Expert: Ronald Levy, M.D. - 11/8/2009

Question
Hi Dr. Levy:  I'm a basically healthy 54 year-old and I was told that I need to have general anesthesia for a hemi-colectomy (they said that it has to be general).  My only experience with anything anesthesia related (other than one dental episode) was the colon scope that I had last month and the anesthesia part was a disaster.  They promised to use the minimum amount of sedation and titrate "for my comfort", but they didn't do this.  I told the doctor that I reacted badly (paradox?) to sedation and he promised to try a test dose first, but he just squirted in 4mg of midazolam all at once and let me trash around as the nurses tried to restrain me.  I'm only 115lbs and ended up with bruises on my wrists (they did too) and the exam had to be rescheduled.  What bothered me the most was the attitude of the staff as I was in distress:  "relax dear, you won't remember any of this".  Wrong.  The next exam was done with nothing and unfortunately indicated cancer.  O.K.  The problem and my question;  is this the way that anesthesia is done?  Promise the patient one thing and make no effort to accomodate her wishes?  I realize that if something emergent happened that the plan might change, but they didn't even try to accomodate me.  The problem is, now I don't trust aneshtesia at all, especially the "amnesia" drugs like the midazolam that I got.  For my colon cancer surgery I asked if amnesia drugs could be avoided, the CRNA said "no problem" but when I put this on the consent, she told me that I couldn't do that.  I know that I sound like a control freak, but due to my previous experience, I want to avoid another debacle.  It seems like the CRNA could care less that I had an awful experience, she just said "trust us".  Can I list "no midazolam or amnesics" on the consent"?  I was supposed to have the surgery on friday, but cancelled it at the consent phase just before I was to go into the O.R.  Thanks

Answer
First of all, general is not like sedation so you won't have the same bad experience. Second, I would not recommend rejectin amnestics. If they don't work on you, then it won't do harm. If they do work (which I am sure they will) then your anesthetic will be more comfortable. I am sorry for the experience you had and NO this is not how anesthesia is done. You clearly had a bad anesthesia team. While it is not forbidden to write on the consent form, I would also recommend against that because you tie the hands of the anesthesiologist and if he should need to give you one of those drugs, you have forbidden it. If you really don't want amnestics, talk with the anesthesiologist who sees you the morning of surgery and explain your concerns and wishes. Assuming he is an honorable person, he wil either honor your wishes or tell you that he can't and the reason why.


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston