Local or General anesthetic?

[Alan]

Yesterday I had cryoballoon AF Ablation under a local anesthetic at 10am and was eating lunch by 1pm. I was kept under observation for a few hours and released once the wound in the groin was sufficiently healed, plus I had several ekgs and blood pressure readings to confirm all was well. It was fast and painless after the initial injection to administer the local anesthetic. I was able to chat with the team throughout the procedure, never even felt more than a little drowsy.

What has surprised me is the reaction of several folks I know who have told me they would want a general anesthetic when catheters are being inserted into the heart, and punching through the wall dividing the top 2 chambers to get at the left chamber.

Given the option of local or general which would you prefer to have?

https://www.heartrhythmdoc.com/arrhythmia-treatment-options/cryoablation/

Heart doctors began using heat-based ablation to treat AF more than a decade ago, but new scientific evidence supports the use of cold therapy for this condition as well. The FDA approved the first cardiac cryoablation catheter in December of 2010.

An electrophysiologist (EP doctor) performs cryoablation to disable the heart cells that cause AF and restore the heart to a normal rhythm. Cryoablation is a minimally invasive procedure in which the EP doctor uses a thin flexible tube, known as a balloon catheter, to locate and freeze this heart tissue. Cryoablation is an appropriate treatment for atrial fibrillation when medications and other AF treatments do not restore the heart to a normal rhythm.

 

[HadEnuff]

the distinction can be misunderstood by the layperson.

The deeper the sedation, the greater the risks. Most patients think "general" anesthesia means you are "out" and don't remember anything. This can be accomplished with techniques that an anesthesiologist would not consider "general" anesthesia.

To answer your question, I'd tell the anesthesiologist that I don't want to feel anything, and I don't want to remember anything. I want the safest treatment that accomplishes that, which I believe is not as deep as what an anesthesiologist would call "general".

 

[Alan]

Good points, I had assumed “General” meant unconscious. The cath lab I was in was full of high tech equipment with huge monitors and I was absolutely fascinated with the whole process. I agree that no pain is the priority. I was amazed when after a very short time the surgeon said something like “1 down, 3 to go”, which meant he had already threaded the catheter in and through the dividing wall, inflated the balloon and applied the freeze inside the opening of the first blood vessel.

 

[Octogirl]

I agree with your choice- Local The deeper the sedation, the greater the risks. Unless there is pre-existing anxiety, so that being awake would lead to anxiety (not good for your heart) - I would choose less risk. YEMV

 

[Walt34]

For all the procedures that I've had they used the least amount of anesthesia possible. That's a Good Thing from what I understand are the risks of anesthesia. A few years ago a long-time good friend went into surgery for what was supposed to be minor surgery, but she died on the table.

When I went in for a cardiac catheterization a few years ago I was absolutely freaked that I was going to be conscious for it. Actually, it turned out to be very interesting, although the cardiologist did get a bit annoyed with me because I kept lifting my head to see the screen better and when I did that the catheter insertion would would bleed. But he didn't tell me that until later, all he said was "don't move!"

 

[LOL!]

I've never been given a choice, but I tolerate general really well at least with my experience with 6 surgeries.

For my last procedure, I asked the anesthesiologist about the previous one a couple weeks before, so he read me the OP notes which I found interesting because my heart rate and blood pressure got too low during the operation and they had to do something about that.

But a friend of mine had this happen: He had a heart attack on his couch, but the EMTs were there in a few minutes since he lives close to the fire station. The EMTs radio'd ahead and he went right into the heart cath lab and a stent. He was conscious when he heard the surgeon say, "The computer died and the screen just went black. Better call the IT guys quickly because I'm stuck here." He heard the entire conversation which ended with the surgeon saying, "You guys should have instructions right here on what to do if the screen goes blank." and the IT guy saying "We did that, they are taped right on the keyboard there." "Oh, yes, I see them now."

So much for a modern cath lab and high tech equipment.

 

[audreyh1]

I have never been under general anesthesia. I’ve had a vein catheter type procedure but this was an embolization of the uterus, with the entry at the groin. I think they gave me the colonoscopy type anesthesia. I remember bits of it. I remember telling the radiologist that I was starting to feel cramping (as expected).

 

[aja8888]

I've been under many times:

Car accident - broke both lower arm bones in half in left arm (screws, pins and plates installed), shoulder rebuilt also, but that was a second major surgery.

Hip replacement (2009) - total hip joint put in.

Two implanted teeth (2017) - Out for the drilling and insertion of the threaded stud mounts.

Right knee scoping to fix two torn meniscus's - 2017.

Colonoscopy (2018) - I was not awake for this. That was a good thing.

I'm sure there were more, but I can't recall.

 

[Bestwifeever]

I hope the procedure was resoundingly successful, Alan!!!

I’ve had general anesthesia I think five times. I think of local anesthesia as simply novocaine but probably it is more like sedation with or without pain blocks as necessary? The waking up from general anesthesia was hard. OTOH the level of local anesthesia I had for cataract surgeries varied from great for the first eye to awful for the latter, where a different anesthesiologist decided to keep it extremely light for no reason. As I get older I am becoming more of a coward and would orobably go with general if I really had a choice—in reality I would go with what the doc recommended.

 

[audreyh1]

But that does sound like a scary procedure. Let us know how it turns out for you!

 

[Huston55]

Local or General...THAT is the question!

Funny you should ask...

Back in the day (1979 to be precise), I had to have a meniscectomy. I’d injured my knee playing Rugby in college, and the torn meniscus was causing pain and knee stability problems. In 1979, my choices were: leave the meniscus in & live with it or, cut (scalpel) it out; no arthroscopic surgery at that time, at least not in the US Air Force.

So, since I was 24 yo & fit, I’d decided to have knee surgery, do the rehab & be back to 100% in short order. During the surgery consult, they asked me about anesthesia; local or general? I was surprised at having a choice.

Now, I had just read the book “Coma” https://en.m.wikipedia.org/wiki/Coma_(novel), and there was NF-Way I was having general anesthesia! Not completely logical I know but, I considered general anesthesia riskier for such a minor surgery; PLUS, I couldn’t get the book out of my head; this was my thought process at the time. And, I wanted to be awake to observe, as much as possible, the surgery.

Surgery day comes, I’m in pre-op, they give me a happy pill & a spinal block. After a while, the surgeon comes in, rubs the handle end of a surgical instrument against the bottom of my foot and asks if I feel anything. I could only feel a dull pressure against the bottom of my foot so, I tell them that. They kibitz, then decide to give me a boost to the first spinal. All’s well after a short wait and they wheel me into the OR; I fall asleep...

...sometime later, I wake up. First thought is, cool, now I can listen/watch as they perform surgery. Immediate second thought is, I CAN’T BREATHE! Tell the surgeon! OH, SH!T, I CAN’T TALK. Move your hands, signal that something is wrong! OH SH!T, I CAN’T MOVE ANYTHING! I’M GOING TO DIE RIGHT HERE! Oh wait, wait, I can blink my eyelids. So, I blink my eyelids as furiously as I can. After what was surely just a few seconds, that seemed like an eternity, I see the anesthesiologist’s face appear above my head. He says, “Hey, he’s awake now. I guess he realizes he can’t breathe (just what I need, a comic anesthesiologist)...don’t worry it’ll be fine.” Then I see the oxygen mask appear over my mouth. Realizing I wasn’t going to die, I went back to sleep.

Moral of the story: don’t read Robin Cook books before surgery.

 

[6miths]

The deeper you go the further you have to come back. Rarely someone doesn't make the return trip. Interesting to hear people having GA for tooth implants, knee scopes and colonoscopy. Likely these would not be true GAs with intubation and ventilation but just a deeper level of sedation. Regional anesthesia is an option for surgery on limbs. I had light sedation for colonoscopy but the GI guy said probably reasonable not to bother next time as visualization was quite easy.

 

[W2R]

I hope the procedure was resoundingly successful, Alan!!!

+1000 So glad you have this behind you and no apparent complications occurred!

Given the option of local or general which would you prefer to have?

I would choose the best surgeon I could find, and I would follow his advice and that of his anesthesiologist. I assume that they would be on the same page about this. General anesthesia is usually thought to be riskier than local, so if the surgeon recommends it then he probably has good reason to do so.

When I had my cataract surgery, it was with local anesthesia. There is no patient on the face of the earth who was more terrified of a surgery than I was with those. This was due to my grandfather's 100% blindness being due to botched cataract surgery back in the 1940's. Granted, surgical techniques are lightyears advanced by now, but sheer terror is not always an entirely logical emotion.

Anyway, the idea of somebody carving on my eyeball was not exactly my idea of a great time. When they told me it would be a local anesthetic, I blinked a few times, felt like fainting, took some deep breaths, and then said...…(!)……(gulp)……"er, OK". I was far beyond scared, but knew I had an excellent surgeon.

The surgery took 4 minutes and was completely painless and not frightening at all. Frank drove me to and from, and afterwards we were on our way home in a jiffy.

Like you, I am so glad I did not object to local anesthesia.

 

[Katsmeow]

Over 20 years ago I was having a procedure that was to be done under general anesthesia. I also knew it could be done under some type of anesthesia that wasn't general but I wouldn't remember anything. Anyway -- it was determined it be under general.

When I woke up, I felt tired and awful. But -- no surgery had been done. There had been an issue that caused them not to be able to locate the area in my body that was being operated on so no surgery occurred. The only thing that had happened was I had gone under general anesthesia. But I felt bad for about 24 hours and it was totally due to the general anesthesia.

Anyway - subsequently the procedure was done again and this time the non general anesthesia was done. To me - it was the same in the sense that I didn't remember anything afterwards.

The difference was that I woke up and felt great. I remember being in the recovery room talking on my cell phone and feeling totally fine. The first procedure I had felt awful for 24 hours. This time, I felt fine within half an hour of waking up.

Since then, I always do non-general anesthesia if I can. I have had general anesthesia several times.

 

[cbo111]

For a lot of us with enlarged prostates, heavy sedation can result in problems. Often, the bladder "goes to sleep" during the procedure and is very slow to wake up. This requires a catheterization for several days which is a real treat!

 

[Gumby]

Let me cast my vote for propofol. In addition to colonoscopies, I've had it two separate times during surgery to remove tumors. What a great drug. It was like the best sleep I've ever had, without any long lasting effects. I did once have general anesthesia, and a spinal tap, for knee surgery in 1979. I felt like crap for days.

 

[aja8888]

Let me cast my vote for propofol. In addition to colonoscopies, I've had it two separate times during surgery to remove tumors. What a great drug. It was like the best sleep I've ever had, without any long lasting effects. I did once have general anesthesia, and a spinal tap, for knee surgery in 1979. I felt like crap for days.

\

Good stuff that propofol!

 

[NoMoreJob]

I'll choose whatever the doctor recommends. My primary concern is that (s)he is comfortable with my condition during the procedure.

 

[Telly]

General, and make it at least 3 stars!

I have had two abdominal surgeries under general, with breathing tube. No problems afterward, throat really dry after the first time, some sips of water after fixed that. Never knew the tube was inserted, or removed.

Had hand surgery where I needed to move it at certain times during the operation, so it wasn't going to be "general". I was going to be monitored and adjusted very closely, both Doc and the Anesthesiologist were aware of my concerns. I was to be brought "up" only enough for me to understand and do proper movement, with Doc yelling at me, then down again. My level of consciousness was mostly determined by them talking with me.

Have used generic Halcion for root canal and crown work, that was great. Sleep! Sleep! Took two pills at home one hour before start of procedure. No problems, but must be driven by someone there and back. And slept for most of the way home, and an hour or so beyond that when back. It's got to be the cheapest easiest anxiety reliever ever. No worries! And the time goes by just like that.
Tried Nitrous Oxide for a crown work (no root canal). Found I'm resistant to its effects, had to have them run it at the max for quite a while to have any hope of it working on me. It did take the edge off, but time went by slow. They won't keep it at the max the whole time due to many people having a sudden, involuntary, forceful vomit effect.

I don't know if it has any relevance (my resistancy I mean, I know the chemicals are totally different!): Some years ago in an emergency room, then on to in-patient for surgery, I found that I am totally resistant to Morphine, at least at the max level that they finally stepped me up to trying to get an effect. They decided not to back up a tanker truck. Switched to Hydromorphone, that finally had some pain reduction effect, but not anywhere near what was expected. The whole idea of "pain management" just wasn't working well for me.

 

[gcgang]

As I was being wheeled in to surgery for the broken ankle suffered the night before playing soccer, the anesthesiologist asks the question OP posed. Local or general? I ask, what's the difference? His reply, local you can be paralyzed from the waist down, General you might not wake up. Wtf? Put me out. Some docs lack bedside manners. Lol.

 

[Just_Steve]

I have had several operations and procedures but guess never a general because was never intubated. Whatever shots of whatever substance worked wonders.

 

[skipro33]

Had hernia surgery and they knocked me out. Can't imagine that on a local only. Heck, my neuter surgery was local and I was shaking like a dog dumping a peach pit. I was also knocked out for a wisdom tooth extraction. Woke up in a chair after I had been laying down on a table last I remember.

 

[GoodWishes]

I would ask what the doctors recommend. I try to have as little medicine as possible. I believe all medicine have various short term/long term side affects even if I don't feel any. So I carefully weigh the benefits vs risks.

 

[Alan]

I hope the procedure was resoundingly successful, Alan!!!

But that does sound like a scary procedure. Let us know how it turns out for you!

+1000 So glad you have this behind you and no apparent complications occurred!
.

So far so good. I was told I may expect to feel palpitations and episodes of AFib over the first few days but nothing yet except a good steady rhythm. I’ve had 87 recorded instances of irregular heart beat this year on my bp monitor, 55 of them were AFib, as recorded on my Alivecor device.

Follow up appointment is in 3 months and I stay on the blood thinners until then. If all is still well then it is declared a success otherwise they may have to go in for a “touch-up” to ablate more areas using RF ablation. I’m hoping I will be in the 70-75% that have a first time success rate.

My wife had a local for her cataract surgery a month ago and will be going in again very soon for the other. Her complaint is about how bright it is, since the eye is dilated and she found that was the worst part. She had an eye test yesterday and goes back to the ophthalmologist on Monday who she hopes will tell her he will operate later this week.

 

[HFWR]

Wake me when it’s over.