Question re Post-Op Amnesia

jwk · Oct 28, 2005

I am 3 weeks post-op from abdominal hysterectomy with BSO. I had an excellent surgical outcome, despite nothing going as planned and lots of surprises. My only complaint is that the gas passer slipped me something in pre-op before I finished my pre-anesthesia interview. I have very little memory of my four days in the hospital, and lots of memory lapses since being home.
I know that low estrogen can cause "brain fog" but at this point I have no other menopausal symptoms. I don't feel like I'm in a fog, just can't form a memory. I had an adverse reaction to the Vivelle patch put on at the hospital so am waiting for surgery drugs to clear my system, and also waiting for menopausal symptoms to appear. I have a lot of "belly fat" so assume I am receiving adequate estrogen from that at the moment.
Can the after effects of anesthesia last this long, or should I be concerned? I saw my surgeon one week post-op to remove staples and he brushed off my concerns. I don't want to be a drama queen, but am concerned that maybe I have a problem with what was given me, and possibly should be aware of it in case of future surgeries.
Any and all thoughts are welcome.

Many patients will recieve something like midazolam in preop because of anxiety. It has an amnestic effect, but it is very short-lived. I would suggest that you were "in a fog" for several days because of the meds you recieved postop, not what you received before or during your surgery. If I had to guess, you probably got narcotics in some form for pain, and many patients get something to help them sleep. Look to those as causes.

It's amazing how many people want to blame anesthesia for post-op complaints of all sorts - that includes the surgeon, who of course thinks they're blameless for just about everything. You said "...despite nothing going as planned and lots of surprises...". To me, that's a pretty good indication of either poor pre-op counseling and teaching, or unrealistic expectations, or both. When I give patients midazolam, I tell them that they probably won't remember much of their pre-op experience, and also that I get much better looking when they're on drugs. But the days of anesthesia just wiping you out for days on end following surgery are long gone. Pretty much all the drugs and agents we use are designed to be very short acting and clear your system quickly. That's why people can walk out of surgical centers 30 minutes after their surgery, instead of having a 2-3 day hospital admission for a D&C or tonsillectomy which was the norm when I started doing this 25 years ago.

Homesick Gypsy · Oct 28, 2005

Thanks jwk. The problem with a hysterectomy is that you don't know 100% for sure until you get a clear field. Evidently, my fibroids had grown faster than anticipated since the last sono, and there was a huge one on the back of my uterus. More importantly, the endometriosis was much more extensive than we knew and had glued the uterus to my rectum, bladder, and bowels. They had to be surgically separated. A testament to my surgeon's skill is that I have had zero bladder or bowel issues. So the bikini cut turned into an extended vertical, sutures turned into staples, surgery took almost twice the time anticipated, and the epidural turned into a general.

I believe the gas passer had the best of intentions. He did a wonderful job on the IV, using a local which I didn't even feel. He seems like a kind and caring individual, I just wish he would have let me finish the interview... One of the things I wanted to tell him was that my sister and I have both been overdosed based on actual body weight. He didn't call me the night before, so pre-op was the only time I had with him. I had an unpleasant experience with my last general anesthesia, and I think he was trying to avoid that. We discussed changing from epidural to general, and how I felt about transfusions, but then - it was lights out. No more discussion.

That being said, I had a morphine pca for 20 hours post-op. Right after removing the pca, the nurse gave me Darvoset for pain, to which I am highly allergic. Once the Benadryl kicked in, all I had was 600 mg Motrin, plus stool softeners. I also had an ON Q inserted during surgery but that was just marcane. No problems sleeping, but problems waking up. :wink2:

I was upset that he treated me like a child instead of informing me that he was giving me the lights out med. I am a grown up and I wasn't hysterical. I was a little anxious having the bomb dropped on me that the epidural I had expected wasn't to be, and the general I didn't want was what had to happen. But we discussed it and I agreed.

I've had general before several times and never had memory issues. It was my understanding that drugs these days were pretty short lived. Not blaming anyone - I had a terrific outcome, considering what it could have been. Just trying to figure it out. And figure out if I should be concerned enough about the memory loss issue to pursue it with my ob/gyn or primary care physician.

apaisRN, RN, CRNA · Oct 28, 2005

Giving you a med and not telling you (when you were still awake) isn't kosher. It IS demeaning, and also very frightening for the patient. If that was what happened, you might try to talk to him and emphasize that he makes sure to tell future patients when he gives them Versed.

jewelcutt · Oct 29, 2005

The medicine you recieved, midazolam, has both retrograde (majority) and in some people, antegrade amnestic effects. This happens all the time, we give pt's the versed and a day later they don't even remember meeting us in preop, or don't remember a conversation we had before the medicine was given. Just the other day, my mom had a cysto, I sat in the preop area with her for 45 minutes before she went back. She didn't remember me being there later that day. Anesthesia personnel are pretty good about doing a complete preop interview, because they also don't have much time and want to be as thorough as possible. If you needed to tell them something important and it was on your mind, I'm sure you did, but probably don't remember it.

subee, MSN, CRNA · Oct 29, 2005

Thanks jwk. The problem with a hysterectomy is that you don't know 100% for sure until you get a clear field. Evidently, my fibroids had grown faster than anticipated since the last sono, and there was a huge one on the back of my uterus. More importantly, the endometriosis was much more extensive than we knew and had glued the uterus to my rectum, bladder, and bowels. They had to be surgically separated. A testament to my surgeon's skill is that I have had zero bladder or bowel issues. So the bikini cut turned into an extended vertical, sutures turned into staples, surgery took almost twice the time anticipated, and the epidural turned into a general.
I believe the gas passer had the best of intentions. He did a wonderful job on the IV, using a local which I didn't even feel. He seems like a kind and caring individual, I just wish he would have let me finish the interview... One of the things I wanted to tell him was that my sister and I have both been overdosed based on actual body weight. He didn't call me the night before, so pre-op was the only time I had with him. I had an unpleasant experience with my last general anesthesia, and I think he was trying to avoid that. We discussed changing from epidural to general, and how I felt about transfusions, but then - it was lights out. No more discussion.
That being said, I had a morphine pca for 20 hours post-op. Right after removing the pca, the nurse gave me Darvoset for pain, to which I am highly allergic. Once the Benadryl kicked in, all I had was 600 mg Motrin, plus stool softeners. I also had an ON Q inserted during surgery but that was just marcane. No problems sleeping, but problems waking up. :wink2:
I was upset that he treated me like a child instead of informing me that he was giving me the lights out med. I am a grown up and I wasn't hysterical. I was a little anxious having the bomb dropped on me that the epidural I had expected wasn't to be, and the general I didn't want was what had to happen. But we discussed it and I agreed.
I've had general before several times and never had memory issues. It was my understanding that drugs these days were pretty short lived. Not blaming anyone - I had a terrific outcome, considering what it could have been. Just trying to figure it out. And figure out if I should be concerned enough about the memory loss issue to pursue it with my ob/gyn or primary care physician.

Were your general anesthetics for short procedures or longer ones? How old were you when you had them? Your body has sustained very major assault and I wouldn't worry about your memory yet while the physical healing is going on. There is documentation that "elderly" patient can have long term memory deficits following general anesthesia. For any others out there undergoing hysterectomy in the future, IMHO spinal anesthesia with an intrathecal narcotic plus a light general is a more elegant form of anesthesia.'

Lots less gas afterwards when peristalsis isn't thwarted.

athomas91 · Oct 29, 2005

the anesthesia provider likely did finish your pre-op - and you may have very well told him/her all the info you needed to but just don't remember. it is also a possibility that you don't remember them telling you they were giving you a sedative.

common sense dictates it highly unlikely that a provider started an interview but medicated you and didn't finish it...doesn't make sense.

Homesick Gypsy · Oct 29, 2005

My daughter and best friend (an RN) were standing there and my recollection of everything that happened up to that moment is intact. Since I don't have much recollection of the hospital at all, I'm going to get a copy of my records next week. Perhaps I'll see on there that I did inform him after the drug. He didn't tell me he was giving it, but evidently my daughter and best friend could see what he was doing and thought it was funny. I was not amused.

I wouldn't say I'm elderly yet - I'm 50. This is probably the longest surgery I've had, the others being sinus surgery, (age 49) exploratory lap (age 28), and tonsillectomy (age 12). That may have some bearing on it.

Subee, my surgeon recommended, I wanted / planned for an epidural and didn't find out until 30 minutes before surgery that the gas passer refused to give it. I wanted to be as conscious and alert as soon as possible to participate in my health care.

Best laid plans of mice and men.....

heartICU · Oct 29, 2005

Subee, my surgeon recommended, I wanted / planned for an epidural and didn't find out until 30 minutes before surgery that the gas passer refused to give it. I wanted to be as conscious and alert as soon as possible to participate in my health care.

Do you have any othe reasons to not have an epidural? Bleeding problems, recent ingestion of NSAIDS, do you take anticoagulants? Also - did he explain the reason for no epidural? When doing a TAH, tuggin on the peritoneum and manipulating the bowels will often cause a lot of nausea and discomfort in patients who have them under regional anesthesia. What did your anesthesia provider tell you as the reason for no epidural?

Homesick Gypsy · Oct 30, 2005

hearticu - The two reasons he gave were that I am obese (100 lbs overweight) and that the OR table would be tilted head down, putting pressure on my lungs. He told me he didn't feel like he could be sure of maintaining my airway under those two conditions. He said I was thin enough on my back but he still didn't want to do an epidural. The three of us discussed it - the gas passer, my RN best friend, and me.

In spite of being obese, I have very good lungs, normal blood pressure, clotting, low cholesterol, etc..... No anticoagulants, no nsaids, no bleeding problems. I forgot what degree he said the table would be tilted, but remember thinking it was a pretty severe tilt. He told me they tilt it to hopefully get the bowels as much out of the way as possible. Although I have photos of the surgery and it looks like I'm level.... at least when the picture was taken.

jewelcutt · Oct 30, 2005

That sounds about right, some surgeries basically have people standing on their heads, and with someone 100# overweight, I would be concerned too. Obesity can cause a lot of problems for anesthesia. A lot of patient's recieve epidurals for postoperative pain and still go under general anesthetics. If the anesthesia provider thought your best plan would be a general anesthetic and was concerned about giving you regional, he probably had a very good reason. It seems like he took the time to explain all of this too you and his reasoning, which is very good.

yoga crna · Oct 30, 2005

All of the discussion has been good and I am in agreement. However, I have one major beef--please do not call the anesthetist or anesthesiologist a "gas passer". I take great exception to using such a term that denotes a lack of respect. I know it sounds cute, but if you give some thought to the responsibility and education necessary to administer anesthesia, you will understand the importance of showing respect.

Yoga