Frequently Asked Questions about Anesthesia

What is anesthesia?

Anesthesia is freedom from pain. Each year, millions of people in the United States undergo some form of medical treatment requiring anesthesia. Anesthesia is a safe and effective means of alleviating pain during nearly every type of medical procedure.

Anesthesia care is not confined to surgery alone. The process also refers to activities that take place both before and after an anesthetic is given.

What are the types of anesthesia?

General Anesthesia - General anesthesia acts primarily on the brain and central nervous system to make the patient unconscious and unaware. It is administered via the patient's circulatory system by a combination of inhaled gas and injected drugs. After the initial injection, anesthesia is maintained with inhaled gas anesthetics and additional drugs through an intravenous line (IV).

Local Anesthesia - is medicine given to temporarily stop the sense of pain in a particular area of the body. A patient remains conscious during a local anesthetic. For minor surgery, a local anesthetic can be administered via injection to the site. However, when a large area needs to be numbed, or if a local anesthetic injection will not penetrate deep enough, physicians may resort to regional anesthetics.

Regional Anesthesia - involves injection of a local anesthetic (numbing agent) around major nerves or the spinal cord to block pain from a larger but still limited part of the body. You will likely receive medicine to help you relax or sleep during surgery. Major types of regional anesthesia include:
Spinal - often used for lower abdominal, pelvic, rectal, or lower extremity surgery. This type of anesthetic involves injecting a single dose of the anesthetic agent directly into the spinal cord in the lower back, causing numbness in the lower body.
Epidural, and caudal anesthesia - this anesthetic is similar to a spinal anesthetic and also is commonly used for surgery of the lower limbs and during labor and childbirth. This type of anesthesia involves continually infusing drugs through a thin catheter that has been placed into the space that surrounds the spinal cord in the lower back, causing numbness in the lower body.
Nerve blocks - A local anesthetic is injected near a specific nerve or group of nerves to block pain from the area of the body supplied by the nerve. Nerve blocks are most commonly used for procedures on the hands, arms, feet, legs, or face. Example - a Brachial Plexus block may be used by your anesthesiologist to provide anesthesia to your entire arm and shoulder.

What should I expect before surgery?

Before your surgery, an anesthesiologist will perform an examination and evaluation to determine the type of anesthesia you will receive. The anesthesiologist and CRNA will interview you to determine the best combination of drugs and dosages and the degree of how much monitoring is required to ensure a safe and effective procedure.

Your age, weight, medical history, current medications, previous anesthetics, and fasting time will be recorded. Truthful and accurate answering of the questions is important so the anesthetist can select the proper anesthetics. For instance, a heavy drinker or drug user who does not disclose their chemical uses could be under medicated, which could then lead to anesthesia awareness or dangerously high blood pressure. Commonly used medications such as Viagra can interact with anesthesia drugs; failure to disclose such usage can endanger you.

An important aspect of this assessment is that of your airway, involving inspection of your mouth opening and visualization of the soft tissues of the pharynx. The condition of teeth and location of dental crowns and caps are checked, neck flexibility and head extension observed. If an endotracheal tube is indicated and airway management is deemed difficult, then alternative placement methods such as fiber optic intubation may be used.

Eating & Drinking Before Surgery

If you have had food or drink within a few hours of surgery, there is a higher likelihood that you will vomit while receiving anesthesia. Vomiting increases the risk of complications and should be avoided if possible. Be certain to tell your anesthesiologist what food and drink you have had during the past 12-24 hours. Emergency surgery is an exception to the rule of no eating or drinking shortly before surgery, and special precautions can be taken to minimize the risk. When planning your surgery, ask your surgeon about eating and drinking restrictions.

Communicate With Your Anesthesiologist

During your preoperative examination, please feel free to ask your anesthesiologist any questions you have or to voice concerns. Be certain to inform the anesthesiologist of:
  • What food and drink you have consumed during the past 12-24 hours
  • Any special dental work (false teeth, bridges, etc.)
  • Any bad experience during previous surgeries
  • Any drug allergies

During Your Surgery

The anesthesiologist will be in the operating room while the anesthesia is administered to you. A certified registered nurse anesthetist (CRNA) may work with the anesthesiologist during your surgery to administer the anesthesia and may monitor your condition during surgery. However, the CRNA is always under the supervision of the anesthesiologist who will be present during any part of the surgery requiring greater training and experience. The anesthesiologist will assume control in the event of an emergency.

Anesthesia Drugs
The drugs used for anesthesia continue to improve with each passing year. The newer drugs have fewer side effects and complications; however, you need to inform your anesthesiologist of any previous negative experiences during surgery. The anesthesiologist must know this information in order to administer the proper drugs in the proper dosage.

Breathing Tubes
During your surgery you will probably not need any breathing device other than an oxygen mask, if you are having local or regional anesthesia, or sedation. General anesthesia decreases your ability to breathe on your own, and anesthesiologists have several ways to assist your breathing. These breathing aids include the use of an endotracheal (breathing) tube and a laryngeal mask airway (LMA). If you need an endotracheal tube, it will be placed into your "wind-pipe" by passing it through the vocal cords using a laryngoscope. The endotracheal tube will be removed as soon as you are able to safely breathe without on your own.

Dental Work & Teeth

You will probably not be aware of the placement or removal of the endotracheal tube. If you need an endotracheal tube, your anesthesiologist will take every precaution to avoid any complications during the placement and removal of it.

The two main risks of an endotracheal tube are:
  • Potential damage to teeth or dental work.
  • Sore throat: During your preoperative evaluation, please inform your anesthesiologist of any special dental work (false teeth, bridges, etc.) or if you have experienced any problems with a breathing tube during prior surgeries.

Laryngeal Mask Airway (LMA)

As an alternative, your anesthesiologist may use a Laryngeal Mask Airway (LMA) instead of an endotracheal tube. The LMA is an effective method of assisting your breathing with a decreased likelihood of a sore throat. The LMA is frequently used for short day surgery cases.

Wake-up During Surgery?

You are not likely to wake up during surgery, but if you did, you will probably not feel any pain or even remember being awake. Anesthesiologists are specially trained to administer the proper amount of anesthesia to keep you asleep during surgery.

After Your Surgery

After your surgery or procedure, an anesthesiologist, a certified registered nurse anesthetist (CRNA) will take you to the post anesthesia care unit (PACU) and will stay with you until a recovery room nurse can safely care for you. You will recover and awaken from the anesthesia in the PACU, a specialized unit staffed by registered nurses with specialized training, certification, and experience.

Your recovery from anesthesia will take a variable amount of time depending on the type of medications used, type and duration of surgery, and your special needs. You will stay in the PACU until you have met specific criteria for discharge to your hospital room or home.

Nausea and Vomiting

Some patients experience nausea and vomiting after surgery. Before surgery, let your anesthesiologist know if you have experienced nausea or vomiting after a previous surgery. You may be given medications to reduce or eliminate nausea. Inform your recovery room nurse if you feel nauseous.

Discomfort and Pain

You will probably experience some discomfort and pain after your surgery, but you will most likely receive drugs for the relief of post-operative pain. Tell your recovery room nurse if you experience any pain.

Drowsiness Is Normal

You will be sleepy and drowsy after surgery, and you may feel drowsy for a couple of days or longer depending on your surgical procedure.

Sore Throats Are Common

Patients frequently experience sore throats after anesthesia, but they should not last more than one or two days unless it is related to your surgery.

Who will be involved in the operation?

There are quite a number of highly trained medical personnel who will be involved in your operation. The surgical team will include the surgeon himself, the doctor who will be the surgical assistant, a professional nursing sister, called the “scrub sister”, and her assistant, the floor nurse, who fetches and carries for her. The anesthetic team consists of the anesthetist, an anesthetic assistant, and the recovery room sister.

Why is starvation important?

One of the risks of an anesthetic is that stomach contents can be regurgitated or that there may be vomiting, and your lungs will be contaminated with stomach contents. This can have very serious consequences. For this reason your anesthetist will instruct you not to take any fluid for at least two hours or solid food for four to six hours before your operation.If your operation is been carried out as an emergency and there is not time to allow your stomach to empty, your anesthetist has to use special techniques to minimize the risk of aspiration, as it is called. But it is always best to keep risks to an absolute minimum, and pre-operative starvation is the best way to do this.

What should I wear to the hospital or facility?

Please wear loose fitting clothes that are easy to put on and will fit over bulky bandages or surgical dressings. Leave your jewelry and valuables at home.

For more information on Anesthesia, you can visit the website for: The American Society of Anesthesiologists

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