About Anesthesia

Key Topics for Patients

Types of Anesthesia

Types of anesthesia include general anesthesia, regional anesthesia, and monitored anesthesia care. Sometimes choices can be offered, but often the nature of the surgery will determine the type of anesthesia that is feasible.

General anesthesia induces full unconsciousness. Typically, a breathing device (such as a tube or a laryngeal device) is placed to assist with respiration and to facilitate administration of anesthesia. Inhaled anesthesia gas is commonly used, as well as assorted intravenous medications. The nature of the types of cases we provide anesthesia for in our practice makes general anesthesia by far the most common choice. The safety profile of general anesthesia has never been better.

Regional anesthesia is where part of the body in “numbed” so that surgery may be performed without discomfort. Peripheral extremity blocks, spinal, and epidural blocks are all examples of regional anesthesia. Regional anesthesia is not without risks, and in our practice general anesthesia is commonly more suitable for the types of cases our surgeons perform.

Monitored Anesthesia Care is where sedation (to varying degrees) is provided in cases where the procedure does not require general anesthesia. Commonly, this is chosen when the surgeon can use local numbing medicine to numb the area. Medical conditions of the patient often require an anesthesiologist for your safety. Furthermore, sedation may be required or preferred. Because the level of sedation can vary for many different reasons, chances of patient recall during these procedures are inherently higher and not out of ordinary or appropriate experience (unlike more dramatic but rare cases of recall under full general anesthesia). Your anesthesiologist can explain this so that understanding and realistic expectations are established.

Common Anesthesia Medications

Your anesthesiologist is an expert in handling the medications needed to ensure your comfort and safety. The exact medications chosen depend on many factors including patient factors (allergies and medical problems) and surgical factors. If you have special concerns or preferences based on prior experience, please discuss this with your anesthesiologist.

General anesthesia is often induced with an intravenous medication called propofol. The benefits of this medicine have made it the most commonly used induction agent. Inhaled anesthetic gases (desflurane or sevoflurane) are frequently used to maintain anesthesia.

Preoperative medicines may include agents to reduce anxiety such as midazolam. Medicines to reduce nausea, such as zofran, have helped to reduce the incidence of this side-effect. Other anti-nausea medicines may also be used.

Commonly used pain medications include fentanyl, sufentanil, and morphine. Sometimes other pain medicines are used in the operating or recovery room.

In the operating room, antibiotics are typically given unless they are not indicated. Other medications can include muscle relaxants and medications to improve your safety and care, such as medications to raise or lower blood pressure, or to treat specific medical conditions.

If you have specific questions about medications, please discuss this with your anesthesiologist.

Medical Conditions and Personal Habits Can Affect Anesthesia

Medical conditions certainly do affect risk. Your medical record and laboratory and study results convey important information, but you should share information as completely and accurately as possible with your anesthesiologist.

Examples include history of anesthesia problems (allergies, drug reactions, difficulty with breathing tube placement); sleep apnea; neck motion problems; lung disease like asthma or COPD; heart and vascular diseases like hypertension, coronary artery disease, heart attack, congestive heart failure, or valve issues; kidney, liver, or stomach disorders; nervous system issues like stroke or seizures; endocrine disorders like diabetes or thyroid problems; obesity; and muscle disorders. The more we are aware of your medical problems, the better we can manage them.

Medications (including prescription, over-the-counter, and herbal supplements) should all be revealed. Problems with medications are fortunately rare and manageable, but sharing this information is essential for your safety.

Personal habits such as smoking, alcohol, and drug use (especially narcotic, cocaine or amphetamine use) should also be shared as accurately as possible. Your confidentiality will be respected. It’s simply about optimizing your care.

Risks and Potential Complications

Anesthesiology as a field has been at the forefront of establishing proactive safety measures. Modern anesthesia is safer than ever before. As with any procedure, however, there are risks ranging from the very minor to the very severe, and complications can occur. A large part of the risk of anesthesia derives from preexisting medical conditions in our patients. Surgery and anesthesia, of course, do have inherent risks as well. The spectrum of anesthesia risk is very broad.

Relatively minor side-effects and complications are statistically more common than serious ones. Examples could include nausea and vomiting, shivering, sore throat, residual drowsiness, minor lip or dental injury, muscle aches, and bruising or swelling at the IV site.

Serious or life-threatening problems are fortunately very rare. Awareness under anesthesia, heart attacks or other heart problems, strokes, nerve injuries, lung and breathing problems, kidney and other organ dysfunction, complications from the breathing tube or invasive monitors, allergic and metabolic reactions, and other serious problems can occur.

Allergic Reactions

Allergic reactions are fortunately very rare. When allergies are known, offending medications can usually be avoided. When allergies occur unexpectedly, they can usually be managed safely. Nevertheless, they can be a serious problem and anesthesiologists are vigilant in monitoring for signs.

Not all adverse reactions are allergies. Some are medication side-effects that certainly can cause considerable discomfort or concern to patients and care providers alike. Patients are encouraged to discuss any prior adverse reaction with the anesthesiologist to illuminate the nature of the problem and to formulate a plan for optimizing your care.

Malignant Hyperthermia

Malignant hyperthermia is a rare but serious inherited muscle-related disorder in which dangerously high temperatures and muscle breakdown occurs due to various stimuli including commonly used anesthetic agents. If you or a family member have had such a reaction, it is important to communicate this to your anesthesiologist so that proper precautions can be taken. Prevention and management have never been better, and excellent resources are available.

Awareness Under Anesthesia

Awareness under general anesthesia is fortunately uncommon. Estimated rates in the past have been quoted at about 1.5 per 1000 cases and the rate continues to improve. Rest assured that every precaution is taken to prevent this. This subject has certainly received a lot of attention in the media and on shows like Grey’s anatomy, but the subject is more complex than what the media usually portrays. Concerns certainly warrant discussion with knowledgeable providers. Some surgeries are performed with varying levels of sedation that, if not explained to the patient, can be misconstrued for awareness under general anesthesia. If you have special concerns about this topic, feel free to discuss this with your anesthesiologist. Rest assured that you are in good hands, that this issue continues to become ever more rare, and that your anesthesiologist is truly cares about prevention.

Useful Resources for Patients

ASA Resource for Patients :

www.lifelinetomodernmedicine.com

This site is sponsored by the ASA specifically for patients. It presents the background of anesthesiologists, types of anesthesia, what to expect before, during, and after surgery. It also presents a list of FAQ’s and an extensive list of anesthesia-related topics.

American Society of Anesthesiologists:

www.asahq.org

Patient Education Page: www.asahq.org/PatientEducation.htm

Patient Safety Page: www.asahq.org/safety.htm

This is the official site of the ASA. Patients may also find this helpful.

Malignant Hyperthermia Association:

www.mhaus.org

This site provides information about malignant hyperthermia to patients and providers alike. It is of particular interest to families with known or suspected MH.

 
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