Anesthesiologist Questions General Anesthesia

Am I really paralyzed under general anesthesia?

I've been told that you are paralyzed when you have general anesthesia. Why?

19 Answers

For many general anesthetics yes you are - although the appropriate term of being administered "muscle relaxants" to prevent voluntary muscle movement is much less worrisome to hear right? Often a patient is paralyzed during the intubation (or placement of a breathing tube). Muscle relaxants further aid in allowing retraction of tissue such as muscles, organs etc to allow access to the surgical site. Patients are also paralyzed to allow for mechanical ventilation from a ventilator. You are monitored and these medications are reversible when the appropriate time occurs.
The simplest answer to this question is this is YES.... General anesthesia (GA) is a physiological condition when an individual needs to receive medications for muscle paralysis, sedation, analgesia, and amnesia. A patient that undergoes GA has been placed in a controlled, reversible state of unconsciousness. This is what allows someone to tolerate surgical procedures that otherwise would result in unbearable pain, which may not be tolerated by the individual.
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Hi, it depends on the surgery and type of General Anesthesia. If it is a general anesthetic that utilizes an endotrachial tube(ETT) to proved ventilation or there is need for muscle relaxation for surgery, then yes. A paralytic agent is used to relax the muscles to allow the passage of an ETT, to make ventilations easier and provide ease of surgical exposure and access. If paralysis is not necessary an alternative device called the Laryngeal Mask Airway(LMA) can be used without paralysis and allows the patient to breathe on their own through the anesthetic.

I hope that is helpful.

Dr Ketch
The paralyzing drugs are required for most procedures but not all. The paralyzing agents are fully reversable except in a person with a rare disorder. Family history is important for decision making. The worst scenario with this disorder is that the patient will remain under anesthesia until the paralyzing agent has worn off. The patient will be comfortable during this time frame.
Part of a general anesthetic is muscle relaxation, so a patient does not move during surgery. The other two parts of a general anesthetic is amnesia, (don't remember), and analgesia, (pain relief).
Not always but in 70 -80% operation they use muscle relaxant to facilitate
the operation literally muscle relaxants paralyzes
you temporary at the end of operation they reverse it but all them you are
unconscious and pain free
There are many way anesthesia team monitor the depth of unconsiousness and
paralysis . public they should know in extremely rare cases people have
experienced awareness this is very rare always human error or problem with
the potency of drugs again it is a rare event.

The purpose of anesthesia is to enhance your surgical experience by providing amnesia and analgesia. In terms of general anesthesia, it will provide both amnesia and analgesia as well as providing an optimal operating conditions for your surgeon. By using paralysis, your surgeon will have a "non-moving" target. This is critical in the setting of delicate surgeries.
General anesthesia may mean different things under different
circumstances. For some surgeries, like knee arthroscopy and hysteroscopy,
the patient may be asleep but no muscle relaxants are needed so the patient
is not paralyzed. Other more invasive surgeries, like laparoscopy and
exploratory laparotomy do require the use of muscle relaxants to insure a
motionless operative field for safe surgical technique. Anesthesiologists
administer drugs and monitor patients to insure that they are not conscious
during both kinds of general anesthesia. Muscle relaxants are reversed at
the end of surgery, so both groups of surgical patients have full motor
strength when they awaken from general anesthesia. Anesthesiologists are
careful to insure patient unconsciousness (along with adequate oxygenation,
ventilation, and hemodynamic stability) when muscle relaxants are used, so
that no patient should ever experience any wakefulness when paralyzed
during surgery.
That is not totally accurate to say you are paralyzed under anesthesia. But during surgery, there may be a need for the muscles to be relaxed for the surgeon to be able to perform his duties. So an anesthesia provider might use medications that will block the transmission of nerve impulses to the muscles and thereby cause a blockade of the neuromuscular transmission, or in layman's terms to paralyze the muscles. General anesthesia is a combination of sedatives and hypnotics and inhalation anesthetics that will interfere with the cognitive function of the brain, and muscle relaxants to aid the surgeon in his need to get to whatever he might be operating upon. Not all general anesthetics require muscle relaxation, but some aid the procedure.
The use of muscle relaxants as part of general anesthesia began in the 1930s to provide more effective relaxation for surgical procedures without the risks of heavy doses of inhaled anesthetics. Muscle relaxants used in anesthesia do cause temporary and reversible paralysis. This requires use of a breathing tube and a ventilator to breathe for you. The medications are given after you go to sleep (induction) and are reversed at the end of surgery before you wake up. You are monitored by an anesthesia provider at all times during surgery to make sure that your air exchange is normal as well as your blood pressure, heart rate and temperature. Oxygen and carbon dioxide levels are continuously monitored for your safety.
This has been a standard practice in anesthesia for many years and is generally considered part of the reason anesthesia is so much safer than in years gone by.
Frequently, patients are giving a short acting muscle relaxant to aid in placement of an endotracheal tube (which both protects the patient from intraoperative aspiration and for intraoperative ventilation) as part of induction of anesthesia. Patients receive intravenous anesthetic and hypnotic drugs before the muscle relaxant rendering patients amnesic to the muscle relaxants effect. A
Muscle relaxants may also be given intraoperatively to improve surgical access such as relaxing abdominal muscles during bowl surgery. The level of neuromuscular blockade is monitored using a neuromuscular stimulator, and observing the degree and strength of muscles, generally those of the hand, to electrical stimulation. Additional, a muscle relaxant reversal agent at the end of the procedure.

Despite anecdotal stories, it is extremely rare for patients to have any intraoperative awareness of their surgery, muscle blockade, etc., as anesthesia is induced and maintained using a combination of drugs including those specifically chosen for their amnesic and pain relieving properties. Although still quite rare, most case reports of intraoperative awareness occur either during emergency caesarean sections under general anesthesia, where the Anesthesiologist is trying to limit the amount of anesthetic agent received by the baby prior to delivery, or during emergency trauma surgery, where the Anesthesiologist must balance inducing anesthesia and amnesia with the effects of anesthetic agents on blood pressure in patients with severe trauma and blood loss.
Some types of surgery require the use of a class of drugs called muscle relaxants which prevent the muscles from contracting.  (These are very different than the so called  muscle relaxants that are purchased in your local drug store.) This requires the use of artificial ventilation to provide oxygen and clear CO2 from the lungs.  Depending on what muscle relaxant is used, they usually are reversed prior to "waking up" the patient.  "Paralyzed" is often incorrectly used as a euphemism for this process. 

Steven Dain MD, FRCPC
Not necessarily, muscle paralysis is not a necessary part of a general
anesthetic. It may facilitate artificial breathing or be beneficial in
some procedures, such as chest or head surgery. Other times, muscle
paralysis is not used and in some cases, may be catastrophic.
Muscle relaxants are being used as part of anesthetic management. It helps the surgeons to get a better exposure and helps the patient to tolerate better the breathing tube. While it is true that the patients are muscle relaxed/"paralyzed" to a certain degree during general anesthesia, this happens only during unconscious state and it is fully reversed before emergence from anesthesia. Thus they will not experienc or remember the actual feeling of being "paralyzed".
Depends on type of surgery. Most surgeries require paralysis. When muscles are relaxed, surgen able to operate and doesn't need to fight muscle strain and potentially cause damage to your tissue. Once surgery completed, paralysis is reversed.
As a general rule you do use a palalytic agent when you put the patient asleep. You do this in order to avoid laryngeal spasms, which are spastic reactions of a part of your breathing tract when using inhalational gases and/or during the placement of the breathing tube. Further during the surgery your body may have muscular contractions which can interfere with the surgery itself. Paralysation will avoid that.
Only if they enter abdomen or chest usually
Yes and no. Regardless of the actual use of paralyzing agents, mere fact of anesthetizing a human being involves control of respiration and maintaining cardiovascular stability until the end of the surgical procedure and beyond. Depending of the kind of surgical procedure, respiratory control may have to be extended into the post-operative period as well.
Not all general anesthetics or surgeries require paralysis, but some do. Most abdominal and all intrathoracic surgeries require paralysis. If the anesthetic or surgery requires that your breathing be controlled, then paralysis will be maintained.