The number of myths about anesthesia out there never cease to impress me. Today, I really want to do some myth-busting because every now and then, these myths actually impact patient care and not positively.
1. Regardless of what you may have heard, anesthesia is not always to blame.
A few years ago, a colleague on call was contacted by an irate Obstetrician (OB) . A patient of the OB had developed a headache after delivery and he blamed it on the epidural she had received for labor. He needed her seen stat to fix the situation. My colleague saw her stat. There was a small problem – she never got a labor epidural or a labor anything from the anesthesia department. My colleague ordered a CT-Scan which showed a Sinus Venous thrombosis and that wasn’t caused by anything we did!
Anesthesia is blamed for almost anything that goes awry preoperatively. Think I’m kidding? Ask any OR nurse or surgeon. Even when a surgeon is late, anesthesia gets blamed for not realizing the surgeon will be late!
Anesthesia is surely not responsible for all preoperative complications and any surgeon who tells you otherwise needs to be tarred and feathered. In blaming anesthesia for all, patients are sometimes cheated out of knowing important history.
2. My doctor said I can never be put to sleep. He said if I need anesthesia, I should get a spinal.
If you are a doctor or nurse practitioner and you ever tell a patient this, may you lawn be invaded by giant dandelions every summer till 2092! Seriously! The result of this bad advice is that, the poor patient shows up for a craniotomy and insists on a spinal. Or needs a thoracotomy and wants only a spinal. If you ever tell a patient that, please come with him into the OR to do the spinal and manage the anesthetic.
Please leave anesthetic choices to people who actually provide anesthesia. Irrespective of how sick a patient might be, with the right anesthetic and monitoring, he or she might do just fine. Telling them they will only survive if they get a spinal makes our jobs harder as we have to spend valuable time trying to explain to the patient why you were wrong and we are right. Don’t do it!
3. Epidurals and Spinals paralyze people.
A study in the UK in 2009 showed a risk of 1:20000 – 50000 of getting serious neurologic injury from an epidural or spinal. It is rare. Not that it cannot happen but it is really rare. The very act of the needle entering your back has not paralyzed anyone yet. Now if a patient is on an anticoagulant and gets neuraxial anesthesia, the chances go way up since an epidural hematoma can result. For most patients though, in the hands of a good practitioner (like most procedures in medicine), the risk is really low. So stop listening to the your cousin Bubba who heard from Leroy that Dan’s wife got paralyzed from an “epidermal”.
4. It’s just a small case.
Dear Surgeon, it may be a small case but there is no small anesthetic. None. If anyone ever tells you otherwise, call the FBI. There is no small anesthetic. The minute a patient’s consciousness is altered, the airway is not as protected and hemodynamics may change. The same degree of vigilance is needed as in every other anesthetic. So repeat after me: “IT MAY BE A SMALLL CASE BUT THERE IS NO SMALL ANESTHETIC”.
5. I woke up during my colonoscopy so please make sure I don’t wake up during my colon resection.
For a colonoscopy, most patients are sedated whereas for a colon resection, almost all patients are under general anesthesia. Prior to the widespread use of propofol for colonoscopies, most patients were sedated for colonoscopies with versed and fentanyl. That combination got some patients through the procedure but for many, the combination was woefully inadequate and these patients never were totally comfortable. Hence, they remembered patches of the procedure. A general anesthesia on the other hand is a different animal. You are out. Anesthetized and paralyzed, often with a BIS monitor on to monitor for awareness.
So no, if you woke up during a colonoscopy, it does not count as having a history of awareness.
Above are a few of the many myths that dog us anesthesia providers daily. Even if this post helps to bust only one myth, that will be awesome. All anesthesia providers will be really grateful. Then as the quote goes by Raheel Farooq goes: “Misunderstanding is generally simpler than true understanding, and hence has more potential for popularity.”