Sedation or Anesthesia?
September 16, 2019 7:21 AM   Subscribe

I have to have a hysteroscopy to remove some uterine polyps. My doctor has offered sedation or general anesthesia. What are the benefits/risks of each?

I have never had anesthesia. I had sedation once and I'm especially concerned with the recovery period in the hour or two after and the loopy/out-of-it/chatty part. I can get very mean and even violent in that period. Is the same true of anesthesia? This is giving me lots of anxiety.
posted by anonymous to Health & Fitness (11 answers total) 1 user marked this as a favorite
You might want to ask your doc if there's any choice in medication, since you had an unfortunate reaction to the last one. In general, sedation is better if you can deal with it, and cheaper — fewer people involved and usually a faster recovery time. But some people cannot deal with the procedure at all, and full anaesthesia is better for them.
posted by ubiquity at 7:31 AM on September 16, 2019 [2 favorites]

I have had a number of procedures that involve general anesthesia, including a few where local was an option. I will always take general over local. I don't want to be around for any of it.

As for how you react when coming out of it: the staff will have seen everything, literally everything. They will be prepared to deal with any of your behavior coming out of anesthesia, and they won't hold it against you. It's pretty well known that people often behave in ways they never would otherwise.
posted by fiercecupcake at 7:47 AM on September 16, 2019 [5 favorites]

I’ve had both. My last operation was a knee replacement lasting several hours, under sedation (plus epidural). I am far from squeamish or easily upset, but I found the sedated experience really traumatising. I vaguely woke up a few times, and it gave me a profound sense of upset. Personally, as long as there were no medical reasons against it, I would have a general every tine.
posted by JJZByBffqU at 9:02 AM on September 16, 2019 [3 favorites]

I had extreme nausea for two days after my last general anesthesia. Just another thing to consider. I would always choose conscious sedation, but then I have never had any problems with conscious sedation. For me it feels the same as being asleep.
posted by something something at 9:05 AM on September 16, 2019

My doctor took two attempts to get my uterine polyps out - first one with no sedation or anesthesia. It was painful but fine, I knew it'd be over in 15 minutes so it was bearable. But she couldn't get them, so I went back for anesthesia another time and had day surgery. it was my first anesthesia too, and I was daunted, but it was fine. I was sleepy in a kind of nice way for a few hours afterwards, and had to arrange for someone to drive me home, and to be with me at home for... I think 24 hours after.

My main lesson learned was that I wish I'd taken longer off work afterwards to recover. I took a few days, but then went straight back into a super-busy, high adrenaline, 10 day event at work, which was really stupid. It did a number on my mental health as much as anything else - I suspect the anaesthetic plus exhaustion caused that. So plan to go easy on yourself afterwards if you do go for anaesthesia.
posted by penguin pie at 9:15 AM on September 16, 2019 [1 favorite]

I’d get anesthesia because it allows the doctor more flexibility. My understanding is that uterine polyps vary a lot in terms of how hard/easy they are to extract.
posted by internet fraud detective squad, station number 9 at 9:34 AM on September 16, 2019 [1 favorite]

Communicate with your anesthesiologist about your experience coming out. They have tricks and knowledge to keep that from happening again. Even if you go with sedation, they should be able to minimize or eliminate that reaction.
posted by stoneweaver at 9:43 AM on September 16, 2019 [3 favorites]

Anesthesia is known to cause constipation, so if that’s something you want to skip, go for sedation. It can also take many weeks for your brain to feel back to normal. Given the option, I go with sedation followed by propranolol to prevent traumatic memories from settling in deeply. I find it very difficult to get my guts working properly again after general anesthesia, and hate that I don’t feel as sharp for a long time following. They’re both very safe choices, but in terms of side effects, they’re not really comparable. Since most doctors are focused on the big “will it kill you” question, they’re not great at taking in to consideration or disclosing the other considerations.
posted by stoneweaver at 9:51 AM on September 16, 2019 [1 favorite]

Whenever I have a cavity I go to the dentist and have to endure them trying it with nothing and then with sedation so I can show them that sedation does nothing for me. I would never choose anything but anesthesia when anesthesia is a choice.
posted by bleep at 11:25 AM on September 16, 2019

Absolutely no one can answer this question for you except an anesthesia provider. You will have a preoperative appointment or phone call with an anesthesia provider specifically to discuss your medical history, the risks and benefits of different types of anesthesia, and what to expect the day of surgery, and you’ll have the opportunity to ask questions.

Ignore the rest of the information you’re hearing—it’s either incorrect, largely speculation, and/or anecdata that has a good chance of being irrelevant to you and your experience.
posted by jesourie at 1:20 PM on September 16, 2019 [2 favorites]

I just had this procedure today! I was only offered general, but even if they'd offered sedation, I would have chosen general. After wide awake hysteroscopies, I was happy to sleep through this one.

Nthing recommendation to take the day off, if you can, to give yourself permission to rest.

Do talk to your anesthesiologist about your concerns, as soon as you are able. You may not be offered access to the anesthesiologist before the day of surgery. Consider asking to chat with her beforehand. This is your right as a patient. A wise anesthesiologist will be happy you're helping her plan in advance.

Possible additional questions:
- Will you be intubated?
- How the removal will be done (scalpel? laser? little vacuum?)
- Any medications you should start when you get home?

Anecdotally, I've been under general five times in the last three years. No adverse or lingering effects. Lights out, some gentle dreaming, then lights on, feeling comfortable and relaxed.

In contrast, the few times I've been under sedation (dental work), there was a window of "not myself" -- to varying degrees -- once to an extent that was scary. I can understand not wanting to repeat that. For me, general has not been like that.

Naturally, your mileage *will* vary, and your anesthesiologist will be the best source of guidance.

Good luck, and speedy recovery. May this all be behind you soon.
posted by AteYourLembas at 3:52 PM on September 16, 2019

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