a joke.


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## Bro Bundy (Sep 14, 2019)

Coming out of it always felt like the drugs i used to take at clubs ..I was a natural


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## Jin (Sep 14, 2019)

What’s the stuff dentists use for taking out wisdom teeth? The videos I’ve seen of people saying funny shit coming out of that are funny AF.


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## Bro Bundy (Sep 14, 2019)

Jin said:


> What’s the stuff dentists use for taking out wisdom teeth? The videos I’ve seen of people saying funny shit coming out of that are funny AF.


I had all 4 taken out in one shot and it was great.!! First they put the laughing gas mask on me as 2 hot girls were working around me while i was getting high in the chair..Seemed like the mask was on me for a good 15 min and i was breathing in deep..After they took the mask off i was totally bent and having a hell of a time .The dr gave me a shot of what seemed like heroin on steroids and it put me out..I woke up feeling like  I just snorted a 40 jar of K..Got 100 percs and went home smiling


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## Bro Bundy (Sep 14, 2019)

for my nose job it was much stronger stuff they hit me with but my tonsil surgery was by far the strongest anesthesia I ever had, i had a machine breathing for me ...Right bricks?


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## Trump (Sep 14, 2019)

[FONT=Roboto, sans-serif]Midazolam, when I came round from that all I remember is asking if I could have some more
[/FONT]


Jin said:


> What’s the stuff dentists use for taking out wisdom teeth? The videos I’ve seen of people saying funny shit coming out of that are funny AF.


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## NbleSavage (Sep 14, 2019)

I'd hear about the process in general, Bricks. Whats the strategy from the perspective of the anesthesiologist?


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## snake (Sep 14, 2019)

Going under on Tuesday for my shoulder. I can't recall what it was but you said to ask for some special med.


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## BRICKS (Sep 15, 2019)

Straight30weight said:


> I’ve been under more times than I care to count. Occasionally I do not come out of it well, once, without me really knowing it, I had a very violent outburst after surgery. I don’t remember it but was told several times about it by several people. When I came to I was restrained to the bed. Wtf is that all about?
> 
> I’ve had my throat stretched many time (**** I’m going to regret saying that), once I came to in the middle of it with this massive dildo thing jammed down my throat. That was pretty horrible. And no, it’s not a joke.



Different people wake up differently. If you're abusing rec drugs or alcohol it's evident and I can tell you pretty much which drug but either how they go down or wake up.  For example, meth woke ups are like wrestling with a pissed off gorilla.  So just don't ever lie about that stuff cause we know.  We 
don't care, but we do need to know. 

Now as far as you're concerned, it probably just is what it is.  The drugs I use are the most potent there are and like I said, everyone reacts differently.  We're used to it and prepared for this.

As far as waking up during your EGD and esophageal dilation, it's a heavy sedation and that's always possible.  I work hard so this doesn't occur, but o those we have to walk the line of keeping you deep and an unprotected airway where we're sharing that turf with the surgeon and he's fkn with the sphincter that keeps reflux from ruining our day


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## BRICKS (Sep 15, 2019)

Jin said:


> What’s the stuff dentists use for taking out wisdom teeth? The videos I’ve seen of people saying funny shit coming out of that are funny AF.



Dentists use nitrous oxide.  I only use it in very rare situations because it contributes heavily to puking.


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## BRICKS (Sep 15, 2019)

Bro Bundy said:


> for my nose job it was much stronger stuff they hit me with but my tonsil surgery was by far the strongest anesthesia I ever had, i had a machine breathing for me ...Right bricks?



For your tonsils maybe you were ventilated, maybe they let you breath on your own.  Either way you were intubated with an endotracheal tube to secure your airway and protect your lungs from aspiration.


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## BRICKS (Sep 15, 2019)

Trump said:


> [FONT=Roboto, sans-serif]Midazolam, when I came round from that all I remember is asking if I could have some more
> [/FONT]



Good shit but you tend to forget or black out stuff afterward that first day.


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## BRICKS (Sep 15, 2019)

NbleSavage said:


> I'd hear about the process in general, Bricks. Whats the strategy from the perspective of the anesthesiologist?



Strategy for anesthesia? Broad question, but with respect to surgery anesthetist (sleep), analgesia (pain management) and amnesia.  I keep the patient deep enough to provide an optimum surgical field for the surgeon, with patient safety first.  Basically I address all the physiologic changes/responses to anesthesia and surgical stimuli.  The surgeon works on his part, and I'm the guy that keeps you alive and whole so you leave in the same shape you came in or better.  Airway, breathing, circulation, acid base balance, body temp, patient positioning to prevent stretch or compression injuries, and on and on. Anesthesia is actually the "boss" in the OR.  If we say a case doesn't go, it doesn't go, and it can't get done without anesthesia.


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## BRICKS (Sep 15, 2019)

snake said:


> Going under on Tuesday for my shoulder. I can't recall what it was but you said to ask for some special med.



You're going to make sure and ask for an interscalene block.  Your provider will use ultrasound to inject about 30 ml or so of local anesthetic around the nerve that go to that shoulder.  This will give you a decreased need for pain med in the first 24 hours and also allow anesthesia to use a lot less narcotics during surgery.  You should wake up comfortable and feeling pretty good.  You want this bro.  Shoulders hurt like a mthrfkr afterward.  My shoulder  patients are usually out of recovery and out the door in about 20 min post op and they're comfortable for 24-36 hours.  Results with different providers may vary.  I have a rep as being really good with blocks.


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## dk8594 (Sep 15, 2019)

...::.

Already answered


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## j2048b (Sep 15, 2019)

BRICKS said:


> After 23 years in practice I'm still amazed at all the nonsense people believe or have been told/read on the internet.  Post any questions you have about anesthesia and I will be happy to address them.




why do i have such a hard time waking up? last time took 4 nurses and the doc to wake me and had to shake me, yell at me and almost called it, then i woke up....veryone was panting and bent over and nurses were freakin out....


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## BRICKS (Sep 15, 2019)

j2048b said:


> why do i have such a hard time waking up? last time took 4 nurses and the doc to wake me and had to shake me, yell at me and almost called it, then i woke up....veryone was panting and bent over and nurses were freakin out....



People all respond differently, but you may have had an anesthesia provider that was heavy handed with the drugs.


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## Flyingdragon (Sep 15, 2019)

Bricks, this post is making me sleepy, was that the intent?


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## BRICKS (Sep 15, 2019)

Flyingdragon said:


> Bricks, this post is making me sleepy, was that the intent?



Whatever works brother.  It's boring as hell, until it isn't.  And when it isn't that means you're not having a good day and very bad things are probably happening.


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## TODAY (Sep 15, 2019)

Which flurane do you use most often?


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## Jin (Sep 15, 2019)

TODAY said:


> Which flurane do you use most often?



Showoff.....


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## TODAY (Sep 15, 2019)

Jin said:


> Showoff.....


Lol, I'm genuinely interested. I have ZERO practical experience in operating rooms.


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## Flyingdragon (Sep 15, 2019)

Did u not get my humor?  Anesthesia = sleepiness....




BRICKS said:


> Whatever works brother.  It's boring as hell, until it isn't.  And when it isn't that means you're not having a good day and very bad things are probably happening.


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## BRICKS (Sep 15, 2019)

TODAY said:


> Which flurane do you use most often?



I use desflurane for pretty much everything, except for asthmatics and pediatrics.  Desflurane is quickest on and off.  Sevoflurne is less pungent for pediatric mask inductions and less irritating for asthmatics. In fact, it's used in definitive treatment of status asthmaticus (intractable asthma attack).

More info than you wanted perhaps


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## BRICKS (Sep 15, 2019)

Flyingdragon said:


> Did u not get my humor?  Anesthesia = sleepiness....



Yeah bro, I got your humor.


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## TODAY (Sep 15, 2019)

BRICKS said:


> I use desflurane for pretty much everything, except for asthmatics and pediatrics.  Desflurane is quickest on and off.  Sevoflurne is less pungent for pediatric mask inductions and less irritating for asthmatics. In fact, it's used in definitive treatment of status asthmaticus (intractable asthma attack).
> 
> More info than you wanted perhaps


No, that's great info. Desflurane appears to be less likely to contribute to beta amyloid plaques, as well. Are there any circumstances that would lead you to choose isoflurane over the others?

Also, is it always necessary to use propofol alongside the flurane?


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## notsoswoleCPA (Sep 15, 2019)

I know my wife was given Propofol for her ECT treatments.  She said it felt like fire was running through her veins just before going under, every single time.

The only time I was completely under was for the removal of my wisdom teeth.  My last oral surgery was for dental implants, and I was awake for that, albeit I did take two Valium before the procedure.


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## j2048b (Sep 15, 2019)

BRICKS said:


> People all respond differently, but you may have had an anesthesia provider that was heavy handed with the drugs.



Possibly, every surgery ive had ive warned them i dont wake up so.kick my ass and do what u got to do fo make sure i wake up or ur gonna be payin some monies hahaha plus being allergic to certain things, they have to watch what they do, or one of those items may just end me if they arent aware or attention to detail...


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## BRICKS (Sep 15, 2019)

TODAY said:


> No, that's great info. Desflurane appears to be less likely to contribute to beta amyloid plaques, as well. Are there any circumstances that would lead you to choose isoflurane over the others?
> 
> Also, is it always necessary to use propofol alongside the flurane?



Isoflurane has pretty much gone by the wayside.  Used to use it a lot for longer cases and inpatient surgery as it's slow to come off.  Desflurane and sevo used to be more expensive, but when parents expire the price drops.

Propofol has replaced sodium thiopental (pentathol) as the induction agent (what we use to put you to sleep).  Propofil is used exclusively now pretty much save for certain settings like trauma, where different agent (s) better serve that purpose.


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## BRICKS (Sep 15, 2019)

notsoswoleCPA said:


> I know my wife was given Propofol for her ECT treatments.  She said it felt like fire was running through her veins just before going under, every single time.
> 
> The only time I was completely under was for the removal of my wisdom teeth.  My last oral surgery was for dental implants, and I was awake for that, albeit I did take two Valium before the procedure.



Propofol has a tendency to sting a little as it first goes in.  I mix it with a little but of lidocaine to mitigate that.


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## BRICKS (Sep 15, 2019)

j2048b said:


> Possibly, every surgery ive had ive warned them i dont wake up so.kick my ass and do what u got to do fo make sure i wake up or ur gonna be payin some monies hahaha plus being allergic to certain things, they have to watch what they do, or one of those items may just end me if they arent aware or attention to detail...



Definitely have to keep my head out of my ass at work. Anesthesia is very safe, but that's because your provider has his (her) head in the game.  Of the millions of anesthetics given annually their are about 30 deaths from anesthesia per year.  Compare that to the average of 100 deaths per day in cars.  Nobody gets nervous when they jumped in that car to come have that anesthetic that they're all nervous for.  Again, that's cause we make it safe.


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## snake (Sep 16, 2019)

notsoswoleCPA said:


> I know my wife was given Propofol for her ECT treatments.  She said it felt like fire was running through her veins just before going under, every single time.





BRICKS said:


> Propofol has a tendency to sting a little as it first goes in.  I mix it with a little but of lidocaine to mitigate that.



Yeah I had it the last time I went under and the burn wasn't bad but I remember a crushing feeling in my shoulder before I went ZZZZZ


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