Expert: Dr Ian Jackson - please note UK based - 1/24/2011

Question
Hi Dr Jackson
I had a septohinoplasty operation last Wednesday. I have had general anaesthetic on 4 other occasions prior to this and never had any issues what-so-ever(in fact have found it pleasantly relaxing). This time however I had the most horrific experience of my entire life and was searching for some advice/information as to what actually happened to me as I was going under. I read an identical experience that Dr Levy answered on the 3rd dec 2009 whereby a lady was traumatised by her inability to breathe as she was going under (I also honestly felt like I was dying as my limbs flung up in my last desperate attempts to breathe... Like something from a horror film!).  She mentioned that she specifically asked for 'versed' not to be used and this could apparently be the reason why she remembers this experience which happens but most people don't remember it. The problem I have with this response is that I didn't ask for them to use/not use anything in particular- the only thing I mentioned is that when I come out of a general I cry and shiver uncontrollably (as though full of adrenaline) - this was the first time I came out of anaesthetic and didn't do that. The first thing I asked when I woke up was what happened and they tried to palm it off as a panic attack!! It was nothing of the sort. It felt as though they gave me medication in the wrong order - is that possible?  Or perhaps they gave me additional medication to stop the shaking? I really need to know what happened and whether I was actually close to dying (FYI the last thing I remembered was the oxygen mask coming over my face). I never ever ever want to go through that again and would like to understand what on Earth happened.
Thanks
Cristie

Answer
Cristie
I am really sorry to hear about your experience it sounds horrific.

Firstly about what happened
I cannot second guess about the drugs etc that were used for your anaesthetic but there are three plausible reasons for your experience.
The first one is that many anaesthetists give a drug called fentanyl intravenously just prior to putting their patient off to sleep. This is a powerful pain killer we use in anaesthesia and in some patients it causes a really unpleasant feeling - my wife suffered this and I have never used the drug in this way since. However it is not usually a feeling of inability to breathe.
The next possibility is that you were given some midazolam intravenously prior to putting you off to sleep. This can be unpleasant for a small number of people - however again it is not a feeling of you can't breathe.
The final possibility is that you were indeed given the drugs in the wrong order. It is possible that you were given a muscle relaxant before you were put off to sleep and this would cause the feeling of being unable to breathe. I have personally made this mistake and spent a long time talking to the patient explaining what I had done wrong and apologising for my error. Like you she vividly remembered what happened, my explanation didn't take away the memory but it ensured that she knew clearly what had happened, that I had written about it in her notes clearly and she knew that it was very, very, very unlikley to ever happen again.
Of the options either number 1 or number 3 are the most likely.
What should you do?
Two options really - first is to accept my explanation and leave it there. The second option would be to write to both the Medical Director and the Clinical Director of the Anaesthetic Department of the Trust and explain what happened, that you are not happy with the explanation given to you and ask for them to review your notes and provide an explanation of what happened. That would ensure that what happened was examined and may shed light on the incident that might help in the future. The main example would be if you felt this way because of fentanyl - that information would ensure that you were not given the drug before being put of to sleep in the future. As the Clinical Director of an anaesthetic department I would want to know if someone had an adverse experience like this in my hospital. (who knows maybe it was!)

I hope the above helps a bit with this distressing experience.
Kind regards
Dr Ian Jackson