l'm frightened to death of........

  1. This may be an odd place to post this, but l need some words of encouragement please. l haven't discussed this on the BB, mainly whined about it in chat, l have been having mid to high back pain with very strange symptoms...l won't go into all of it. After 2 MRI's and a GB U/S, l have discovered l have gall stones, and the way l feel, l could be sitting on potential hot GB...don't feel well at all......so here's my delemma....I am terrified of being put to sleep for surgery (which is where l think l am headed ). l have been a nurse too long and seen too many bizarre situations and outcomes. l have had anesthesia 2 times before not counting my tonsils when l was 5...l had no problems except a lot of difficulty waking up.....l am NOT a good patient, l admit l am scared. Is there any other options other than general anesthesia for this proceedure?....could you please detail for meat least a little about the anesthesia and the proceedure....any info and encouragement will be appreciated....thanks.......LR

    ps....they won't do surgery on an inflamed GB will they?
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  2. 13 Comments

  3. by   WntrMute2
    Technically a gall bladder could be removed with a epidural or spinal extending up to T4. However, and this is a big however, almost all GB surgery is done laproscopically and that requires general anesthesia and intubation. A good surgeon takes less than an hour and you may well go home the same day. if you insist on regional anesthesia, you will have insured an open procedure which is far more complex and has weeks of recovery time. see a psychologist if needed but get over the fear. one of the first things you learn is that regional anesthesia is not inherently safer than general anesthesia.
  4. by   l.rae
    thanks wintrmute2....intubation is scarey too...l was involved in one thatwent real bad, we lost a 40yo viable pt cause the treach was nicked...l will NEVER forget that site as long as l live...this personpuffed up like a Macey's baloon right before my eyes...LR
  5. by   alansmith52
    I know this fear you speak of.
    last march I had to have an ERCP (Esophogo retrograde choleagio Pancreatography) Don't ask.
    this first day they say oh we'll just give you some versed and shove this scope down your throat, yeah right I thougt. when I woke up they told me. we used 12 versed and 250 of fent and you were still wild so, I had to come back the next day to be intubated. for a day its all I could think about, even when I laid down and all the Iv's were in me and I coulds see the white prop running to my hand I thougt, I can't belive I am about to be intubated. as it turns out. I loved it and would do it everytime if I had the choice. I didn't feel a thing. it was wonderful. and it was probably the best sleep I've had in ages.
    matt
  6. by   kmchugh
    l.rae

    When you see your surgeon, ask him/her to call the anesthesia group that will be doing your anesthetic. Go talk to them, tell them of your fears. General anesthesia is safe. In a way, it's too bad you saw the intubation with a bad outcome, because they are the minority rather than a common occurance. I've done thousands of intubations. Some have been tough, but never had a bad outcome. Read closely what Dave told you about regional anesthesia for a gall bladder. Right on the money. Most surgeons won't allow you to take the regional route, and if you find one who will, it will be impossible to find an anesthesia group that will agree. Lap gall bladders take 45 minutes to an hour and a half, and are usually done on an outpatient basis. You go home that night or the next morning. And not feeling too bad, either. Open gall bladders are MAJOR surgery, with about a nine inch incision just below the bottom rib on the right side. There is major pain associated with open gall bladders, and an open procedure involves a four to seven day hospitalization (so its unlikely your insurance company would pay for an open gallbladder to help alleviate your fear.) And you will be feeling rough for at least two weeks, probably more like four.

    Bottom line, PM me, I'll try to help you with the fears you have. Or, talk to the anesthesiologist/CRNA who will do your anesthetic. Believe me, general anesthesia is the way to go.

    Kevin McHugh, CRNA

    Edited to add: Get this taken care of NOW. The longer you wait, as symptoms wax and wane, there is more scarring. The last two open gall bladder surgeries I have done anesthesia for were done open because the patient had extensive scarring. No other way to get the gall bladder out. And, yes, I've seen lap surgeries done to take out a "hot" gallbladder.
    Last edit by kmchugh on Nov 23, '02
  7. by   l.rae
    Dave, Kevin, Alan...your words of wisdom are MUCH appreciated! I thank all of you sincerely for the advice...I just had the U/S and the tech showed me the stones on the screen, still waiting for official reports and referrals. Kevin, thanks for the generous offer...you can anticipate l will be taking you up on this, probably early next week. l work this wknd........have a great day, and thanks again to all.......LR
  8. by   researchrabbit
    I hypnotized my nephew prior to surgery and it really reduced his anxiety and fear. If you're close by, I'd hypnotize you too. (I'm in OK)
  9. by   Roland
    be considerably higher than with the closed procedure? In addition, I realize this is probably a stupid question but exactly WHY would general anesthesia have to be used with the laparoscopy approach. Couldn't a willing patient remain sufficiently still with just local anesthesia? Even if it were possible would this approach constitute such a huge deviation from protocal that a physician would be placing themselves at an excessive liability risk for even making the attempt? I say this as someone who has had a root canal without ANY pain killer (while in the Navy on deployment they actually RAN OUT of Novacain). It hurt worse than I can even describe, but I managed to remain absolutely motionless (although my finger tips were badly cut afterwards from my squeezing them so tight against my finger nails during the procedure)
    Last edit by Roland on Nov 23, '02
  10. by   meandragonbrett
    Oh my word Roland a root canal w\o anything! I would totally freak out! I have to have MAC to have ONE TOOTH pulled! And that's not a wisdom tooth! I know, I'm a big `ole baby when it comes to dental stuff! Good luck LR. Let us know how it goes!

    Brett
  11. by   WntrMute2
    Originally posted by Roland
    be considerably higher than with the closed procedure? In addition, I realize this is probably a stupid question but exactly WHY would general anesthesia have to be used with the laparoscopy approach. Couldn't a willing patient remain sufficiently still with just local anesthesia? Even if it were possible would this approach constitute such a huge deviation from protocal that a physician would be placing themselves at an excessive liability risk for even making the attempt?

    The issue is not holding still. There are a number of reasons laprascopic procedures require intubation. 1) The insuflation of gas into the abdomen pushes the abdominal contents cephalad. This tremendously increases the work of breathing and reduces tidal volume. Smaller breaths and increased RR are needed. Sometimes PEEP is needed to prevent closure of the airways. 2) The CO2 gas diffuses across the peritoneal membranes and causes hypercarbia. This further increases the need to control respirations. 3) Increased abdominal pressure increases the risk of aspiration. 4) The trendelenburg position needed for portions of the procedure further increase the risk of aspiration and decreases the ability of the respiratory system to compensate for the above changes. 5) Local anesthetics won't cover abdominal dissesctions very well either. So it would require neuraxial anesthesia. The liver would require at least T4 level of blockade. This level of block has the risk of impacting the diaphragm, just the muscle you don't want weak in this situation. I wouldn't want to intubate someone under emergant conditions because the block migrated higher than expected. 6) Many surgeons request skeletal muscle paralysis, one has to control respirations for that. I've seen about 100 of a variety of laproscopic procedures, all intubated, one can count on it. One exception, in post-partum tubal ligations, the fallopian tubes are so close to the abdominal wall, they can be done with the epidural and a little sedation. A very small amt of gas and pressure is required to bring the tubes into the field; otherwise it is the ETT.
    Last edit by WntrMute2 on Nov 24, '02
  12. by   l.rae
    hopefully next week l can see a surgeon....there is still a lot of doubt as to whether or not this pain is r/t the gallstones b/c it is so atypical.......thanks for all the good thoughts/advice....you know how slow the medical protocol can move, l am hoping l don't end up in ER with an emergency surgery while waiting.....l will keep you up dated.....thanks again to wonderful professional nurse friends......LR
  13. by   Qwiigley
    L.rae;
    Just wondering what you have done about this pain. Today is 12/7. Soemthing should have been resolved. I had my gallbladder removed last March. Versed, fentanyl and propofol. A little droperidol for the N/V; life is good. Home on Tylenol the next day. (and I'm an asthmatic)! Try to have faith.
  14. by   l.rae
    Thanks Quigly, believe it or not, l just got the "official" word yesterday that l have gallstones. The u/s tech told me there were stones during the procedure, but l have been waiting on my doc to call and get me referred to a surgeon....l had one person tell me they waited 6 wks to get an apt with a surgeon (the one l want) and 3 more weeks after that before they could schedule the surgery. The pain has been very atypical of GB, am still wondering if this could be the source, nitemare of nitemares to go thru this surgery and STILL have pain.....Anyway, thanks for your words of encouragement, the are very reassuring. l am a big baby...whaaa!.........LR

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