Expert: Ronald Levy, M.D. - 7/23/2011

Question
I am 43 yrs old, having elective plastic surgery on Aug 12th. I havent had any surgeries since I was 20 yrs old...a LONG time.  I have been put under 3 times in my whole life....  the first time they gave me sodium penathol, I weigh around 100 lbs and I remember them saying wow I have given her enough for a 250 lb man and she still isnt under.. then ALL the sudden the room spins REALLY fast and I went under...couldnt get me awake...when I did wake up I felt like a truck had hit me and they said I had some kind of reaction...  2nd time was simliar..again soldium penathol...didnt wake up easily..took hours... third surgery I remember the room spinning..which by the way I HATE that feeling and then when I woke up I was FULLY awake but couldnt open my eyes for about an hour..they said what they gave me that was a normal response...I felt fine..just couldnt open my eyes..didnt even feel groggy....sooo my question is this... I am told I have to have a general and cant be put in twilight sleep as they need to control my airway as they will be sitting me up and laying me down...ALSO was told tho that they dont paralyze me...  dont they HAVE to use the drugs to paralyze me to get the trach down?  and do the drugs now a days make the room spin like that?  Is there something I should tell the anesthesiologist about me not waking up and having to have alot to put me under??  I would prefer twilght sleep, I have been given versed and demerol for dental surgery and thought that was awesome...dont remember a thing...haha but thats not a bad thing...BUT I do remember I slept a LONG time when I got home...  so I am SCARED to death seriously and just want some reasurrance on the drugs I guess...  I dont like being out of control...and feeling the room spin... is their a specific drug I can ask for that doesnt make the room spin and doesnt make it hard to wake up...something that wears off easliy and you wake up feeling pretty normal???

Answer
Good News. In the last 20 years a new drug came out called Propofol which has all the qulaities youw want. It won't make the room spin, you wake up quickly and less groggy and it is also an amnestic and an antiemetic. As for paralysis, there are 2 possible answers. If they are going to use an LMA then you don't need paralysis as the device does not go into your trachea but sits outside of it and still controls your airway. Even if they use an endotracheal tube, they can give you a very short acting paralytic (succinylcholine) which wears off quickly and then not use paralysis for the case. You should certainly tell your anesthesiologist about previous surgeries but it probably mean little if he uses Propofol.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston