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Anesthesia

I could not breathe in the recovery room

02/18/2008

Question:

I have just had my ovaries and tubes removed because of my family history. When I woke in the recovery room, I had the most terrible experience of my life. My eyes were open, but I could not move or breath. No air would go in or out. I could not raise my arms in distress or do anything to raise the alarm that I could not breath, only stare into the eyes of the nurse. I thought, any minute now I am going to die. It was so distressing. I have been having flash backs ever since. The nurse did some thing to me, which I later found out was a "Jaw thrust". When I could breath again, I told her "I could not breath then." I was still very drowsy, and I can not remember her explanation. I was returned to the ward wearing a oxygen mask, which I know is common. That night I could not sleep. I was frightened to go to sleep, as I kept re-living that terrible moment of when I could not breath. I`m frightened that it may happen to me again. The next day I spoke to the nurse about my experience, telling her I needed to know what had happened to me. I remembered the name of the nurse looking after me in the recovery room, so I asked to speak to her. The nurse in question was on annual leave for two weeks, so the Anesthetist whom put me to sleep came to see me. He told me it was probably the muscle relaxants, or the pipe in my throat had moved, and apologised to me for any trauma I had experienced, I told him, "It may of only been for a few seconds, but it seemed like forever to me." I asked the Anesthetist if I needed to report this problem if I need any surgery in the future, he told me no. But I am going to anyway. I am trying to put it behind me, but I think about it every day. Your comments would be most appreciated.

Answer:

Thanks for describing your very upsetting experience. Some patients do need a bit of a "jaw thrust" to open the breathing passages after anesthesia because of residual anesthesia or muscle relaxants. We tend to assume that most of these people are too sleepy to be aware of any breathing difficulties or to remember it. I wonder now how many patients have been as traumatised as you?

It is never possible to be certain about these things without a full account of the case however the explanation you were given by your anesthetist sounds likely to be true. Incomplete recovery from the effects of muscle relaxants does sometimes occur and can be extremely distressing. Certain medical factor and drug interactions can make this more likely to occur.

The psychological trauma from such an experience can be intense and sometimes long-lived so you may want to seek some form of counseling if you continue to be troubled.

People who have had such experiences first need affirmation that in fact the event did occur and was not an exaggerated reaction or even an imagined experience. It is good to know that your anesthetist did speak to you after the event, apologise, and offer an explanation.

I completely agree that you should report this problem in the future.

What must be foremost in your mind is how to prevent this from happening should you need surgery and general anesthesia again. The good news is that the return of full muscle function after the administration of muscle relaxants can be accomplished through careful monitoring and the administration of appropriate reversal drugs. Such monitoring is, or should be, available in any operating room. There is a new drug, called Sugammadex, that promises to revolutionise this area of practice, by pretty much guaranteeing the reversal of some relaxants within a very short space of time.

There is the outside chance that your symptoms were a result of pseudocholinesterase deficiency, a rare deficiency of the enzyme that breaks down one of the muscle relaxant drugs called succinylcholine. Your anesthetist would be able to tell you if it is possible that you have this problem, but even if you are unable to determine whether this is your problem the experience you had should be preventable through the measures described above.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University