Expert: Ronald Levy, M.D. - 2/25/2010

Question
Dear Professor,

I am a 39 year old female from England.  A while ago I had to go into hospital for surgery on a cerebral aneurysm.  The aneurysm was to be clipped using traditional surgery.  On the morning of the surgery I was given 2 pre-med pills (I assume some sort of valium) and got into bed to wait transport down to theatre.  There was a delay in the theatre so by the time I went down I was fully awake.  In the theatre prep room I met the aneasthatist who prep'd me for surgery.  He put the strange ankle massagers on my legs and the heart monitors etc then told me to relax whilst he injected something into the back of my hand.  I was laid with my eyes closed and waited to fall asleep.  However, I didn't fall asleep.  After a few seconds I naturally attempted to breath in and found that I couldn't.  No matter how hard I tried I simply couldn't breath, move or speak.  I couldn't communicate to the anesthatist that I needed to breath because I couldn't even move my little finger or open my eyelids.  After a few seconds my brain started to scream that I needed to breath and my lungs were on fire.  A small spark of sense at the back of my mind knew that at some point he would introduce a breathing tube down my throat.  Most people would be terrified of having a tube put down their throat whilst conscious but at that moment I was mentally begging him to do it as quickly as possible.  I really thought I was going to die.  I don't know how long it lasted - It seemed an enternity.  I do not know whether I passed out due to the administering of another drug or whether it was because of a lack of oxygen.  The next thing I knew was waking up in the recovery room.  I suspect the aneasthatist gave me the drugs in the wrong order - ie he gave me the paralyzing drug rather than the drug to make me unconscious.  Is this possible?  Is it routine to give the different drugs in seperate injections or are they combined into one injection?  I'm terrified of having any further anesthetics and can honestly say I'd rather die than go through that experience again.

Answer
I doubt he gave them in the wrong order. More likely he just gave them too close together. In your case, they did what is called a rapid sequence induction, whereby we try to intubate you as quickly as possible to prevent you from aspirating (more common in cases like this). To do that we give the sleep agent (which normally works in 15-30 seconds) and then the paralyzing agent (which works in 30-60 sec). These drugs are never combined in the same syringe. While it seemed like an eternity, it was probably closer to 15 sec. What you experienced is very rare and highly unlikely to happen again, so you shouldn't fear future surgeries. I would still recommend you tell any future anesthetists that this happened to you so they can make sure that you are asleep next time. If you had gotten the "Valium" appropriately, you probably would'n have remembered this so make sure that you get it for any future procedures.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston