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Anesthesia

Severe Coughing and Not Being Able To Breath

10/28/2006

Question:

I am terrified to have general anesthesia after the past two surgeries I have had. Immediately upon waking up from the first surgery I started coughing uncontrollably and could not get my breath. The attendents in recovery immediately must have known what the problem was and gave some type of injection and immediately I stopped coughing and could breath. This was terrifying and I honestly thought I was going to die. I was told that when they removed the tube this caused spasms in my throat and if I ever had surgery again to always tell the anesthesiologist so that they could be prepare for this. The next surgery I had I did tell the anesthesiologist but when I awoke from this surgery I had the same problem but this time noone immediately came to my aid until some time later...a panic attack does not describe this terror. I need two surgeries - my thyroid removed and a surgery on my knee for a torn cartilage (meniscus). The thyroid surgery I have avoided for years due to my experience and now I cannot walk due to the torn cartilage. What can I do to prevent this problem so that I can have these surgeries? Or will I always have this problem..so what can I say to the anesthesiologist so that they will be more alert to this possible problem. Please assist me if you can...I cannot keep avoiding these surgeries not due to being afraid of the surgery but due to waking up after the surgery. Your answer would be greatly appreciated!

Answer:

You must discuss your problem with your surgeon and with the anesthesiologist who will take care of you. Many larger hospitals, especially academic medical centers, have pre-anesthesia clinics in which such difficulties can be explored, diagnosed, and appropriate plans made for future surgical procedures. You should try to obtain your hospital records so that the episode you describe can be fully reviewed by your doctors.

You may have a condition known under many terms, such as vocal cord dysfunction, or paradoxical vocal cord motion, but commonly referred to by anesthesiologists as laryngospasm. The site of trouble is the upper airway - at or above the larynx, or voice box. The vocal cords come together to narrow or close off the airway. These terms may in fact encompass a variety of different conditions of different causes. This suggests the conditions are not that well understood.

Before your next surgery you should consider being referred to an ENT doctor who can actually examine the voice box directly just to make sure there is nothing wrong with the anatomy. Assuming there is nothing wrong with the structure of your larynx, and there are no serious medical conditions like tumors or infection, the condition you seem to be describing is not life-threatening, but obviously very scary.

There may or may not be a psychological aspect to this condition. Sometimes coughing or panting can break the spasm and relieve the obstruction. Acute, severe episodes can be treated with oxygen, or Heliox (80 percent helium/20 percent oxygen) which flows more easily through a narrowed airway.

Sedation is another treatment for this condition - you may have been given intravenous sedative to relieve the problem last time. Intermittent, positive pressure also can resolve an attack. That means applying pressure to the airway using a mask placed tightly over the nose and mouth and a flow of oxygen. Lidocaine, a local anesthetic, applied to the larynx by the anesthesiologist just before the end of the surgical procedure and before the airway (breathing tube) is removed might be useful in prevention. The anesthesiologist can also make sure that the airway is cleared of any secretions that might irritate the larynx to cause spasm before you wake up. I hope these suggestions help.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University