Turtle

One factor in the decision of what type of anesthesia is used is personality. The procedure - how painful, how much nerve manipulation, how long, location, is the most important. Then comes health issues, general surgery for a minor surgery for a patient with heart problems is dangerous, and avoidable. There are various kinds of regional anesthesia, from a spinal block, to a regional block that may make the whole arm insensate, to a bier block that works on the hand, to a digital block for a toe or finger. Local anesthetic injected around a nerve or nerve plexus. Patient preference is another big one, from the ones who hated the idea of being out of control and want as little sedation as possible, to the ones who "want to be knocked out!" On one day, a patient only wanted a block, and no sedation at all, for a surgery that would have warranted a general anesthetic. Once in the OR, we found out her father died under general anesthetic. She did very well, even watching the surgery on the monitor, very cooperative and pleasant throughout. Even with a tourniquet, which is often the limiting factor, even with complete numbness, the limb starts to ache intolerably.


Finally, there are those who may not want to be intubated, but wind up too anxious and unable to tolerate being still or unable to follow directions once surgery starts, who become a danger to themselves. One should not thrash about when a surgeon is wielding a scalpel around delicate tissues. It's always an option to ramp up the level of anesthesia.

The word we use for them is Squirrely. Not a factor of age or gender, but core personality. Once spotted, it's a sure sign of propofol shortage.

Having had a few minor surgeries on myself, I'm pretty sure I'd want, and be able to tolerate, the least anesthesia possible. I just hope I never need any ever again. But I am, at center, not at all squirrely.

More turtley.