What's the Big Deal with Sedation?

I've been asked to explain why I'm so frightened of sedation.

So I will.

You see, I am asthmatic and as such, I should be cautious about sedation.

Everyone should be cautious about sedation really, but especially asthmatics, perhaps some more so than others, as many case studies will attest.

But in my case, I have a history to support my fears.

My first experience with anaesthetic was in April of  1962 when I had my appendix removed.  I awoke in recovery vomiting myself silly, with Nurse Ratchet telling me to use the barf bowl (what the hell did I know, I was eleven years old for Christ's sake?).

My next visit to the operating room was in 1965 when my tonsils were removed; that occurred without incident.

I was back in OR again in 1972 and 1973, first to confirm the diagnosis and then to clean up the endometriosis that plagued my body.  The recovery from the surgery was relatively easy:  the impact from the disease had been so extensive that I was physically remarkably improved post surgery.

Then, in 1978 I had a hysterectomy and  I came to in the recovery room in respiratory distress.  The nurse thought I was in pain from the abdominal surgery that I had just endured and she tried to reassure me that everything was alright, I was just waking from the operation and all would be OK soon.  I of course was unable to tell her that I couldn't breathe because I couldn't breathe.   Finally, a very alert nurse noticed my distress and she jumped into action, literally saving my life.  It was determined that I had suffered a delayed response to the suppression that the anaesthetic had caused to my respiratory system.  Of course, it didn't help that they were also feeding me an aspirin-like pain reliever which I cannot tolerate (I experienced further complications from that later on during my recovery).

Fast forward to 1982 when I had bunions removed.  At my follow-up visit with the surgeon, he told me that he "had almost lost me on the table" (an unfortunate turn of phrase, I know, but he was a straight shooter) and had he not known my medical history, he might not have known how to get the best remedial response.  He advised me that I might want to keep in mind for future elective surgeries to mention that I should be put on corticosteroids prior to any surgery and should have a steroid drip used during the surgery to help keep me breathing (he assured me that any anaesthesiologist would know the drill).  Interestingly enough, it was that surgery that also taught us that I am allergic to cat gut -- my feet swelled up bigger than the biggest balloons ever as a result of the stitches used for that bunion removal!

Anyway, I've managed to avoid sedation in any form since 1982.

Except in, I believe it was about 1990 when I had to undergo an endoscopy (come to think of it, the problems I was having then were not unlike the ones I'm having today -- no explanation was ever found then either).  For that test, all I was given was the relaxant (there really is no need for "sedation" for the procedure) and even with that, the nurse had to keep telling me "you have to breathe" because my breathing kept dropping off.

Obviously, sedation is a problem for me.

I've had dental work for which others have been put under but I have had it done with freezing only.  My dentist simply will not risk complications when he is not equipped to deal with the unknown.

My dental surgeon is equipped to deal with complications and still he does the slicing and deep cleaning of my gums under freezing only. I simply will not risk sedation unless it is absolutely necessary.

So, from the day I was given the booking for the endoscopy/colonoscopy, I was stressed, one might say.

In fact, stressed would be putting it mildly.

Not about the procedure, you realize.

The procedure itself didn't concern me at all.  I wasn't looking forward to the prep for the procedure and that was a whole different discussion.

But I was concerned beyond belief about the fact that I would be sedated.

I tried to discuss the matter of sedation with the surgeon but he pooh-pooh my concerns:  "Nothing like anaesthetic; if you can take valium you can take this," he said.  "Bring your puffer with you," he admonished.

I contacted my doctor to express my concern, and he too pooh-pooh my worries:  "Nothing to be worried about, it's nothing like anaesthetic; you'll be fine," he insisted.  (That response, I might add, is very unlike my doctor.  Had the discussion taken place in his office, rather on the telephone, it would have gone quite differently.)

My point, and it was and is valid, was that I was terrified.  What good would my puffer do me?  I'd be "out of it" -- how the hell could I grab for my puffer?  My concern was that I would be unable to tell anyone that I couldn't breathe if I couldn't breathe!

I was convinced that I was going to meet my maker on December 18th.

But I couldn't confide that fear, in those words, to anyone.

Obviously, the doctors who should have recognized the perfectly valid concern (and the very real risk) weren't taking me seriously.

My husband and daughter, both of whom know how scared I am of anaesthectic, didn't need to know how absolutely terrified I was going into it (they will now) -- it would have just made them more nervous themselves and frankly, the stress around here was enough to deal with without making it worse still.

While I might tolerate heavy pain killers very well, and I can take a sleeping pill on occasion, I never take anything to such a dose that I would be "out" sufficiently well to allow a medical procedure to be performed on me without my waking up (it's all about dose).

I don't care what the name of the drug -- if it puts you to sleep sufficiently well to allow a medical procedure to be performed without your being aware, it has the ability to snuff your lights out (mine anyway)!

It was interesting that when I met with the anaesthesiologist prior to the procedure, one of the first questions he asked was if I had any experience with anaesthetic of any kind (remember the surgeon's insistence that "this is NOTHING like anaesthetic"?) and when I expressed my terror at being sedated, he didn't downplay my concerns one bit.

In fact, he wanted to hear the history and he validated everything I told him.

And he explained that the incident back in 1978 was probably exacerbated by the pain-killing drugs they likely had given me which I could not tolerate (they would have had anti-inflammatories properties and I cannot take anything with anti-inflammatory properties -- I have asthma).  That reaction set in motion future ones.  He suggested that they probably did not appreciate the seriousness of my asthma back then.

Now, I'm sure that a large part of what went into his decision to NOT sedate me was the stressful state that I was in over being sedated (not to mention that I'm sure he didn't want to be the one on whose watch something did go wrong, if it were to go wrong).

In any event, he made the right call and I truly appreciate what he did for me.  But my stress could have been alleviated so easily if I could have talked with him when I first met with the surgeon.  He could have put my fears to rest right then. It seems to me that the moment I expressed concern about being sedated, that surgeon should have flagged my file as a patient who might benefit by contact from the anaesthesiologist prior to the procedure.

But that's just my humble opinion.  A five minute conversation could have eliminated a month of stress and worrying.

And I wouldn't have had to spend the past month convinced that I was on my way to an appointment I wasn't ready to keep.