Everything you’ve always wanted to know about anesthesia but were too groggy to ask

What if I feel the pain during the surgery?"

"Suppose I don’t wake up afterwards?"

"Doesn’t it produce forgetfulness if you do it too often?"

Surveys show that about half of all patients who undergo surgery that requires loss of consciousness or significiant sedation (deep relaxation, or twilight sleep) share the common fears expressed above. Truth be told, there are some patients who are frightened more about the anesthesia than the surgery itself.

But it’s a fear with little basis in fact. Serious complications almost never occur in the absence of any pre-existing medical problem. Experts estimate it’s safer to have a general anesthesia than to ride in a car. Anesthesia today is 10 times safer than it was in the 1970s – and 100 times safer than in 1955!

In fact, undergoing anesthesia is arguably the safest of all medical procedures. During the last decade, anesthesia-related deaths in the US have plummeted 25-fold – to about 1 in 250,000. Furthermore, fatalities are nearly always limited to patients who were unstable or severely compromised before surgery. In addition, fewer patients today experience the most common aftereffects of anesthesia – postoperative nausea, vomiting, grogginess and confusion.

Several advances account for these improvements. Virtually all operating rooms use monitoring equipment and techniques that reduce the likelihood of error while anesthesia is administered. Nausea and vomiting are minimized by new anesthetic medications and anti-nausea drugs called antiemetics. The newer anesthetics also wear off as soon as they are no longer needed, resulting in less postoperative grogginess and confusion. Finally, anesthesiologists must meet rigorous postgraduate training standards.

Anesthesiologists, however, will be the first one to caution you that safety should never be taken for granted. And if you are planning a surgical procedure that requires significant anesthesia, it’s important to know as much as possible how you can help your anesthesiologist deliver the safest and most effective care.

What Your Anesthesiologist Needs To Know About You

Apreoperative evaluation performed by an anesthesiologist is routine for all planned surgeries – and its importance cannot be overemphasized. One study found that preanesthetic evaluations provided information that changed care plans for more than 15 percent of participants. All preoperative evaluations should include the following points:

• Results of preoperative tests, which may include an electrocardiogram, laboratory tests, or imaging studies;

• Your general health, including any chronic medical conditions such as diabetes or emphysema, and your current activity level;

• Recent or unusual symptoms, especially shortness of breath or chest pain, that raise the risk of postoperative complications;

• The names and dosages of any prescription or over-the-counter medications, or vitamin or herbal supplements you take;

• Allergies to food, medication or latex;

• Your history of alcohol, cigarette or illicit drug use;

• Past anesthesia-related problems you or family members have had;

• Unusual mouth or throat anatomy or dental problems that would complicate endotracheal tube placement;

• Your concerns or preferences about postoperative pain management;

• Other concerns or special requests you might have.

Forms Of Anesthesia

There are three main types of anesthesia: general, regional and local. General anesthesia produces complete loss of consciousness and blocks pain throughout the entire body. Regional anesthesia produces variable degrees of sedation and blocks pain in a specific region. Local anesthesia blocks pain in a limited area, sometimes with sedation but without loss of consciousness. The goal of anesthesiology is to provide the appropriate degree of pain blockade with the least amount of sedation.

All three types of anesthesia can be used on an inpatient or outpatient basis. Longer, more involved surgeries (such as coronary artery bypass grafting, or laparoscopic procedures) frequently call for general anesthesia. Regional anesthesia is typically used for significant but somewhat less extensive operations including most lower abdominal, urologic and gynecologic procedures and orthopedic procedures of the legs and arms. Regional anesthesia is also used when a surgeon or anesthesiologist wishes to monitor the patient’s conscious responses during the procedure, as in certain types of brain surgery. Spinal, epidural and caudal anesthesia involves injection of a local anesthetic near the spinal cord. Local anesthesia is appropriate for relatively minor procedures, such as stitching of a small wound or dental work. It can be used with intravenous sedation for more extensive operations. The newer anesthetics can achieve a level of local pain control and sedation that closely mimics that of general anesthesia.

Safety Checks

During general anesthesia, a breathing tube (endotracheal tube) is usually placed in your windpipe (trachea). A monitor can be used to determine whether that tube is properly positioned and whether you’re breathing properly throughout the surgery.

Among the newer monitors that have helped reduce complications is the pulse oximeter. It’s a small noninvasive device that attaches to your fingertip. The oximeter constantly measures the amount of oxygen in your blood. Should your oxygen level drop for some reason, an alarm sounds.

Other monitors may be used to keep track of your heart rate, circulation, blood pressure, temperature, body fluid balance and other bodily functions.

Along with the advances in monitoring, there is today a better understanding of how anesthesia affects the individual. In addition, there are shorter-acting drugs and new intravenous drugs that can preempt the nausea and vomiting that sometimes occur after anesthesia.

Recovering From Anesthesia

At the end of surgery requiring general anesthesia, the anesthesiologist essentially reverses the effects of the anesthetic drugs.

As you come to consciousness, you’ll be carefully monitored by anesthesiologists and nurses who are skilled in postoperative pain management. If you’re experiencing pain at this point in your recovery, it’s important to ask for something to take care of it. Putting up with excessive pain after surgery gains you nothing and can be detrimental.

In the last five years, regional anesthesia has been increasingly used to control postoperative pain. That, in turn, reduces the need for other pain medication that might otherwise leave you feeling groggy for a longer period of time.

Local anesthetics can also be helpful following surgery. They’re especially useful in reducing pain where an incision has been made.

Safer Than Ever Before

Each person’s experience with anesthesia is different. But thanks to advances in this area of medicine, anesthesia is now safer than ever before and can be tailored to specifically suit your needs.