Hello doctor,
I am a 55-year-old female. Before asking my question, I need to provide some background and context. I have had many surgeries and am a well-educated person. I am not a typical patient, given my knowledge, background, etc., including the fact that I get a copy of my complete chart for each surgery or medical procedure using any form of sedation or anesthesia. I am knowledgeable about most drugs used during anesthesia and how they work. I have been told by a surgeon (included in his surgical report) and two dentists that I require a lot of anesthesia. I have had multiple bad experiences with anesthesia, primarily conscious sedation. In my last surgery, I became alert, aware and had full memory of the second, third and fourth stitch. I have experienced pain and awareness or memory during other oral surgeries and other procedures. I abhor the idea of conscious sedation, and the drug versed, specifically, except when used for induction. I have had my specific verbal and written expectations violated. This has all lead to both fear of some simple procedures (like oral surgery and even regular dentistry) and a distrust that I will be cared for in a manner that I do not find acceptable. Two days ago, I had oral surgery and had some memory of pain and other things and, because of my experience, I am also a person that brings a high-quality recorder into the procedure room or OR (when the opportunity presents itself). So, for the oral surgery two days ago, I recall experiencing pain and asking for more medication. I recall being told to calm down (the audio recording supports these recollections, plus the oral surgeon and anesthesiologist, who I paid extra out-of-pocket to have available so I could be in deep sedation and not experience pain.
My question is short. I have a procedure with the anesthesiologist at 8 AM. He also does some pain management procedures, and I will be getting the nerve block test for lumbar RFA tomorrow. I will have a CRNA who will be doing the anesthesia or sedation. But, I wont be able to discuss what happened to me during oral surgery with the anesthesiologist. I am a bit upset about that. I have a fear of dental and other painful procedures. I know that the local anesthetics do not work as well on me as they do on others which is presumably why I was feeling pain and this is an issue not just for the procure in the morning. It is an ongoing issue that just grows more intense with every procedure that my trust is violated, and I experience pain and, I need the RFA. I have multiple herniated discs and arthritis, facet joint damage. I do not know how to articulate my needs in such a way that the anesthesiologist or CRNA (later this morning or in the future) takes my concerns seriously. I do not just need something to calm me, and in fact, the very thing that an anesthesiologist would use to calm me is one of the most fearful things to me. I do not want to experience pain. I do not need anesthesia, and I do not need to be calm (well, I would be calm if these things did not repeatedly happen to me). I just need no pain and if that takes a heavier dose of Propofol (in a hospital setting). So be it. If that takes more local anesthetic. So be it. I need to be unconscious, or I need enough pain management and deep sedation or no sedation. What do I need to say to get that without offending or getting interpreted as just another person who is afraid of the OR (which I am not). Is it possible that I would share that after being given versed? What if I just tell them no versed? Low dose Propofol would do the same thing, right?
Please help me.