Expert: Ronald Levy, M.D. - 5/1/2009

Question
QUESTION: Hi again Dr. Levy,

I had my ERCP yesterday to remove the stent from my bile duct, and everything went great with anesthesia and the procedure itself.  In my 1st question to you I was in error; I actually stopped breathing upon induction of the sedative before they could even administer the SUX.  I had been in the hospital flat on my back, very sick for 2 weeks when they did this and I quit breathing.  

At any rate this time they sedated me slowly and used what was called a "partial paralytic" yesterday.

Today I have a heck of a headache and I am stiff and sore all over.  I have no belly pain from the ERCP itself.  However I feel like I've been at Bally's for hours working out!  Is there a reason for this?  I am trying to walk and move around as much as possible to relieve the soreness/stiffness.

Thank you very much again for your time!!

ANSWER: When they give you an anesthetic, you are supposed to stop breathing. Of course, you are also asleep at this time so you wouldn't know. If you were awake and they hadn't given you the SUX, you would still be breathing.

There is no such thing as a partial paralytic. SUX is an ultra short acting paralytic so that is what they probably meant and it is also why you are so sore. SUX causes ALL your muscles to contract at the same time and many patients complain about the soreness. We generally only use it when we have to because of fear of aspiration or fear that the patient cannot be intubated. You probably fell into one of these categories.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

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

QUESTION: Hi Doctor and thanks for your quick response!

I probably was not clear on point one, where upon induction of the sedative back in February, I stopped breathing and they sent out a code blue.  This was before they had a chance to give me SUX.  So I was very afraid to go back to sleep to have the stent removed yesterday.

I was told I'd be given the paralytic to get the tube into my trachea.  I didn't know what they meant by "partial" paralytic either, I thought that a bit odd; either you are paralyzed (sp?) or you're not lol....

Previous times that they had used SUX with me, I never noticed the soreness I'm experiencing, and I guess my question to you is it best to rest the muscles, or keep moving around as much as possible as I have been?  Thank you so much again Dr. Levy!

Answer
I think I get what happened. Originally they wanted to do the procedure as a sedation case but they oversedated you. That caused you to stop breathing (basically they put you to sleep) and then they had to give you SUX so they could intubated you during the code blue (they give the paralytic so that your vocal cords will open up for the tube). The second time when you had the muscle soreness I am sure was due to SUX. It doesn't necessarily happen every time or to everyone but it happened to you THIS time. It doesn't matter if you exercise or rest, it will go away by itself.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston