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Anesthesia

Being Paralyzed-Necessary or Not?

01/05/2010

Question:

I hope that this question doesn`t sound too dumb...I recently had knee surgery (torn meniscus) and the anesthesia was general. I had a bad reaction during dental surgery to the valium-like drug midazolam (it was terrible, I went nuts)...so I asked them not to use it. Just before the surgery they wanted to give this drug to me, I reminded them again that I was intolerant of it and the anesthesia person said o.k. but that it wasn`t a good idea. While "waking up` I felt that I was suffocating and struggling to breathe; I overheard the comment "that`s what happens when they refuse benzo`s"...it turned out o.k. but for me it was terrifying. The anesthesioligist sais that this was my fault for refusing the drug that would have prevented this and would not explain. The anesthesia nurse said it was because I was awake and paralyzed and that the midazolam would have prevented me from remembering this. I am not criticizing anyone, but can you tell me what might have happened? I don`t expect things to be perfect; in fact the surgery did not go well and the ortho doc said that she didn`t remove enough cartilidge and needs to redo the procedure. No problem, but I`m scared to death of that suffocating feeling; so this may happen again, but the drugs prevent you from remembering it? Sounds scary to me! The anesthesia nurse said that this anesthesiologist "paralyzes everyone" for general to insert the breathing tube easily, but that many providers do not do this. I was told that I have an "easy airway". I tried to ask the anesthesiologist about this but all he will say is "we will take good care of you". My surgeon is no help because she admits that she know little about anesthesia. I don`t want to second-guess anyone, but is it absolutely necessary to paralyze someone just to insert the breathing tube? And is the CRNA right in saying that some providers don`t routinely do this? I understand that everyone is different, I just want to avoid this scenerio again and nobody will talk about it. I`m 35, great health (except for my knee) and take no drugs and haven`t seen a doc (except for the surgeon) for many years. Thanks.

Answer:

It's not absolutely necessary to be paralysed for insertion of a breathing tube that is passed through the vocal cords (known as an endotracheal tube). But it is very much the norm. Breathing tubes that stay above the vocal cords - such as the laryngeal mask airway - don't usually require paralysis. Knee surgery can be accomplished without general anesthesia. Spinal and epidural anesthesia are alternatives, as well as certain nerve blocks. If these methods are used, then sedative drugs can be avoided, although it must be said that most anesthesia providers would administer some sedation along with the spinal or epidural. Most commonly this includes a benzodiazepine and/or propofol.

You are certainly within your rights to refuse particular drugs which you feel you have reacted poorly to, however it is often difficult to prove that an individual drug caused a problem as anesthesia invariably includes a number of different drugs. And don't forget the reaction to the surgery itself - both the physical and psychological response - which may be more significant than any anesthesia/sedation-related response.

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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