Expert: Ronald Levy, M.D. - 1/25/2008

Question
Hello. I recently had hernia repair surgery, during which the anesthesiologist used versed and fentanyl. I had discussed prior to the procedure, a very unpleasant reaction to general anesthesia nearly 13 years ago, which she took into consideration.  I awoke from the recent surgery with nearly complete amnesia of the procedure, but also (even until now) very little recollection of events for two hours before I went into the operating room. I also felt nauseous in the PACU and was in a "terrible dream state". I drifted back and forth and then was told by the PACU nurse to inhale smelling salts. This action revived me somewhat, then after about one hour, my wife took me home. Over the next six hours I had brief hallucinations (audible and visual)before I finally fell to sleep, nearly 13 hours after the introduction of the anesthesia. My question is why these reactions? Why and when do you use smelling salts in PACU recovery?  I weigh 215 lbs., am 53 years old, non-smoker,  without any medical problems. 6mg of versed was used. 4cc's of fentanyl were used. 950cc of Ringers/Lactate was IV'd for about two hours. Actual surgical procedure was to last 20-30 minutes.  Please advise.  Thank you!

Answer
The amnesia is normal and in fact a desired outcome. Most people are scared of the whole OR procedure so not having any recollection of the whole event is desirable. As for the nausea, this is probably due to the Fentanyl and the fact that they did a hernia repair and sometimes the tugging on the contents of the hernia sac can cause nausea. The dreamlike state is probably secondary to the Versed. You got a fairly high dose so its effects will last a little longer. With respect to smelling salts, I have been in practice for over 10 yrs and I have never used or seen them being used so I can't speak as to why she gave them to you. Normally just verbal stimulation is enough to arouse someone. Versed is a relatively short acting drug with few metabolites so it is better than using Valium which tends to stay around longer. Considering your age (and if you are overweight?) Versed can take several hours to wear off. There is no need to worry about these reactions.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston