How long does it take anesthesia to leave your body? Dr. Kaveh LIVE

there are four things that affect how long anesthesia takes to leave your system one of them is your mental health State anxiety and history of past traumas another one is the type of surgery another one is your medical history and the last one is what type of anesthesia is being used anything from gases like the ones that come out of the ventilator behind me to IV agents like propofol or midazolam or fentanyl so good to see everyone coming on here and I appreciate everyone's warm comments especially with everything that we've been going through I really appreciate it thank you so number one is the type of surgery you're having because certain surgeries require more anesthesia and the more anesthesia you get typically the longer it takes to wake up hello Heidi good to see you as well so the biggest one is neurosurgery when people are having surgery in their brain you're inherently uh interrupting brain tissue interrupted brain tissue takes longer to wake up from anesthesia it might take hours or sometimes even days after major brain surgery to wake up from anesthesia for its effects to wear off of your brain another intensive surgery is cardiac surgery so things like cardio uh coronary artery bypass like when people say they've had a triple bypass or a cabbage those surgeries also typically take longer because the healing process and the anesthesia wearing off kind of melt together and it can take a long time Kathy thank you for that super thanks some hospitals will have patients actually stay intubated overnight and then they begin to remove the breathing tube the following day after major cardiac surgery in other institutions they'll actually wake patients up in the operating room there's some variability because it is a major surgery and the body takes longer to wake up the effects of the anesthesia May last longer as well very good questions for everyone who's asked and the other big point for the surgery is the duration because the longer the surgery the more anesthesia is hitting your brain and the next part is going to be the specific Industries anesthesia type sorry when you're going live sometimes you have to clear your throat so number two is anesthesia and the longer your surgery is the longer the context sensitive half-life of anesthetics kicks in the context sensitive Half-Life is a really special concept because it doesn't come up for most medications Phoenix thank you for that super thanks as well it's very kind the longer a medication is hitting your brain it is not linearly correlated to the amount of time it takes to wear off so for example if you got a propofol infusion remember propofol is the white one here if you received propofol for 60 minutes it would take about 10 minutes for the propofol to wear off but if you had propofol for two hours it might take 30 minutes for their propofol to wear off fully these numbers aren't exact it's an order of magnitude every additional hour of that white medication takes another 10 minutes to what would be a standard time that you'd expect it to wear off once again these are all very rough numbers that we use when we try to time patients waking up because the anesthesia has to come out of your brain so that your brain can function again gases are kind of similar the most commonly used gas in the United States is going to be civil fluorine here it's always marked with a yellow label sibo fluorine comes off relatively quickly similar to propofol about 10 minutes or so if timed correctly you can actually begin to wake up it might take 20 minutes typically the longer the surgery the more it has gone into your lean body mass so the sibo fluorine molecules go into fatty tissue into in body mass like your muscle and the more anesthesia gas or liquid like propofol is in your body it takes longer for it to all come out of your body and to ultimately leave your brain so for average day surgeries we're talking about patients usually coming to within 60 minutes most patients leave an Ambulatory Surgery Center like a Day Surgery Center within an hour after general anesthesia or they're ready to go at least if you have major surgery in a hospital you might be there overnight but the anesthesia will certainly wear off in most cases before you're actually ready to leave the hospital it might take a couple of hours as long as it's not major cardiac surgery or major brain surgery there are of course other exceptions but that's the general rule of thumb now there's also a dependence on the type of medication used if it is isoflurane I don't even have it here because it's kind of old it's usually a purple gas hey Heidi thank you for that super thanks as well the Purple Label isoflurine that one actually sticks in the body longer it might take more than just 10 or 20 minutes after the average length of surgery there's another one called it desflorain that comes off very fast it's also very expensive and is a very potent greenhouse gas so it's actually not used for those reasons and others in the operating room and can also be irritating the lungs and might trigger asthma there's a medication called nitrous oxide laughing gas you see this blue one here laughing gas is special because it comes on very quickly and it comes off very quickly and you could theoretically wake up within minutes even if you've been on laughing gas for a very long time but laughing gas is also a tremendous environmental pollutant and it's not used for that in several other reasons there's a very good question by Mama Bear 76 hair loss after anesthesia that's a really good question it's called telogen effluvium We believe it's the same reason that any hair loss can happen after a prolonged stressor or a significant stressor whether it's surgery or anesthesia car accident loss of a loved one when I started college meant years ago at Berkeley I actually lost part of one of my eyebrows it was very I was like what is going on but anyways you can imagine a giant life stressor and telogen of fluvium you can look it up fortunately it is reversible once the body renormalizes speaking of stressors and traumas we'll talk about that in just a moment um actually if you guys appreciate me coming on here even with all the challenges that we've been going through like I mentioned I really appreciate it if you hit that like button and share what you've learned with others Lisa we'll talk about redheads as well that's actually coming up as well but um your support helps me do this more often and I don't like to do ads or product placement I want you to learn more so you can be more confident about your body and how it works whether you're having surgery or not or share with people who you love who are having surgery to help Empower them because you have more power over your health than you've ever been told and with this knowledge you can certainly take advantage of that power so before we talk about redheads and the mental health and Trauma components that can influence how long it takes anesthesia to wear off we need to talk about other types of medications specifically midazolam versus said can stick around the body for a long time if it's given as an infusion it's Half-Life or the time it takes for the blood concentration to half is not as short as most medical students and doctors think especially if they've been receiving it for a long time if the patient has been receiving it for a long time because it also builds up in fatty tissues another commonly used medication is fentanyl the one seen here fentanyl if given as an infusion during a surgery can stick around the body for a long time compared to Shorter acting opioids like sufentanyl or Remy Fentanyl however it is much shorter acting than longer acting opioids like Hydromorphone or Dilaudid Donna thank you for that super thanks so the type of medication also has a different Half-Life meaning how long it lit it hangs around your bloodstream the residue that someone had mentioned earlier and like skater Surfer says fentanyl is a pain med and we use it during surgery either as infusions or as bolus pushes to help minimize the need for other anesthetics that's called a balanced anesthetic by using multiple agents so that we minimize the toxicities and side effects of any individual agent so next the question is about redheads redheads might be more tolerant to the yellow gas I pause a little bit because it's still a controversial issue and the biggest issue that I think patients should know about if they have red head is that the anxiety and the build up to needing more anesthesia can increase anxiety that can increase anesthesia requirements Levi is asking about red beards red beards do not appear to have the same basis genetically as the of the melanocortin one gene mutation that redheads have so it looks like it's different but it's still overall a very uh a lot of research to be done because the anxiety component from fearing that you need more anesthesia and that you will be under dosed or wake up can actually cause you to need more anesthesia because the more you wind up the brain whether from current anxiety past anxieties panic attacks medical trauma these might increase and certainly in children it appears more so because they've been studied more to increase anesthesia requirements so the more anesthesia you get the typically longer it takes or typically the longer it takes to wake up so patients that are anxious alone they might take longer to wake up because they have needed more anesthesia but I'll tell you the far more important component is when patients have mental health conditions that they're trying to self-medicate especially with marijuana or cannabis I'm not implying anything bad about it per se except that it is often used in a non-healing way the cannabis plant can be very powerful when used appropriately but in my experience the risks at how it's used recreationally especially when it's advertised the way it is here in the Bay Area in San Francisco where I work the effects can be the opposite because they might dramatically increase how much anesthesia a patient needs and it might take them so much longer to wake up in addition to increasing other side effects once again I'm not anti-cannabis but I'm anti-using it in a way that's not responsible different discussion for a different time but when I have redheads or anxious individuals or individuals with traumas or chronic pain insomnia Etc who are using cannabis to help with those conditions once again it's not about judging it's about recognizing that the more THC possibly CBD but we don't know yet the more THC the brain sees the longer the wake-up might be because they need so much more anesthesia so that propofol doses that you're giving will hang around the body longer that contact sensitive Half-Life kicks in because the longer they've gotten the infusion and the higher the dose of propofol the longer it's going to take to wake up now if somebody wakes up delirious or combative like someone just asked that's also a very important point one patients can harm themselves two of them might have a traumatizing experience unlikely but it's possible but number three is that the longer it might take because if a patient especially a child wakes up combative and emergence delirium sometimes we need to put them back to sleep one of my favorite medications for that is dexamethatamidine brand name precedex sometimes you can give a very low dose to calm the emergence delirium but not put him back to sleep sometimes however they need and they need so much anesthesia they come out of their emerging stellarium that they will actually sleep longer so instead of at 10 or 20 minute kind of reorienting it might take 45 60 75 minutes these aren't Make It or Break It differences but they do make a difference now southern belle multiple times has said pseudocolinesterase enzyme deficiency this is a very important Condition it's very rare but it is very important so thank you for bringing it up this can prolong the amount of time it takes to wake up but not for any of the standard reasons we talked about this is a really kind of a scary disease because if you don't have the gene that it takes to metabolize this medication here called succinylcholine it even says warning paralyzing agent if you don't have the enzyme that it takes to metabolize or break down this medication you will be asleep longer maybe not consciously asleep but your body will be paralyzed longer I've seen this once in the last 10 years and it was weird because the patient was like trying to say something but it looked like they were sleepy they weren't asleep though they were trying to speak but they were still very weak because they didn't have the enzyme you and me if we have normal metabolism enzymes we will metabolize succinylcholine in a matter of minutes if you are heterozygous for that it might take maybe 30 45 minutes if you're homozygous and you don't have it I don't know if Southern Belle is heterozygous or homozygous it might take over an hour it might take plural hours and we need to know so some patients get it tattooed or they were or they'll wear a medical bracelet so in an emergency setting they don't receive succinylcholine either if they have pseudocholinesterase deficiency because then you might be awake but paralyzed or they may have a bracelet for malignant hyperthermia in which case they can't receive succinylcholine either now Linda Brawley I really appreciate your super thanks there it means a lot I hope that you're learning some good stuff here now I wanted to end by just saying that the medical trauma that can happen in the operating room or in that patients bring into the operating room really needs to be acknowledged I've had so many patients over the years that come in with an anxiety that they're unwilling to share with anyone else until you close the curtain and sit down you may need to hold their hands as you know it's usually most contextually appropriate to touch a joint like a knee an elbow a shoulder and look them in the eye and ask them to please be honest be authentic you know the problem with PTSD and I really credit Gabor mate that making this more publicly known when we had PTSD we're often inauthentic with ourselves we're not honest enough with ourselves because we spend so much time in flight mode out of the fight flight and freeze responses we're stuck in flight mode so when we are not honest with ourselves because we're so disassociated from ourselves we might not really even appreciate that we're anxious and when we're not appreciating our anxiety we can't accept help from others that are trying to help us reduce our anxiety the more anxiety we bring into this operating room like we said it shows it might show when that emergence delirium which will take you longer to wake up because you need more anesthesia more anesthesia and longer wake up it might increase your risk of just needing more anesthesia to stay asleep it might increase your risk of any anesthesia awareness translating eventually to a potentially PTSD experience I'm not saying every anxious patient will develop PTSD but if heaven forbid something unfortunate happens if your anxiety is too far off the chart it is priming your central nervous system to register that experience as a traumatic one and without the right support can turn into acute stress disorder or PTSD I've had patients that have taken a long time to wake up maybe from pseudocolinesterase deficiency like we said or any other number of reasons and they have this fear of am I ever going to be back in my body why can't I move I keep forgetting to breathe these experiences can happen in prolonged wake-ups for any number of reasons and we need to recognize it's not just a matter of slapping the patient in the face to say hey wake up keep breathing but to be present not shocking and jarring because that does register in the body you look at the heart rate monitors when you slap a patient awake because they're taking a long time to wake up you will see their sympathetic nervous system respond how can we treat those patients that are taking longer to wake up for any number of those reasons that I mentioned I'm not saying it's their fault but it's something that their body is going through and we need to respect that there is a natural waking up process influenced by those factors and we can't simply force them out of it any more than you can force yourself to fall asleep at night sure I guess you could take you know Xanax or something but we're talking about natural waking up natural falling asleep so that's why the trauma that we're bringing in if we're not authentic with ourselves or our anesthesiologists or doctors we close that door to them being able to help us have a safer and more healing experience whether it's anesthesia and surgery whether it's a psychedelic experience like with my patients who are receiving ketamine and my ketamine infusion clinic or if it's with your loved ones or your friends who are trying to help you heal from any number of struggles that you're trying to heal from I hope that you do feel supported by your support group and I hope that you also appreciate just how much power you have you can't influence all those factors I mentioned but you can't influence a lot of them and I hope that you've taken away something that you can Empower yourself with or those who you love if any surgery or in any other life stressors until next time we have more power over your health than you've probably ever been told

Channel: Medical Secrets

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Id: 5meARtFWzIw

Length: 18min 29sec (1109 seconds)

Published: Thu Jun 29 2023