What are the side effects of general anesthetic?
August 12, 2010 9:58 PM   Subscribe

Are the common side effects of general anesthetics REALLY that common? What if I eat toast beforehand?

I am having surgery tomorrow. I can't tell you what it is because it may cause this to turn into a different sort of discussion.

I apparently have only one option when it comes to anesthesia; and that's general. So my appointment is at 8am, I have to stop eating tonight at 12am. But there's a few major issues for me:

1. I have an enormous phobia of vomiting (emetophobia); and
2. I can't go more than an hour or two without eating otherwise I get nausea and throw up!

So I guess what I'd like to know is:

Does EVERYONE get nausea after waking up from a general? And for how long?

Would it be okay if I took a couple of anti-emetics (i.e. Maxolon) beforehand?

Would it also be okay if I just had a slice of toast or some crackers since I've taken some anti-emetics and should technically not be throwing up anyway?
posted by foxy to Health & Fitness (40 answers total)
Your doctor gave you specific orders. I would suggest you follow them. Surgery and anesthesia is serious business.
posted by sunshinesky at 10:02 PM on August 12, 2010 [9 favorites]

You need to tell the nurses in admitting in the morning that you have taken anti-emetics and what food and liquids you ingested and at what time. They tell you NPO for a reason, it is no joke.
posted by mlis at 10:07 PM on August 12, 2010

I really, really wouldn't eat anything beforehand. When I was given the wrong info before having my wisdom teeth out, I ate three bites of a bagel that morning and then was told that because of that, I'd need to reschedule the procedure if I wanted general anesthetic. If the anesthesiologist finds out that you ate something, chances are huge that they won't be willing to go through with the surgery. There's a reason they tell you to not eat beforehand--while everyone doesn't necessarily experience nausea from general anesthesia, the issue of aspirating your own vomit is a serious one. Do you really want to risk getting stomach acid in your lungs? (I know that's gross, sorry if it's a trigger for you.)

Explain your situation to them; it won't be the first time they've heard it and they may be able to give you an anti-emetic in your IV. FWIW, when I was put under for emergency surgery, I had zero nausea coming out of it.
posted by corey flood at 10:07 PM on August 12, 2010 [2 favorites]

I've been under general anesthesia. I didn't want to at first - for my surgery, at the last minute, I switched my procedure to a laparoscopic one which required general as opposed to local anesthetic - for pretty much the reasons you cite. I am a ball of anxiety even under the best circumstance. I'm also, like most people, a bit fearful of the unknown and the idea of the (small) risks general anesthesia carries.

What wound up happening, after encountering this terror called general anesthetic? I fell asleep on a table and woke up in a chair. No side effects. I felt great, considering the circumstances.

That said, you should follow your doctor's orders. Anesthesia is, as sunshinesky accurately points out, very serious business. They're not telling you to skip breakfast out of pique - the orders are meant to help you. IAAD, but my understanding is that food in the stomach can interfere with the anesthesiologist's ability to give you the correct dose. Seems best not to mess with that.

Surgery is scary. I'm sorry you'll have to go through with it. On the bright side, though, after tomorrow you'll understand that it's not such a big deal after all. Best of luck.
posted by Sticherbeast at 10:08 PM on August 12, 2010 [1 favorite]

Honestly it depends. If you are getting something like a colonoscopy or anything done to the stomach/colon region then its absolutely no food because fecal matter can block the view of certain things, especially a camera.

You should definitely consult your doctor about the other stuff, or even call the office and ask the assistant/secretary (these might even be common questions they get asked all the time).
posted by BurN_ at 10:10 PM on August 12, 2010

Contact your doctor or anesthetist first thing tomorrow. They need this information for your safety, and may also need to reschedule your surgery.

In the future, you should bring up these issues well in advance with your doctor.

Please do tell them. This is important for your health and safety.
posted by zippy at 10:11 PM on August 12, 2010

I was given an anti-emetic before I woke up in my recent surgery. I was told they were going to give it to me before I went under - but was told by a friend to ask for it if it wasn't offered. I'm thinking this is fairly standard practice these days.
I had to sign something that said I hadn't eaten anything and that if I had - surgery was going to be rescheduled. As mentioned, serious business. Sleep is your friend - go to bed early and wake up just in time to get yourself to the hospital. Good luck in your surgery.
posted by Wolfie at 10:11 PM on August 12, 2010

Do not eat. You will not have your surgery; they will refuse. Don't lie about it, they refuse for a good reason, you could become seriously ill and/or die.

I can't go more than an hour or two without eating.

So you're telling us you wake up 1 or two hours every night to eat something otherwise you throw up??? You - everybody - can go a long time without eating. A loooooong time. I'm betting you manage to go circa 8 hours without eating several times a year, if not every night. Don't make this bigger than it is; follow the doctor's orders and explain your anxiety in the morning.
posted by smoke at 10:17 PM on August 12, 2010 [2 favorites]

It's not a case of having nausea when you wake up. It a case of might you have nausea while you are under; if you do you might not be able to vomit it all the way and then you would choke. Yeah, the doctors would probably be fast enough to take care of you, but it will make the whole procedure longer and have greatly increased the chances of complications. Really, keep your stomach empty, and don't, don't take any other medications just before anesthesia.

It's only an eight hour fast, and that might seem long but you can do it.
posted by Some1 at 10:18 PM on August 12, 2010

So you're telling us you wake up 1 or two hours every night to eat something otherwise you throw up???

Yes that's exactly what I'm saying. I'm 8 weeks pregnant ;) The surgery are well and truly aware of this. Perhaps I should have added that before.

If I eat, I am hungry again no more than an hour later, so hungry that it REALLY hurts and makes me nauseous. I wake up numerous times through the night and snack on crackers or corn cakes.
posted by foxy at 10:29 PM on August 12, 2010

It's too late to bring this up now. Either follow the orders and have your surgery, or reschedule the surgery and talk about this with your doctor, not AskMe.

If you don't follow the rules, your risk of dying increases. Do you want to die?
posted by jrockway at 10:37 PM on August 12, 2010

I had surgery a few weeks ago and mentioned to the that nurse I saw before the surgery that I get very nauseous from general anesthesia. They gave me a scopolamine patch to wear behind my ear which helped a lot, and also an Rx for Reglan to take after I was done with the patch. I didn't even need to take the Reglan, the little patch worked really well. They told me that they usually tell people to put the patch on the day before. Maybe if you're in this situation again you could ask for the patch the day before so you won't end up in this situation again? I know that's not super helpful right now though :(

Bottom line is definitely mention your concerns to the nurse, I imagine they will do the best they can to help you control your nausea.

I know surgery is scary and puking totally sucks. I am wishing you the absolute best of luck though!
posted by capnsue at 10:50 PM on August 12, 2010

I have never puked from anesthesia -- not when I went under for my wisdom teeth, not when I had major elbow surgery. Puking is not a given.

Do NOT do anything without the doctor's orders. They don't want you to puke, either.

Chew or suck on some ice if you have to.
posted by Madamina at 11:12 PM on August 12, 2010

Absolutely don't eat against the doctor's orders. One of two things will happen if you do. Either the surgical team will find out you ate and not do the surgery or they will not find out you ate and you will possibly endanger yourself. Neither is a particularly good outcome.
posted by Justinian at 11:19 PM on August 12, 2010

I've had 8 generals in my life, only slightly nauseous from one.

no one here is going to tell you it is ok to eat prior to surgery, that can ONLY come from your medical professionals.
posted by edgeways at 11:25 PM on August 12, 2010 [1 favorite]

I have had general anesthesia several times. The one time I woke up nauseous, I thought it was more from the morphine drip than the general. My theory is that it is better to wake up nauseous than to wake up dead.
posted by JohnnyGunn at 11:27 PM on August 12, 2010 [1 favorite]

I would add that people get operated on under general anesthesia who have recently eaten all the time due to emergency circumstances. Eating first significantly raises the risk of complications unnecessarily. It is only when the risk is outweighed by the risk of not operating. Elective surgery can usually always be postponed.
posted by JohnnyGunn at 11:29 PM on August 12, 2010

Please don't eat. If this is a dealbreaker for you right now, call your doc, get the on-call, and discuss it with them ASAP, before you're tempted to eat.
posted by fairytale of los angeles at 11:31 PM on August 12, 2010

Does EVERYONE get nausea after waking up from a general?

No. I've had general anesthesia several times and never had a problem with nausea.

Would it be okay if I took a couple of anti-emetics (i.e. Maxolon) beforehand?

Ask your doctor or nurse.

Would it also be okay if I just had a slice of toast or some crackers since I've taken some anti-emetics and should technically not be throwing up anyway?

Absolutely not. Your doctor gave you specific orders for good reason. If you are truly not willing or able to follow your doctor's orders, you need to notify your doctor or nurse immediately.
posted by scody at 11:35 PM on August 12, 2010 [1 favorite]

When I had my surgery, I also wasn't allowed to eat hours beforehand. However, right before they took me in (I wasn't under general, but still), they gave me an antacid and then made me drink this stuff that absorbed stomach acid so that I wouldn't experience a.) nausea, and b.) vomiting. You know what? It worked great! I felt great as far as my stomach went. I, too, suffer from the horrible fear of throwing up, so I asked a bajillion questions beforehand. You actually LESSEN your chances of that happening if you stick to doctor's orders. Make sure that you don't do ANYTHING without consulting with your doctor beforehand!! It'd be a huge pain to have to reschedule everything because of something so simple. Best of luck!
posted by I_love_the_rain at 12:35 AM on August 13, 2010

I've had a general a couple of times, and I felt crummy afterwards, but no nausea. In fact I had a great appetite and could eat and eat and eat. So you aren't necessarily doomed.

Do not mess around with instructions that are designed to stop you dying in theatre. If this is a show-stopping problem for you, seek advice from the anaesthetist now.
posted by i_am_joe's_spleen at 1:55 AM on August 13, 2010

Chew or suck on some ice if you have to.

Please do not do this unless you were specifically told you could have fluids. Nil by mouth means nil by mouth and is for a reason.

Make the surgery as easy as possible on everyone. I'm sure the doctors & nurses don't want the extra excitement of say, your lungs filling up with fluid while you're under the general anesthetic.
posted by goshling at 2:11 AM on August 13, 2010 [1 favorite]

People are saying they didn't have nausea - but how do they know? They were under general anaesthetic at the time.

Once you are under, they are going to stick a big tube down your throat. I'm guessing there may be issues with this triggering a gag reflex - and you won't know whether you gag or not, because you'll already be lights out. By that time, your life is in the hands of the anaesthesiologist, and the contents of your stomach ending up in your lungs because your throat is full of tubes is probably going to be a crappy start to his day :)
posted by -harlequin- at 3:10 AM on August 13, 2010 [1 favorite]

I have never had problems with nausea from general anesthesia, but I know some people who get very nauseous after surgery. I guess this is something that varies from person to person.

Do not eat anything before surgery, and DO NOT TAKE random medication without prior consultation.
posted by HFSH at 3:14 AM on August 13, 2010

I throw up every time and even with twilight sedation. Last round of surgery they had maxilon on hand to administer intravenously because not throwing up was really really important.

While I was in recovery they rescheduled three people who had eaten and/or drunk during the fasting period. Three people who then needed to go through all the crud of rescheduling and fasting again, all because they needed a drink of water/juice/tea, that jelly cup etc.
posted by geek anachronism at 4:01 AM on August 13, 2010

I have had 3 surgeries with general and i havent thrown up when i woke up. I would just try to get over your fear of throwing up. General anesthetic can actually KILL you if done wrong. Just do what they ask of you.

Also eating before hand when told not to can effect the absorbtion rate and cause you to wake up during the surgery.

My fear of the side effects would outweigh my fear of throwing up.
posted by majortom1981 at 4:23 AM on August 13, 2010

1. Do what the doctors say, they really do know best.

2. I have had general anaesthesia several times, the trick is that when you come round, immediately say you feel nauseous and can you have something for it. You will most likely have a central line in so they can give you an injection that will take effect in about 30 seconds.

I hated feeling sick post-surgery so the last two times I just asked for it anyway, regardless of wether or not I felt sick. The drugs really do work, thats what they are for.

3. Do what the doctors say, they really do know best.
posted by gaby at 4:38 AM on August 13, 2010

There are so many unknowns about your procedure and your health in general that there is no way anyone here can give you specific advice. So please, follow your doctor's orders about not eating.

Anecdotally, I have been under general anesthesia and have also had twilight and an epidural several times in the past 10 years. I too was afraid of the vomiting on an empty stomach... but have found that to be a myth. Anesthetics today are not the anesthetics of 20 years ago. I have never, ever thrown up after anesthesia OR even felt nauseated after a procedure. I've had an appendectomy, two bunionectomies, my wisdom teeth out and have also delivered a baby with an epidural. No problems, in fact I felt awesome after waking up/recovering. The drugs are short-acting and pretty amazing these days.

Best of luck on your procedure and your pregnancy.
posted by FergieBelle at 6:12 AM on August 13, 2010

Coming late to the party-by now your choice has been made and you are having your surgery or not. But wanted to add one more thing....you should start dealing with the fear of throwing up now if you are pregnant. Even if you make it the whole way through morning sickness with no vomiting, I've been told that lots of women vomit during labor. I was so concerned about it that I figured I wouldn't eat so I couldn't vomit. Yeah, I was in labor for almost two days. That was a long time to suck ice.

So hope everything went well, you followed orders, and had a successful surgery.
posted by supercapitalist at 6:26 AM on August 13, 2010 [1 favorite]

As others have mentioned, do not change what you have been told to do without discussing it with your physicians (and I see it is probably too late to help you, but I am answering anyway for the benefit of anyone else who reads this.

The purpose of preoperative fasting is not to prevent nausea and vomiting, but to prevent the aspiration of gastric contents. Depending on what you eat or drink it can take 2 to 8 hours to empty your stomach (more in some situations). During general anesthesia you lose the reflexes (like gagging and coughing) that normally protect your airway and it becomes much easier to aspirate gastric contents. If that happens, the combination of stomach acid and chunks of food can cause a nasty aspiration pneumonia. This can be life threatening, as was dramatized in the movie The Verdict. Most cases aren't as bad as that fictional one, but it is still something that anesthesiologists take very seriously. The American Society of Anesthesiologists even has a task force that keeps track of all the relevant scientific literature and promulgates Guidelines for Perioperative Fasting that are the basis for the usual instructions to not eat anything after midnight. If you look at the guidelines you will see that there is some room for variation, but in my experience if you tell people anything more complicated than "nothing after midnight" there is a good chance they will screw it up. By far the most common reason to cancel or delay surgery in the OR where I work is failure to follow the instructions on eating or drinking. The fact that you are pregnant complicates all this in that pregnancy delays gastric emptying and makes you more at risk for aspiration. The risk is small and there are ways to reduce it further, but given that anesthesia is extremely safe when done properly, even a small risk is taken seriously.

As for your concern about nausea, it is much less of a problem than it was many years ago. Newer anesthetic agents are less likely to cause nausea than the older ones, and there are more and better anti-nausea drugs available. Having said that, nausea is still a problem and it has many causes. The type of surgery, the type of pain medicine used, other medical conditions the patient has, and other factors (some still unknown) all affect the chance of having nausea after an anesthetic. If you are concerned about nausea the best thing to do is tell you anesthesia provider about it (they should talk to you and give you a chance to ask questions before your surgery) and they can come up with a plan to minimize the chance of any problems.

I hope everything goes smoothly, and if you want more detailed information related to your anesthetic, feel free to memail me.
posted by TedW at 6:47 AM on August 13, 2010 [8 favorites]

Due to a run of crap health luck over the last two years, I've been under general anesthesia seven times, with another surgery scheduled for this September. I never had a bit of nausea. Also, with one surgery while I was hospitalized, I was scheduled to have it late in the day (around 6pm), so they brought me breakfast. I had eaten half a bagel, when an orderly appeared to take me to my newly rescheduled morning surgery. I explained that I had eaten, but no one seem to care much since it wasn't very much (including the anesthesiologist).

However, certain people have a sensitivity to anesthesia, like my aunt. She always has problems. Always.
posted by kimdog at 6:48 AM on August 13, 2010

I was put under for the first time to have my wisdom teeth extracted last year. I have a somewhat sensitive stomach, and like you, was freaking out about the procedure and possibility of throwing up.

It went something like this:
1. Anesthesiologist begins administering the medication. "I want you to count to 10."
2. One, tw......................NO CARRIER........................
3. "What the hell? I was just laying down. Why am I in a chair? Why does my mouth feel funny? Is this real life? I should try to stand up. Whoaaaa....bad idea!"

Notice: No mentions of extreme pain, nausea, or vomiting. Your mileage may vary, but in the end, I felt rather silly about stressing about the procedure.
posted by schmod at 7:01 AM on August 13, 2010

You should really discuss this with your doctor. Maybe you could eat some Jello, and maybe small sips of water. But it's really important that your health care team have all the information and that you follow their advice. Good luck.
posted by Mom at 7:13 AM on August 13, 2010

Follow the doctor's orders, but explain your condition.

I had very bad nausea following general anesthesia. It went away once they gave me some food and an anti-emetic.

My partner had very bad nausea following general anesthesia. She asked for an anti-emetic, which they gave her, after cautioning her that it might make her drowsy.

Before my surgery, I was on a lot of morphine, but not allowed to eat or drink for 12 hours. I was incredibly nauseous and hungry/thirsty. They gave me this really creepy sponge lollipop thing that was flavored with some sort of artificial flavoring. I sucked on this sponge-on-a-stick for about 8 hours.

For the nausea I asked for an anti-emetic like Compazine, which really freaked the ER staff out. "How do you know the names of drugs? Who taught you the word 'anti-emetic'?" I replied that I used to watch the TV show "ER." "ER? There's a show about an ER? What?" Digression aside, I got my anti-emetic and drifted off.
posted by MonsieurBon at 9:29 AM on August 13, 2010

For anyone else reading this, TedW has it exactly right. General anaesthesia typically involves both a drug to put you to sleep, and a drug to paralyze you temporarily so that a ventilation tube can be placed into your lungs. While paralyzed (or even if just well and truly asleep from the first drug), you are unable to prevent your stomach contents from leaking backwards into your esophagus. This has nothing to do with nausea or vomiting -- it's caused by relaxation of the sphincter between your esophagus and your stomach. If you go into surgery with a stomach full of toast, that ball of food+stomach acid can wash up into your throat and get aspirated into your lungs, which tend to react exactly like you'd imagine delicate tissue would if you toss a bucket of acid on it. The risk of aspiration is higher if you are pregnant (unaccustomed pressure on your abdomen due to fetus/weight gain, as well as a general tendency of all your tissues to stretch and relax, making it harder for the esophageal sphincter to do its job) or overweight. Please do not ignore the fasting orders given to you by your physician, and if you need to break the fast for any reason, let the anaesthesiologist know so they can decide whether the surgery needs to be postponed.
posted by TheLittlestRobot at 10:27 AM on August 13, 2010 [2 favorites]

The purpose of preoperative fasting is not to prevent nausea and vomiting, but to prevent the aspiration of gastric contents.

A piece of toast could kill you.
posted by KokuRyu at 10:27 AM on August 13, 2010

Sorry to be so late to the show but another emetophobe here. Or rather former. Hypnosis really helped me get over the worst of the phobia. As for surgery, scopolamine did wonders for me too. Talk to your anesthesiologist about it during pre-op; we're not that uncommon. Good luck!
posted by tigerjade at 10:50 AM on August 13, 2010

Is throwing up worse than dying? Follow your doctor's orders.
posted by jjb at 11:11 AM on August 13, 2010

Yes, throwing up is worse than dying for an emetophobe.

Thanks for all your comments folks. My question would have been better phrased like - Will I vomit fluid into my lungs if I eat and take an anti-emetic before the anesthetic. Because they're supposed to stop me from vomiting - but I guess that's not a sure thing.

But anyway, I spoke with the anesthesiologist who decided that because of my GORD, I was best to not go under general for the same reason that I wouldn't be able to if I ate! Fancy that. I was sedated instead, and given a shot of Ondansetron for my worries about nausea, and everything went just swell! And I feel great now!
posted by foxy at 6:30 PM on August 14, 2010

Really glad to here it worked out so well for you, and props for letting the pros know your concerns. :)
posted by smoke at 8:53 PM on August 14, 2010

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