General anesthesia: Should I?
May 12, 2024 11:38 AM   Subscribe

I’m scheduled for general anesthesia tomorrow and I made the mistake of looking up information on the web about it. I’m looking for help to decide whether to cancel it or not.

54 year old male with diabetes that I haven’t been very good about controlling of late. Also obese. This is for an MRI at a radiology clinic and I’m a bit nervous that they’ll err on the side of getting the scan done when it comes to my suitability for general anesthesia. My current glucose levels wouldn’t trigger any hard limits, but they’re high.

Finding an open MRI would remove the need for anesthesia but would likely require flying to another city. Which I’m prepared to do after terrorizing myself online. I’m looking for a saner opinion either way.
posted by Tell Me No Lies to Health & Fitness (16 answers total)
Best answer: When I have had major surgeries with general, each time the anaesthesiologist came and spoke to me before the procedure. Both times it put my mind at ease, especially for the first one where I’d never been under general before. (I was very nervous about it.) Is there a way you can ask to speak to the anaesthesiologist today?

Can you call the radiology clinic and explain your fears to someone there? They should be able to put you in touch with someone who can talk this through with you. I’m kind of surprised they didn’t do that before, to be honest.

I also think that the fact they scheduled this procedure with you and didn’t warn you about anything (it sounds like you thought things were fine till you started searching the internet) means they think you are a good candidate for general anaesthetic, for what that’s worth.
posted by hurdy gurdy girl at 11:45 AM on May 12 [5 favorites]

Is there a specific reason why you can't do the MRI awake? There are certianly anti anxiety medication options that are much less invasive than general anesthesia. You wouldn't be able to drive home after but it would help if that's your concern. General anesthesia would actually be very uncommon for an MRI.
posted by AlexiaSky at 11:50 AM on May 12 [7 favorites]

Response by poster: I chatted with the anesthesiologist on the phone but the topic of diabetes did not come up, which is part of why I’m suspecting what I find online is overblown.
posted by Tell Me No Lies at 11:51 AM on May 12

Best answer: I have a father who is an anesthesiologist and I am incredibly relaxed about general anesthesia and I think general for an MRI is an unnecessary risk in the worst case scenarios: Nurse anaesthetist, stand-alone facility not in a hospital, no MD on site. That setup can happen in some states.

That does not seem to be your situation at all, from your phone consult, so I would go ahead but test your blood sugar on site to be able to provide an up-to-date reading.
posted by DarlingBri at 11:55 AM on May 12 [4 favorites]

Would it help to think about the fact that you can talk to the doctor again tomorrow, and cancel then if they can't assuage your concerns? It's not like today's your last chance to cancel -- they shouldn't put you under without your consent in the moment.
posted by lapis at 11:59 AM on May 12

Best answer: From a relative's experience, general anaesthesia (for actual surgery) needed them to stop their diabetes regimen three days earlier. I take Metformin for other reasons and my doctor said the same (also surgery). That's definitely worth mentioning. Are you sure it isn't twilight sedation instead?
posted by I claim sanctuary at 12:39 PM on May 12 [1 favorite]

I am not a diabetic. I love general anesthesia. I had about 7 surgeries in 2022-23. So very glad I wasn't really a part of them. Good luck. Talk to them.
posted by Windopaene at 12:50 PM on May 12

A less than 2% chance of this being pertinent ... do you have red hair?
posted by falsedmitri at 1:31 PM on May 12 [1 favorite]

I also wonder if this is actually twilight sedation rather than general anesthesia. More like what you’d have for a colonoscopy rather than an abdominal surgery.

The fact that you’re having any kind of sedation for an MRI indicates that there may be some anxiety at play here. Just be sure you’re not feeding into it by over researching. The best thing to do is to talk with the clinic and double check that your diabetes won’t be an issue.
posted by jeoc at 3:59 PM on May 12 [4 favorites]

Around your age, Very Large Man, 6'4", obese but no longer super obese.

Have they explained why you need sedation for an MRI? I'm old enough, and have lived an active life enough, that I have needed several MRIs at this point, none of which I have ever experienced any sedation for. (I actually find laying in a clicking tube with headphones listening to my favorite radio station quite relaxing, but I know that's not universal.)

Is this actually what is generally considered "general anesthetic" or is this a situation where they are going to simply "put you to sleep"? I had fairly invasive hip surgery several years ago, with a combination of local anesthetic and being fully tranquilized, but without what is considered "general anesthetic". I went to sleep, much work was done, and I woke up, but never got proper "general anesthetic". The risk factors seem to be very different. I have had proper general anesthesia, during gallbladder surgery several decades ago, and while it seemed roughly the same to me, it was apparently a rather different process.

Which is to say, it's hard to provide guidance without more information on why you're being sedated or just how they're sedating you. If I were you, I wouldn't cancel, but I would certainly be sure to disclose any and all health information the anesthesiologist may not have been aware of in advance of the procedure. And, if it's possible, maybe see if you can do the MRI without sedation?
posted by I EAT TAPAS at 4:40 PM on May 12 [1 favorite]

Best answer: I had a friend who required general anesthesia for an MRI because their had a disorders that caused them to move involuntarily. They were worried about the anesthetic because of their disorder and the anesthesia, but they went forward because the information that MRI would give them and their treatment team was worth the very small risk.

So I would also keep in my mind what you need this MRI for, and that in most circumstances, general anesthesia carries a low risk. I would make sure our provider knows your BG morning of and that they were OK with your worst recent A1C.
posted by spacebologna at 5:03 PM on May 12

Best answer: I have many diabetics of similar build and age to you in my family, all of whom have had various types of anesthetic for different procedures and been absolutely fine.

Your care team will go over the procedure and its risks beforehand and make sure you consent. Before you sign the thing with your consent is the time to ask some of these questions. If you are concerned that you might forget to ask them, write your questions down ahead of time.

They will be monitoring your vitals during the procedure and after while you recover and wake up, so if there is an issue during any of that they will be alerted and able to adjust plans and dosages and other supportive meds if needed.

A lot of the scarier stuff about diabetes, sedation, surgery, and recovery is because most of the people having to juggle all of these are also very progressed in the disease, layered atop the normal issues from age, since more advanced diabetics are generally older on a population level. Although your high glucose levels and weight may mean you should bring your concerns up with your doctors, if you aren’t having like, organ failure or joint stiffness you are probably lower risk than you currently think you are, after psyching yourself out. There is always a risk, of course, but I’m betting in this case it’s less risky than driving on the highway, and you probably do that all the time.
posted by Mizu at 5:20 PM on May 12

I recently had a broken bone surgery and it was “twilight” anesthesia. I’d be surprised if you need general for an MRI. My anesthesiologist said that general means you can’t breathe for yourself - i.e., respirator.
posted by Mid at 5:53 PM on May 12

Response by poster: Thanks everyone. I decided this whole thing was stressing me out too much so I canceled tomorrow’s appointment and will be doing an Open MRI. (it also helped that I found one in town).

For the record, the reason for the general anesthesia was that even with sedation I had to bail out on an MRI in a normal sized machine. It caught me off guard, as I had one years ago with some sedation and no problems.
posted by Tell Me No Lies at 6:18 PM on May 12 [1 favorite]

I have Malignant Hyperthermia and that always triggers detailed discussions with anesthesiologists. Many of them have never even seen a case of MH, but I have always felt safe knowing they would take all precautions.
posted by terrapin at 5:01 AM on May 14

Response by poster: Done. Once again, thank you everyone for your advice.
posted by Tell Me No Lies at 4:54 PM on May 16

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