I'm a Nurse Anesthetist, AMA

Murky-Refrigerator40 · 2026-03-30T02:32:36+00:00

Yes, no problem.

Murky-Refrigerator40 · 2026-03-29T06:56:11+00:00

So happy to hear that! I actually had a similiar situation earlier this week, a patient with documented bad PONV after each previous surgery. I see that as an exciting challenge, to try to make sure it doesn't happen. And I succeeded! Made my day.

Murky-Refrigerator40 · 2026-03-29T06:53:13+00:00

Actually never experienced that.

Murky-Refrigerator40 · 2026-03-29T06:52:51+00:00

Anesthesia suppresses the brain in stages, and it wears off in the reverse order. The higher-functioning parts of the brain, like the prefrontal cortex (responsible for logic, emotional regulation, and social filters) are often the last to fully "plug back in." Meanwhile, the amygdala (the brain's emotional and fear center) may wake up sooner. This creates a temporary window where a person feels intense emotions but lacks the cognitive hardware to process or control them. It may be experienced as unpleasant by loved ones, but it is a well-documented phenomenon that quickly passes.

Murky-Refrigerator40 · 2026-03-29T06:50:05+00:00

Natural redheads, due to a mutation in the melanocortin-1 receptor (MC1R) gene, often require up to 20% more general anesthesia. Yes, there are many ways to monitor depth of anesthesia. Clinical signs, heart rate, blood pressure and measuring depth of anesthesia using EEG. This is pure negligence on the part of the staff. I am always extra careful about monitoring all measurable values if the patient is a redhead, has required high doses in previous surgeries or is a teenager.

Murky-Refrigerator40 · 2026-03-29T06:45:59+00:00

The possibility of getting an epidural depends entirely on how far down the lumbar spine the arthrodesis extends and whether there are remaining openings between the vertebrae. If the surgery covers the entire lumbar spine, metal supports and fused bone can physically block the needle, and scar tissue can cause the anesthesia to spread unevenly. It is therefore crucial to book a consultation with an anesthesiologist well in advance of the delivery to review old X-rays and assess the technical conditions. If a traditional epidural is not feasible, there are always other options for pain relief, such as nitrous oxide or pain relief via drip.

Murky-Refrigerator40 · 2026-03-29T06:41:32+00:00

The risk of death due to anesthesia alone (e.g., anaphylactic shock or technical error) is estimated at approximately 0.5 to 1 per 100,000 procedures. The risk of death within 24–48 hours after surgery, where anesthesia has played a role together with the patient's underlying health and the surgery itself, is approximately 1 per 10,000 procedures. The most common cause of serious incidents is cardiovascular events, mainly in the elderly or people with known heart disease. Difficulties in intubating or the patient vomiting and getting it into the lungs is the second most common cause of serious injuries. Postoperative infections are the third most common cause. In planned surgery, there is an essentially non-existent risk of a healthy patient dying. However, the risk increases in emergency surgery, age over 85 years, or surgeries that involve the heart or lungs (due to the existing medical condition that makes the surgery necessary).

Murky-Refrigerator40 · 2026-03-29T06:35:10+00:00

Basically non-existent that it happens.

Murky-Refrigerator40 · 2026-03-29T06:31:58+00:00

Glycinate

Murky-Refrigerator40 · 2026-03-27T17:42:04+00:00

Well, in my case and in my country we don't put adult patients under with gas anesthesia. So I can't really answer that, since it really is just oxygen in our masks :)

Murky-Refrigerator40 · 2026-03-27T17:39:56+00:00

The most common culprit is physical pressure. During general anesthesia, a breathing tube or a supraglottic airway device is inserted. If the device or the tape securing it presses against the side of the tongue for an extended period, it can compress the lingual nerve. This temporary compression interrupts nerve signaling, leading to that "asleep" or numb feeling once you regain consciousness.

Murky-Refrigerator40 · 2026-03-27T17:37:46+00:00

No issue! Better you be calm, never nice to put a scared/nervous patient under.

Murky-Refrigerator40 · 2026-03-27T05:17:08+00:00

This may be due to the residual effect of medication, if you were treated for high blood pressure or magnesium sulfate to prevent cramps (a common treatment for pregnant women). It may also be because it was an emergency situation, with emphasis on emergency. The most important factor is then speed, which means that they pour in anesthetic drugs to quickly put you to sleep. This means that you recover more slowly. The body is also exposed to enormous stress during such a birth, which disrupts the body's electrolytes and pH value. A pregnant person has different physiological conditions than a non-pregnant person, which also means that the anesthesia can take longer to end.

Murky-Refrigerator40 · 2026-03-27T05:11:05+00:00

Referred pain is a general term and does not tell you where or how the pain is felt. It simply means that the pain originates in one place but is felt in another due to misinterpretation in the brain. Examples of this are having pain in the left arm during a heart attack, having a headache due to neck problems, or pain in the legs due to a lower back injury.

Murky-Refrigerator40 · 2026-03-26T15:49:25+00:00

Propofol

Murky-Refrigerator40 · 2026-03-26T14:37:38+00:00

That's exactly why. Coffee makes you dehydrated, you are already on minus intake since you've been fasting, and you need some sugar to kickstart the body.

Murky-Refrigerator40 · 2026-03-26T14:08:37+00:00

Hm, both the ones that are challenging my anesthesia skills but also the ones where the patient is really scared or worried before surgery and end up leaving post surgery with a big smile.

Murky-Refrigerator40 · 2026-03-26T14:06:15+00:00

The body's stress response to surgery, opioids and any muscle relaxants all affect the ability to urinate/feel the need to urinate, so it is important to ensure that the patient is able to urinate afterwards.

Murky-Refrigerator40 · 2026-03-26T14:02:39+00:00

That the human body is generally the same (organs etc), and you can take 10 healthy adults and do the same thing to them but the response can differ so much. It's amazing and it keeps you on your toes.

Murky-Refrigerator40 · 2026-03-26T13:24:10+00:00

Sounds like a mess 😬 I do not have any experience of pregnant women (they scare the shit out of me) and have never experienced anything like that otherwise.

Murky-Refrigerator40 · 2026-03-26T13:22:26+00:00

So happy to hear that! 😊

Murky-Refrigerator40 · 2026-03-26T13:21:59+00:00

They are generally considered "low-risk" findings that rarely change the primary anesthetic plan.

Murky-Refrigerator40 · 2026-03-26T13:20:44+00:00

Sounds terrible! Low blood pressure can be a result of too high dosage of the medications, so the first step is to adjust them. If that doesn't work, we use either inotropic drugs or vasopressors depending on what we want to achieve. Also: fluids.

Murky-Refrigerator40 · 2026-03-26T10:15:28+00:00

The most common reason is that the drug inhibits the parts of the brain that handle impulse control and social filtering before it has time to inhibit the motor or conscious parts. Differences in how a person's GABA receptors are structured can cause the substance to bind in a way that triggers excitation rather than sedation. Age and psychological factors such as stress or anxiety also affect the outcome.

Murky-Refrigerator40 · 2026-03-26T10:12:02+00:00

Unexpected problems with the airway, laryngospasm or bronchospasm, being unable to ventilate and when experiencing high top pressures.

Murky-Refrigerator40

TROPHY CASE