"Twilight sedation" vs being knocked out

[Beth Andrea]

Any experiences, opinions (based on knowledge, not fears), thoughts?

I'm just beginning my search for an FFS surgeon, and I've come across the phrase "twilight sedation" a couple times now. How effective is it? I understand the recovery phase would be quicker/easier, but damn I hate pain.

I had a local done for my cataracts, and felt nothing at all. With the left eye, I did feel a little...pressure?...and was aware of conversation in the room, but otherwise had no sensory input that indicated they were operating on my eye (they only do one at a time).

But for FFS....? Please let me know how things went, either way re: anesthesia.

Thanks!

🙂

[Joanna Dark]

I had to have a biopsy done on my pancreas which amounted to them sticking a giant needle into my body and ripping a piece of my pancreas out and i believe they used some type of twilight sedation as I wasn't asleep but not awake either. The drugs administered: IV Fentanyl, IV Valium and IV midazolam. Or as I call it: heaven lol

[warlockmaker]

I had a facelift as a man and will do FFS after the hormones have taken effect. BUT this was my first surgery some 5 years ago and it was under GA which lasted 4+ hours. In FFS I believe they will need to put you under GA - in SRS they can do an epidural. BTW I was very nauseous and need to address with a top anesthesiologist

[Beth Andrea]

I had a facelift as a man and will do FFS after the hormones have taken effect. BUT this was my first surgery some 5 years ago and it was under GA which lasted 4+ hours. In FFS I believe they will need to put you under GA - in SRS they can do an epidural. BTW I was very nauseous and need to address with a top anesthesiologist

Nauseous during or after?

[warlockmaker]

After and its miserable. I was told that i'm sensitive to morphine. The next time I will talk with the anesthesiologist and they can address this with anti nausea meds when you are recovering from the anesthic. But you will not know unless you have had GA before

[Flan]

Twilight anesthesia is the catch name for anesthesia that doesn't involve a nonpolarizing muscle relaxant. Since the need to intubate is removed it is generally much safer at the consequence of being more technically difficult to maintain.

http://www.bmj.com/cgi/content/full/321/7275/1493?view=full&pmid=11118174 🔗 [Link: bmj.com/cgi/content/full/321/7275/1493/]
edit: this is on spinal anesthesia, will look for something on twilight in general

http://www.ncbi.nlm.nih.gov/pubmed/23017475 🔗

[eh-lyssa]

I've had both general and twilight. For Twilight I passed out suddenly and don't remember anything until I woke up groggy. My wife said it looked "scary" as I came to as my BP dropped a but low but I was ok.

For general I started out the same way. All of a sudden i was out and when i woke up 4.5 hours later I was extremely cold feeling (shivering a lot) vomited, and quite out of it. I felt like I had just woke up from passing out due to drinking too much - not that I do that too often. It seems some people like me have a reaction to the medication but it can be counteracted somewhat by other medications for nausea.

[Jess42]

I've had surgery that involved the "Twilight Zone" and I was out cold and had a choice of being gone or aware and chose to be checked out. General ansthesia I think is when they have to put the breathing tube down you throat.

As for coming out of it, I had a severe case of cotton mouth. I was severly thirsty and could drink any amount of water. No nausea but my head felt like a concrete block for about 30min. I could eat whatever I could handle but the cotton mouth made it feel like I was eating particle board. The cotton mouth lasted around two hours.

What the ansthesiologist used for me was what killed Micheal Jackson, Sodium something or other. Tell your anesthesiologist you would rather be knocked out because one minute you are there felling good and calm because of th medication and the next thing you're done. I am like you but pain really doesn't bother me as much as the idea of my body being opened up. That kinda' puts me on the freakout express.

[Beth Andrea]

The big fear for me is that I will be partially awake during the operation...I have a distinct memory of being about 5 or 6, and having a minor tongue-clipping (the piece of tissue that is under the tongue; causes speech impediments) and although everything was visually dark, I could hear them talking, and my mouth being opened, and the actual tongue clipping.

The first thing I said when I awoke and could talk was, "I FELT THAT!!" and was inconsolable for a bit. (This would be in the late '60s). Of course, everyone denied it. I'm sure that anesthesiology has progressed since then, but just wanted to get some real-world experiences with both.

...in SRS they can do an epidural.

Really? OMG...I know epi's are effective, but being able to look down, sight blocked by a sheet (I HOPE!!  😮 ) and a host of bloody hands and bibs...I'd probably pass out from just that!

[Jess42]

God Beth. That was my biggest fear before my surgery. I hate dentist not because of the pain but having somone's fingers and metal tools in my mouth. Like a child, I have to have the gas before and it really doesn't work other than knowing I can't get up and run. That is the only way I can deal with dental work.

I think times have changed since we were kids though and thinking back those times seem like the Dark Ages compared to now. With my surgery, I was out. The anesthesiologist asked me which one I wanted, out or awake, and then aked me if I was ready and I told her yeah and the very next thing I knew she was asking me if I felt OK and I was done. The anesthesiologist gave me some chillout medicine through the IV in the preop area and about a 1/2 second later the world could have ended and I would have cared less. If it's any consellation with my phobia of being opened up and considering it was my first surgery ever, the chillout medicine took away all my anxiety and all seemed right in the world at the time.

BTW, I obsessed, starting about 2 weeks before the surgery, over being awake and feeling everything but helpless to say anything or give any indication or communication that I could feel and hear everything. I actually had nightmares about it. So I can only imagine but would rather not think about what you went through at 5 or 6. Wow.

[Beth Andrea]

My cataract surgeries were like that, and MUCH better my first experience...thru an IV the guy told me I'd be getting two meds...the first might make me a little nauseous, and the second would be "I don't care."

Sure enough, a few seconds later I said, "Oh, there's the nausea...(and almost immediately)...and there's the 'I don't care...'" That was a very good experience. Great technician, too.

[Jess42]

My cataract surgeries were like that, and MUCH better my first experience...thru an IV the guy told me I'd be getting two meds...the first might make me a little nauseous, and the second would be "I don't care."

Sure enough, a few seconds later I said, "Oh, there's the nausea...(and almost immediately)...and there's the 'I don't care...'" That was a very good experience. Great technician, too.

Cataract surgery??? That is another phobia just as bad as dentists. Don't mess with my eyes, i have a hard time using eyedrops not to mention what an ordeal it is doingthe ol' puff of air for an eye exam. Another chill up my spine.

I guess I'm lucky in that very few medications give me the old nauseous side effect. My stomach is like a tank in that nothing I send down there makes me sick. I can eat stuff that would keep a normal human being up all night poppin' tums. Smells on the other hand is a totally different story.

[Beth Andrea]

Trust me, when you start losing your sight to a foggy blur...surgery fears take a back seat. They're still there, but it is terrifying to gradually lose your sight. 

My fear of the surgery was I couldn't visualize how they'd open the lens...I always pictured a big X-acto type blade descending vertically to my eye...and thinking "there's no way they can control the depth!!!"

Turns out there's videos on YouTube showing the procedure...and they don't go straight down...and they don't use an X-acto blade. 🙂 The day before surgery, I was frantic in worry...went for a mile walk, and anxiety was gone.

It's all about having knowledge over fear, and coping with anxiety. <--pithy remark by me 😉

[Jess42]

Trust me, when you start losing your sight to a foggy blur...surgery fears take a back seat. They're still there, but it is terrifying to gradually lose your sight. 

My fear of the surgery was I couldn't visualize how they'd open the lens...I always pictured a big X-acto type blade descending vertically to my eye...and thinking "there's no way they can control the depth!!!"

Turns out there's videos on YouTube showing the procedure...and they don't go straight down...and they don't use an X-acto blade. 🙂 The day before surgery, I was frantic in worry...went for a mile walk, and anxiety was gone.

It's all about having knowledge over fear, and coping with anxiety. <--pithy remark by me ;-)

Well my knowledge over fear consists of running as fast as I can away from it and coping for anxiety was not until the first shot into the ol' IV for my surgery. Which I almost ran from by the way. But I do like the remark, it's just some, especially me, are scaredy cats.

[Beth Andrea]

Believe me, it took me DECADES to get were I am now, and the most progress* was after I started transitioning, and found Susan's and her denizens of The Dark Side...to whom I am truly grateful.














*The biggest step one can take, of course, is that first one, that sets you on the journey...after that, one may progress in leaps and bounds, aided by others or by a hidden strength within...but that first one is a DOOZY!  😉

[Jess42]

Believe me, it took me DECADES to get were I am now, and the most progress* was after I started transitioning, and found Susan's and her denizens of The Dark Side...to whom I am truly grateful.









*The biggest step one can take, of course, is that first one, that sets you on the journey...after that, one may progress in leaps and bounds, aided by others or by a hidden strength within...but that first one is a DOOZY! 

Amen on that one Beth. I kinda' like the Dark Side myself in a " Lucinda, I am your mother" and Heavy Metal sort of way. Note that is a Star Wars reference from my own twisted mind.

[Theo]

It's my understanding that anaesthesia is based on three components:

• Sleep inducement
• Pain blocking
• Muscle immobilising

The anaesthesiologist can handle all three components separately, which is why you can, for instance, wake someone up during an operation and ask them a question without them feeling pain. As Flan posted, the muscle immobilising component seems to be the one that is altered, effectively simply relaxing your normal muscles without simultaneously knocking down your breathing, which is why you get spared the tube. Easy to notice in the wake-up phase, as an oxygen mask + a nurse telling you to try breathing deeply again on your own is a pretty good hint...

What this implies though is that the "Twilight" method should not necessarily be at any more risk than normal anaesthesia when it comes to feeling pain or being conscious the entire time. But if I were you I would certainly voice my concerns about it to your doctor. Also the anaesthesiologist can potentially vary stuff like the sleep component to ensure that you're under properly if you talk to them.

[Beth Andrea]

Thanks for that explanation, Theo. I'll be sure to talk to the anathes...anaethiset...the dr who will knock me out.

[Susan T]

I had a facelift with upper and lower Bleph under a local with sedation. I don't remember much of the first part of the op but I was wide awake from about half way through. I didn't feel a thing and was able to respond to the surgeons request to turn my head etc. The smell of burning flesh was a bit disconcerting  though.