Expert: Ronald Levy, M.D. - 3/22/2010

Question
Sir
I had a left hip arthroscopy in Oct 2009 for femoro acetabular impingement and all went well apart from a post op DVT at 3 weeks for which I had a spell on warfarin. On 19th March 2010 I had the right hip done after having lost 4 stones (56lbs), stopping all alcohol consumption and cleaning up my diet (halving reduced cholesterol to 3.0). On being anaesthetized I slowly lost all my functions whilst wide awake which included no ability to open my eyes, talk, move, but more importantly swallowing and breathing. In short I felt I was choking and suffocating but powerless to indicate it to those I could still hear clearly. For moments I knew I was dying !!! I was of course wrong but have spent the following period not sleeping, no appetite and quite simply shitting myself. Everyone around has no interest, including medical staff and I have been asked, Are you sure you didn't dream it ?. My dreams now include a desire to tie a bag around their heads and when they turn purple ask how they like it then suggest they are only dreaming. I have scowered the Internet as I need to know what happened for sanity. Thanks heavens for your last update to the poor lady who suffered the same and chooses not to have versed. I have some answers now so know it wasn't a dream and can articulate that my Dream! is actually factually based and documented. This is the first i have heard of versed. Why couldn't those with my life in their hands have explained this post operatively. Does the Hippocratic oath not cover my emotional health and well being. My question is did my change in size, health and lifestyle although well intentioned, contribute to this and is the inability to sleep, eat or interact with others an over reaction. I would add that this was not 'an awareness' I was wide awake, had accepted death and in a way feel cheated that it didn't happen. After all I had all the suffering but no peace at the end. Absolutely no more ops for me even though potentially 5 required yet. Sorry for the rant but answers will give me peace of mind. Thanks

Answer
Let me first explain what "likely" happened to you, and then I will explain so of the other issues you mention. Most likely they did a rapid sequence induction on you. You say you lost 4 stones but you don't say what your starting weight was. I will assume it was significant enough to conside you obese or morbidly obese. In these cases you are at an increased risk of aspiration of stomach contents into your lungs during induction so we try to put you to sleep and intubate you as quickly as possible. To do that we give the sleeping medicine immediately followed by the paralytic drug (as opposed to a routine induction where we put you to sleep and then after making sure you are asleep we then give the paralytic). Rarely, the paralytic takes effect before the sleep medicine and that is why you had the sensation you had (becuase the paralytic prevented you from breathing, moving and talking). That's what happened. Now to the rest of the questions.

The Versed (Midazolam) actually would have helped you because you would likely not remember the choking feeling so when you woke up, everything would seem normal to you. Many people dislike this but as a patient, I think this is a good thing because now I wouldn't be afraid to have another operation. The anesthesiologists should not have dismissed your complaints and, in fact, should have explained all this and recommended counselling as this is the equivalent of post traumatic stress disorder. This IS and example of awareness. That, in fact, is the definition. It is not a dream and the anesthesiologist should have questioned you more deeply about the exact events you remember so as to differentiate it from a dream (which some people do have).
The changes you did, did not cause or contribute to this and were good things to do.

As to the future, I will tell you what I have told other people with the same problem.

1) It is rare for this to happen twice but you should tell the next anesthesiologist that this happened to you.
2) DON'T NEGLECT HAVING SURGERY because of this fear. The outcome will only be worse.
3) Seek counselling to understand and overcome this fear.

Hope this helps,

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston