How necessary is a neuromuscular block during surgery?

Question

Hi doctor,

I am going to have laparoscopic surgery to remove an ovarian dermoid cyst. I am afraid of being under general anesthesia in the presence of neuromuscular blocks.

Is there a way to ensure that I am unconscious before administering the neuromuscular block? I have read a horrible story about someone being paralyzed first before the other drugs took effect, and being conscious during intuition. Is a neuromuscular block necessary during this entire surgery, or is it only in the beginning for intubation? Is it possible that intraoperative awareness is more common than we realize because amnesia-inducing drugs erase people's memories of it? Or would anyone with consciousness during surgery also have a memory of it? Are any sort of analgesics used in this surgery?

Is it true that if I experience awareness I would also be experiencing severe pain? If heart rate and blood pressure are indeed sufficient indicators of awareness, then why have other healthy young people like myself experienced awareness while paralyzed without anyone noticing their stress response and therefore deepening the anesthesia? How was that able to occur and what would prevent it from occurring in my case?

I read that some drugs used in anesthesia can block the body's normal stress response so that heart rate and blood pressure would not increase even in a state of intense pain and anxiety. Would I be receiving any drugs that would produce such an effect, blocking my body's normal stress response and preventing those indicators of awareness? Is it possible to listen to a recording on headphones while in surgery? I have a guided relaxation tape that makes me more confident. I would stay unconscious, or at least be able to cope with an awareness experience.

Thank you so much for reading my questions and I look forward to hearing the answers.

Answer 1

Hi,

Welcome to icliniq.com.

Normally, all anesthesia you can see is just a prick of a needle. So, if you do not fear the prick of a needle, then you need not worry.

Once the needle is pricked, and the medicine goes into your body, you will not realize any pain nor remember anything. You would be in a deep sleep.

Anxiolytics are given initially to relax the mind. Sensory perception (the ability of an organism to sense, detect, or experience stimuli in its environment) is lost first, which will be confirmed by an anesthetist by pricking, and then neuromuscular blocks will be given to relax muscles.

Neuromuscular block is necessary since it relaxes muscles, and prevents muscles from undergoing reflex spasm (occurs when your muscle involuntarily and forcibly contracts uncontrollably and can not relax) while doing surgery. Intraoperative awareness is very rare.

Amnesia drugs are very effective, so you will remember nothing. You need not worry about it. Neuromuscular blockers are strong analgesics too. You will have no pain perception at all.

Heart and blood pressure are not indicators of awareness, rather they indicate that the body is functioning normally. Yes, they could demonstrate the body's stress levels, but your anesthetist will take care of it.

Anesthesia is highly advanced nowadays, and drugs blocking heart and blood pressure response are no longer used.

Regarding your last question, it is not possible to listen to the song on headphones.

Just relax. Everything will be fine.

I hope that you get your answer.

Please let me know if you need any help.

Thank you.