Expert: Ronald Levy, M.D. - 5/28/2011

Question
Hello Dr. Levy,

I am 35 and soon will be undergoing general anaesthesia for the first time.  I need an outpatient hysteroscopy for the removal of a fibroid and polyp at the hospital.

I've been undergoing fertility testing and treatments for several months which has required many, many blood tests (as many as 16 days a month).  My veins aren't great to begin with and are worse after the many tests.

I would really prefer inhalation (mask) anaesthesia but am not sure why it isn't really offered for adults (I could deal with the IV after I'm out, but am not looking forward to multiple needle sticks trying to find a vein as this always happens now with blood draws - I've even had them use my foot and I understand the needle for the IV is larger than for blood draws toobgg).

Is there any reason why it isn't an option (I'm in Canada so it may be different).  As well, I've read that they give you something as well that causes amnesia of the surgery.  Does that mean you would remember parts of the surgery without it?

Thank you very much for your time,
Lisa

Answer
Generally speaking, we don't do inhalational inductions on adults for several reasons. First, adults understand what we say and understand the need for an IV. IV inductions are smoother and better than inhalational but you can't get a baby to hold still to put an IV in so we use inhalation, Second, when you go under anethesia, ,you go through several stages of conciousness of which Stage II is the most dangerous. During stage II you go through a peiod of excitement, movement and you are at risk for laryngospasm. With IV induction this period lasts seconds but with inhalational it can last a minute.

On the bright side, anesthesiologists are experts at finding IVs no one else can find and they tend to use local anesthesia so it doesn't hurt as much. As regards the amnesia, you generally would not remember anything anyway but the amnestics also give you some amnesia from immediately before and after the procedure as well.


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston