Expert: Dr Ian Jackson - please note UK based - 7/3/2006

Question
I am so happy I found this board so I can ask a question from you. I had my gallbladder removed about 10 days ago. I had a scary experience when being put under general anesthesia, and haven't had my Dr. follow-up yet, so I am really looking for an answer, because I am having a lot of trouble sleeping now due to anxiety from this situation.

When I was being put to sleep the anesthesiologist gave me the first IV medicine which makes you VERY sedate and relaxed, but still conscious. The longer that was in me, the heavier I felt and the harder it was to breathe etc. He started with a light oxygen mask, then put a heavy tight one on, which was a bit uncomfortable, but I couldn’t really say anything. I felt my mobility cease, couldn't move my arms or muscles at all, and I was pretty much fighting to take each breath, feeling that I was having to struggle to keep alive in a way. I was not being knocked out yet, and it seemed that my anesthesiologist behind me, was probably monitoring me and getting things ready for surgery. Then one of the nurses came over to him and watched me for a second. I could see her observing me opening and closing my eyes etc.,  then she said to him "what’s the problem?" I think above me they tried to have a "silent" conversation so I couldn't hear, but about 20 seconds later he replied "She isn't there yet". So then the nurse looked back at me and this was when I realized I was very paralyzed. She put her hand on the bottom part of my throat, the part below the adams apple and placed steady pressure there. I felt at first she may be trying to take my pulse, and then thought maybe she was trying to slow my breathing, because she left her hand there indefinitely, so it would not have been for my pulse, plus they are already monitoring all that I am sure on monitors. It made me freak out a little, like she was smothering me and I was fighting for each breath. I told myself, she isn’t trying to hurt me and there must be a good reason, so I tried to stay calm but inside I was feeling like she was killing me and I wanted so bad to just ask her why she was doing that, but all I could think of was that she was trying to stop me from breathing. Then finally I remember the anaesthiaologist telling me that he was now going to administer the medicine which we spoke about which may sting slightly, and it did a tiny bit, and then I was out.

What was that holding my throat thing all about? I have never heard anybody else having this done to them. It was a form of torture since I could not communicate and it scared me because I was truly feeling like I was fighting for my life and didn’t understand why she needed to do that, or that she would be doing that.

Coming out of anesthia was very good. The first thing I was aware of was my anesthesiologist telling me to open my eyes, and I did, and my tube wasn't even in my throat anymore, not like my previous surgery where I woke up gagging on it for a long time before they removed it. It was a breeze, but going under was hell, and now I can't sleep. I had surgery 10 days ago and have only slept a total of about 12 hours. This is not only because it has been hard to recover due to it being abdominal surgery and my lungs needing time to get strong and pain taking breaths etc, but I also keep having flash backs. Each time I almost drift off, my heart thumps out of my chest, races and I wake up, I panic like I am going to die if I sleep.

I ended up in the ER room, 5 days after surgery, they thought I may have a pulmonary embolism due to my almost fainting and having extreme trouble breathing, all of a sudden on the 4th day it worsened so much I could hardly stay conscious and my limbs were also going numb and I couldn’t stand up etc. but in the end all the tests were negative and they think I was having a panic/anxiety attack. I still don’t understand how anxiety can make you almost lose consciousness and all the other things which were going on, but I do feel better the past few days, so maybe they were right. I just still can’t sleep. They sent me home with a prescription for Alprazolam, which was the reason I got 6 hours sleep that night after the ER. But I haven't slept since, even after taking the pills now, I feel like I am fighting sleep mentally w/o meaning to, I am exhausted and nodding off where ever I sit. I still have pain and trouble breathing in the normal/hopefully normal part of recovery. But with the other issue on top of that, I was just wondering if that was necessary or why it was done to me, so I can communicate what happened next time I need general anesthesia. I have daymares about it, can’t have nightmares cuz I am not sleeping….haha. Thanks and hopefully you can shed some light on this, truly appreciate any input.

Answer
Christine

What can I say - your experience sounds horrendous. It is really important that you ask to see your anaesthetist and discuss this with him as soon as possible.

The fact that you felt you couldn't breathe, move or speak could be down to 2 things. Firstly the drug given to you to make you feel relaxed at the beginning may have included a strong pain killer and it was this that stopped your breathing. However I don't buy that as an explanation as it normally removes the feeling of needing to breathe which you so graphically describe.

That leaves me with the thought that they gave you the muscle relaxant drug i.e. the drug to paralyse your muscles before they put you off to sleep. This is NOT standard practice and indeed I would not dream of doing that to someone who is still awake.

Now as to the pressure on the front of your throat - I suspect this was what is known as cricoid pressure. This is where the assistant presses on your throat just below your adams apple with their finger and thumb. We do this to protect your lungs as it closes off the gullet and so stops anything coming up from your stomach (food, acid etc). Once again we usually explain to the patient what we are doing and they are only aware of it briefly before falling asleep.

So I reckon that explains what you experienced during the start of your operation. I have no doubt that this trauma has had a profound effect on you and that you need help. I suggest you urgently speak to your anaesthetist but if he is no help then seek help from a psychologist to help you come to terms with this all.

I hope you find some solace by understanding what may have happened. If you describe your experience to ANY anaesthetist in the future they will ensure that it does not happen to you again.

I wish you all the best.
Dr Ian Jackson