Expert: JM Starkman, MD - 8/15/2010

Question
Dr. Starkman I am beyond thrilled to have connected with you a week prior to surgery.  I am to have jaw joint replacement sugery.  I have had multiple past surgeries, including pacemaker inplants, with infection: general anesthesia was required to remove the leads.  I had major spinal surgery as a result of a severe back break with implant.  THe last surgery I had I woke up during general anesthsia.  Terrifying, to say the least.  I have been drinking alcohol more the usual, and the last few general anesthesias resulted in significant tremors.  Neurology ends up involved.  
Please tell me what I can relay so I dont wake up again.  It was a terror.  Have you had patients with significant tremor post surgery?  Do you know what causes that?  Thank you so much.


Answer
You don't want to wake up?......maybe you should hire Michael Jackson's doctor!**.....OK, all bad gags aside, during spinal surgery and due to the manipulation of the spine and spinal column the surgeon will frequently ask the anesthesiologist to awaken the patient during the operation to ascertain the patient can move his legs, hence insuring the bone manipulation of the surgery has not impinged on the spinal column causing paralysis.  So your 'awake' period may have been planned.

Of concern is your drinking habit which may or may not have to do with anesthesia--have a neurologist evaluate your neurological status pre-operatively esp to rule-out delirium tremens and "clear" you for your jaw surgery. You don't mention if an oral surgeon will be doing your operation (they frequently do the anesthesia themselves and are highly trained to do so--but might want to move to an O.R. in a hospital and have an anesthesiologist provide the anesthesia if your case is complicated by a history of delirium tremens).  If an ENT or plastic surgeon is doing your operation that will not be the case--an anesthesiologist will likely be scheduled. Be sure you meet with him beforehand to get all your concerns ironed out in advance.  Tremors that happen in the recovery room right after surgery are common side effects of inhaled anesthetics and are usually short-lived;  can be managed without problems in almost all cases.


** he was not an anesthesiologist, so who's surprised?