Expert: Ronald Levy, M.D. - 7/19/2009

Question
QUESTION: Back In 1996 I was put under general anesthesia in order to have a D&C. I'm not sure what meds i was giving but I do know I had a severe bronchospasm. I'm scared of ever being put to sleep again due to this.I was told that I couldnt be put to sleep because I couldnt be intubated.Is this true? I do have my medical records and have read them but I'm no doctor. please help I'm very very scared

ANSWER: These are 2 different issues. The bronchospasm is likely a one time event and does not predict that the same thing will happen again. This is usually caused by putting the endotracheal tube in before you are completely asleep and relaxed or pulling out at the wrong time (during what we all Stage 2). You do not need to worry about this for future surgeries. While it certainly could happen again, it is no more likely to happen to you as to anyone else (assuming you don't have certain risk factors such as severe asthma).

As to the question of can't be intubated, this is a far more important issue. If this is, in fact, correct, any future anesthesiologist should be made aware of this. It doesn't mean you can't have surgery, it just means that we would use a different apporach to intubate you (awake fiberoptic). If you have the anesthetic record, bring it with you to any future surgery. You might also consider a medic alert bracelet in case you are unable to tell the anesthesiologist this.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

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

QUESTION: Let me first Thank You for taking time to answer my ?.Makes me feel a lot better.The anestesiologist who did this in 96 has since been made to leave the Hospital.I tried to talk to him about it and he refuses to talk to me.I was told by my (OBGYN)years later who was there in 96 not to worry;because the Anesthesiologist did things others did not think was right.That is why he no longer works at the hospital.With that being said I'm not sure if I can be intubated, or if he was just trying to protect himself for something he did or didn't do by saying that.I do know I have allergies ,but have never had any signs of asthma I think I'll get tested.To be on the safe side I will somehow try to figure out about the intubation concern,as well as make sure I always make my records avail before any surgeries if possible.Do You have any advice for me; being that I really don't know about being intubated.Have you ever seen people that can't be intubated?If so what's the reason normaly? Thanks Again You have no idea how much better I feel now.

Answer
If you never had asthma, there is no reason to get tested for it...you don't have it. With regard to intubation, there is a small percentage of the population that is not intubatable for a variety of reasons. In your case it could be, as you say, a bad anesthesiologist. Personally I hate when I see a patient who was told they can't be intubated (yet they look like they should easily be) and I am forced to decide "Is it the patient or the anesthesiologist?" Usually I will err on the side of the patient but that commits them to a lifetime of fiberoptic intubations (safe but not the most pleasant). Since I can't see you and tell you which group you fall in, my suggestion is when you see an anesthesiologist in the future, tell him what the previous anesthesiologist said but also what you later found out about him. The new anesthesiologist will evaluate you himself and decide if you need a fiberoptic or a regular intubation (but he will have a Plan B and a Plan C already ready if he chose wrong rather than scrambling at the last minute).


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston