Anesthesia question: upcoming surgery with Dr. Brassard

[Tammy M]

So I am about 2 months from my GRS date with Brassard (June 16th) and a remaining question that I have is which form of anesthesia to chose: general or spinal?  I don't think I will get to consult with the surgeons/anesthesiologist until the morning of my surgery and this is one choice that they give us.  I've talked with a friend who is an anesthesiology nurse (she just had her GRS with Suporn) and she told me the spinals do not last as long (2.5-3) hours and Brassard probably uses that method because his surgery time is usually around 2.5 hours.  I do not want to be awake at all during my surgery or have the possibility of waking up but obviously I want to be as sedated and numb as possible.  Does anyone else have any experience or knowledge on these different numbing methods and what seems to work best?  I understand my history of back problems may be a factor ind deciding on the spinal and I should talk that over with the doctors, but I would like to find out as much as possible ahead of time. 

[Cindy]

The advantage of spinal is the recovery time. It can take months to get over general anaesthesia as in ongoing tiredness etc.  The disadvantage is moderating the depth of anaesthesia.

[xponentialshift]

I don't know about the spinal, but I had general anesthesia 7 times back in 2001 and it worked very well... Although I do have the vaguest memory of waking up for a few seconds one of the times. No pain or anything, and it could have been my imagination. I only weighed about 60 lbs at the time so I am sure it was very difficult for them to use the right amounts without over exposing my system to the stuff. As an adult that shouldn't be an issue anymore. (Also 13 years of innovation)

I don't know if it is like this for everyone but I was starving every time I woke up after surgery. And would eat a full steak dinner after about 30 minutes (the soonest the doctor would allow me to eat)

[Jessica Merriman]

I have been under general and did not have any problems with it at all. I am with X in the fact I was ravenous for food around an hour after coming out of it. I was only groggy for about 20 minutes and felt refreshed and ready to go back to life as usual about two hours after. I did not experience any anesthesia awareness or any other bad effects.

[Tessa James]

Tammy you ask a great question and the answer must include what works best for you and your team.  I was a CRNA, Nurse Anesthetist, for 33 years and administered thousands of general, spinal and epidermal anesthetics.  Your safety is primary and the skill of your team should be directed toward your success and comfortable course.  I tend to recommend a spinal with long acting components (a mix of local anesthetic and narcotic) that can keep you comfortable during surgery and post operatively for many hours.  Usually sedation with a spinal is very effective in helping people feel anywhere from relaxed to completely asleep. Your anesthetist will be with you at all times during the surgery. Technically a bit more tricky, a continuous epidural can be titrated (delivered through a tiny catheter) for what you and the surgeon need for surgery and for days post operatively.  Doesn't sound like they offer that option however. 

A spinal is typically "placed" (a very careful needle shot) while you are curled up and have some sedation.  Your ability to get in good position for the procedure is helpful and you are correct in assuming that back injuries could make this option more difficult or even contraindicated for you.  Your team will want to know about your complete medical history and are required to give you informed consent, describing the procedure and potential risks.  I advise your cooperation and going in with a positive attitude, knowing you will recover and have so much to look forward to.  This is considered by many staff as a "quality of life operation" vs. the pathology of removing cancer or disease.

There are particular risks such as a a post dural puncture headache from a spinal or epidural.   General anesthesia involves multiple medications to get you to sleep, relax your muscles and keep you there and are typically a combination of intravenous drugs and inhaled gases.  Anesthesia for that length of time involves manipulation of a patient's airway (laryngeal mask or endotracheal tube) and breathing and, of course, consciousness.  Sedation and complete amnesia are two different things and you could ask your anesthetist to explain what you should expect.  Most peer reviewed studies indicate that overall relative risks and recovery are similar while your good health and the anesthetist's skill and vigilance are pluses for you.

Either way you will be in a recovery room area after surgery where you will become more wake and may feel thirsty and hungry but please don't expect real food until hours later.  Time may feel like it "stood still" for the whole day.

I am excited for you and honestly think you will do very well.  Dr. Brassard and the team have likely established a very good "routine" and mucho experience.  Happy landings!

[xponentialshift]

Why no real food until hours later? I never really understood that. It took until the third surgery (I was having about one per week) before my doctor gave the staff special permission to let me eat within about 30 minutes of waking up. By my seventh surgery I was eating a full meal 30 minutes after waking and another meal 2-3 hours after that.

[Tessa James]

An anesthetic can slow or delay digestion while nausea and vomiting are not an unusual side effect.  Until a person demonstrates that they are safe to handle it you sure don't want to hurl and inhale a hurried lunch.  We are all individuals and I'm glad you are being treated as a special one

[xponentialshift]

Thanks for the answer. That makes sense to me now.

[dkl]

Tammy, I'm glad you asked this, I've been trying to decide which way I want to go also. I'm sorta leaning towards general just because that's what I had for my BA, and when I asked around, that's what people "I knew" suggested. I'm still undecided at this point though, guess we have a few weeks to make up our minds.

Tessa, thanks for the information you provided, it gives me something else to consider.

[Nicolette]

The anaesthetist did not offer me a choice. He simply explained he was doing a spinal and why that was the best option. If you can avoid a general then I'd recommend that. I've had way too many. lol. But the last general I had was pretty easy going and I was eating shortly after coming out and had zero nausea. Regarding the spinal. I do have hazy memories that include something like moving bright lights, but I also had a minute where I 'dreamed' I was having srs whilst I was under sedation. I cannot be absolutely certain it was a dream. There was no physical sensation, except when they started to move the gurney out of the theatre and into the lift. I was fully awake in the recovery room, but felt exceptionally cold. The spinal does take a few more hours to work itself out of the system, and it's weird touching my legs and feet and feeling absolutely nothing. Spinal would be my choice again, if I had to do it again.

[luna nyan]

... lots of great info...

Great post!  You saved me from a lengthy reply!
Tammy, good luck with the surgery!  As for anaesthetia, if your anaesthetist is skilled, it's not going to matter much which way you go, your comfort and safety will always be paramount.

[Jenna Marie]

I got a spinal, and this is purely anecdotal, but I had no problems whatsoever with waking up in the middle (I believe the actual operation time ran under two hours, b/c Brassard usually works in concert with Belanger) or long-term side effects. I was nauseous when I first woke up, but they told me that was more likely the morphine while I was under than the spinal.

And Brassard believes in *feeding* you. They offered, no joke, a big steak dinner - real food, too, not hospital food quality - within 3 hours of when I was out of the recovery room. I couldn't eat all that much of it, but I know some of the other women did manage to eat 2-3 hours after getting back to their rooms. I'm afraid I didn't feel up to inquiring about the logic behind it, unfortunately, but I do know that at least nobody got sick from trying to eat too soon.

[mrs izzy]

I had the spinal also (have back issues) then played down on table iv put in and awoke in the recovery room.

I was second of the day and wished not to eat till the next morning.

They handle pain as you need it. I found for me was something the tylenol would handle. Others needed more.

Everyone is there own and you will need to make the adjustments for you. As I tell anyone the GCS is the easy part, aftercare is where all the work comes.

Safe journey Tammy, you are in good hands.
Isabell :-)

[dejan160]

After having had several general anesthesia I can tell you that all depends on the doctor. The first time I had general anesthesia I awake at the operating table, I even felt the extubation and I was fully awake soon after. The second time I had it I couldn't start breathing and I could feel the doctor vantilating me so it was a very scary experience. And the topping of it all was double vision when I opened my eyes that really freaked me out. One time I had hyperventilation after general anesthesia. I am the same but my reaction was different so it is up to the doctor. I have had  my SRS with spinal and sedation and it all went smooth. I don't remember anything. But then I had once local anesthesia with sedation and I have memories. It really depends on the medications administrated, and the depth of the sedation. I believe that they have standard protocols in Montreal that are based in experience and I would trust the doctor. How could you know more then somebody who has done so many patients before you... Be honest to the doctor and let him do an individual plan for u.

I wish u a successful surgery