Expert: Ronald Levy, M.D. - 12/31/2009

Question
I had a D&C today as a result of a miscarriage and was put under general anesthesia for the procedure. I've been under once before for gallbladder removal and experienced no problems at all with anesthesia. While being put under today I recall being "almost" asleep and the anesthesiologist tilting my head back, removing the oxygen mask and attempting to intubate me. I heard him say something about a "crike" (sp?) and something pushed on my neck while the tube was being put in and moved around etc. I remember thinking, "I need to say something, I shouldn't be feeling this," but everything was fuzzy anyway and I immediately went to sleep after the thought. I woke up coughing after the surgery was over, which I know is normal, but I had some soreness in my neck and jaw that has gotten progressively worse through the day (I'm sore from head to toe). It's so bad now that it's impossible for me to pull myself up from a supine to sitting position... I feel like I've worked out at the gym for hours! (I realize that the soreness in the rest of my body is just a normal side effect of the surgery, but my back, neck, and jaw are unbelieveably sore.) I took a Lortab and it didn't help at all. I'm just wondering if this is normal, or if something went wrong with my intubation and that's contributing to my soreness? Is there anything I can do to help this?

Answer
It is normal. You had emergency surgery which means that you had a "rapid sequence induction". What this means is that, because you are a high risk for aspiration of stomach contents into your lungs (1. because you were pregnant and 2. because you had a full stomach at time of surgery), they need to put you to sleep and intubate you very quickly. This is the safest way to anesthestize you. To do that, in addition to the anesthesia, they gave you succinylcholine (SUX) to paralyze you quickly. Occasionally the SUX works faster than the anesthetic so you were still awake but paralyzed. The "cric" you heard was cricoid pressure (which also helps prevent aspiration) and is a pressure on you neck to occlude your espohogus. The reason you feel sore is because of the SUX which causes all your muscles to contract in tetany for 10-20 seconds. People often complain that they felt like they worked out all day. This should go away in a day or two. You can take Tylenol to help a little.

Hope this answers your questions,


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston