Expert: JM Starkman, MD - 12/1/2009

Question
QUESTION: "Hi,

I had a tonsilectomy. No problems but then I had another surgery a year later & something strange happened.

I remember (Im assuming it was at the very end of the surgery) that I can hear everyone talking but I COULDNT move or talk. I tryed to move but nothing. I was really scared!

Now Im supposed to have a hysterectomy & im afraid.

1)Does this sound like a bad reaction or is it nothing to concerning?

2) Would it be safer to request an epidural, numb the waste down instead of general? (As they do for a c-section?

3) Also, my BP tends to run low, 95/60..........
Is this a concern? Would a spinal epidural be better in this situation as well.

Thx for your help!!



ANSWER: Thank you for writing.....I've answered many similar questions...please review them.  Make sure you tell your anesthesiologist of your previous problems so he has an opportunity to address them.  If I were you, I'd request a spinal as you suggested.

---------- FOLLOW-UP ----------

QUESTION: Thank You Dr Sparkman for your reply.

1)If I have the hysterectomy with a spinal, would it drop the Blood pressure lower than general anastesia? What is done if that happens?

I guess Im thinking, if something goes wrong.......Im going to be awake & "KNOW" it.

2)Can you please explain the pros & Cons of General verse spinal during hysterectomy?

3) Also, is one anastesia better to have depending on the type of hysterectomy? IE: Vaginal or laparoscopic?

4) I once had a Spinal Tap for bad headaches & had a horrible headache for 2 weeks after........Is it fair to say, even with that being a drawback, that a spinal is safer??

Any info is VERY appreciated.  Im VERY anxious & NEED the hysterectomy but I WANT to do it THE SAFEST.
THX!!

Answer
Hello, again!

1. Blood pressure fluctuations are typical for many reasons during both regional and general anesthetics.  Your anesthesiologist will address the matter in a number of ways including fluid administration, drugs to up-regulate the pressure and blood transfusion, if needed.

2. Pro: Always works the first time;  predictable;  easily reversed.  Con:  Risk of aspiration of stomach contents;  cardiac and respiratory depression;  allergic reactions or other rarer anesthetic reaction;  sore throat;  nausea/vomiting;  muscle aches;  pain/pain control.

3. A laparoscopic procedure precludes the use of a regional (i.e. spinal) anesthetic.

4. Yes.

Your anesthesiologist also wants to proceed the safest way....discuss your options with him beforehand!