Dr. Kiran Kumar Kolla Gopalkrishna
Anesthesiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am undergoing orthopedic surgery under spinal anesthesia. I am anxious about the surgery and anesthesia. Is it possible for the anesthetist to give me a relaxing medicine Midazolam or other medications before the surgery to remove the fear and stay calm? Also, if I request the anesthetist to use local anesthesia first to numb the skin of the back before the spinal needle is inserted, will it be fine? So that I feel less pain during the spinal needle insertion.
Kindly advise.
Hi,
Welcome to icliniq.com.
I understand your concern.
I completely understand the anxiety of spinal anesthesia. Yes, you will be given Midazolam as a pre-medication and to reduce your anxiety. I suggest because you do not have any contraindication for general anesthesia, choose general anesthesia. It is safer, you will not have any anxiety, and yes, after the surgery you may have pain that can be managed by intravenous opioids like Fentanyl. Request for general anesthesia, if spinal anesthesia fails or surgery prolongs. You can opt for general anesthesia if there are no contraindications. Also, spinal anesthesia is safe, they use thin needles now, and after local anesthesia, you will not feel too much pain. The choice is always taken up by the patient.
Do not worry, face it.
Patient's Query
Hi doctor,
Thank you for the reply.
Will my anxiety reduce after taking Midazolam? I was hoping that a small dose of Midazolam keep me awake and yet reduce fear and numbness of skin by local anesthesia. Is this the way to go as I do not want to go for general anesthesia to start with?
Hi,
Welcome back to icliniq.com.
Yes, midazolam will calm you. You will feel sleepy. Also, please ask for an anxiolytic-like Alprazolam tablet one day prior to your surgery date so that you sleep well.
Be positive and everything will be fine.
Patient's Query
Hello doctor,
Thank you for your reply.
So Midazolam IV 15 to 30 minutes before surgery and numbing the skin initially with local anesthesia before inserting the spinal needle will help with both anxiety and pain? I do not want to undergo general anesthesia but would instead want Midazolam before surgery to help remove the fear of the operation theatre environment and associated shallow breathing and fainting. Also, local anesthesia numbing reduces the pain of the spinal needle. Will this be a good strategy?
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
Yes, perfect. This should be the plan. Also, it can be supplemented with the injection of Fentanyl along with spinal anesthesia. You will definitely feel a better experience and no pain. You have to fast for 8 hours, before surgery time, not even water.
All the best.
Patient's Query
Hello doctor,
Thank you for the reply.
I hope Fentanyl will be a low dose just to keep me off the edge and yet awake and calm. What do to suggest?
Hello,
Welcome back to icliniq.com.
Yes, 50 micrograms would be fine.
Hope this helps.
Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
1 to 2 mg Midazolam IV 15 to 30 minutes before surgery, local anesthesia numbing of skin, and Fentanyl low dose before spinal needle insertion is the plan. Just want to know if this is not something out of an ordinary request that I will be putting to the anesthetist and this is usually used successfully in patients to remove anxiety, fear, and pain, and if they benefit from it. I shall now be discussing this plan with the dealing anesthetist.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
Definitely it is a valid request. Every patient has his own personal preferences and requests. It should be always respected. Your requests are very important and the anesthetist will be more than happy to understand your needs. I suggest please have an honest chat with the anesthetist and have a plan.
All the best.
Patient's Query
Hello doctor,
Thank you for your reply.
In your experience, this plan will work to keep me calm, anxiety-free, and pain-free? I will proceed ahead accordingly.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
Yes, definitely it will work. Please do not worry. As I said discuss with the anaesthetist and let him examine you.
Patient's Query
Hello doctor,
Thank you for the reply.
Want to ask if many patients with anxiety about surgery or anesthesia have benefitted from surgery involving spinal anesthesia before making use of this strategy of Midazolam pre-medication and if they have found it beneficial to remove anxiety. And I hope I am not the first one who will be asking for calming pre-medication from the anesthetist. In your experience, have you used or know of cases where premedication before surgery helps the patient to get calm and remove fear?
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
Yes, Midazolam is commonly used in pre-medication. It is short-acting and very effective in allaying anxiety. It will make the person relaxed and sleepy. Please do not think you are asking for an unusual request. In my 15 years of experience, we have always used Midazolam as a pre-medication.
Thank you.
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