Anesthesia

What is anesthesia?

Anesthesia is the administration of a drug and/or gas to numb part of your body or to create a state of unconsciousness. The main types of anesthesia are local, regional, and general.

Local anesthesia numbs part of your body while you remain conscious. It is routinely used by many doctors in their offices for simple procedures such as sewing up a cut or removing a skin growth.

Regional anesthesia is similar to local in that you remain awake. However, in many cases you may be given a sedative. Regional anesthesia can be used for more extensive procedures than local anesthesia. Two types of regional anesthesia are spinal and epidural.

Spinal anesthesia can be used for many operations below the navel, such as rectal, bladder, and prostate operations, as well as operations on the legs.

Epidural anesthesia can be used for many of the same procedures for which spinal anesthesia is used. Epidural anesthesia, unlike spinal anesthesia, allows for easy reinjecting of anesthesia during longer operations. It can be used to treat pain for several days after the operation.

General anesthesia will relax your muscles and make you feel as if you are in a deep sleep. Anesthesia gases or drugs primarily affect the brain. General anesthesia is usually administered by an anesthesiologist (a doctor who specializes in giving anesthesia) or a nurse anesthetist. The use of this type of anesthesia has to be done with great care, especially in the elderly. The elderly are prone to short-term and long-term confusion after general anesthesia.

When is it used?

The purpose of anesthesia is to prevent you from feeling pain during a surgical or medical procedure.

How do I prepare for anesthesia?

Preparation for anesthesia varies depending on what kind of surgery or medical procedure you are having. Follow the directions your doctor gives you.

What happens during the procedure?

Local anesthesia is usually administered by injecting a specific part of your body with a drug that numbs the nerves. It can also be administered in the form of nose drops or spray. You remain fully conscious.

Spinal anesthetic is injected through a small needle into the fluid-filled space surrounding your spinal cord. The injection is usually painless. Epidural is injected just outside the sac that contains your spinal fluid.

Before general anesthesia, your primary care doctor should review your medications and health problems to assess whether you should have this type of anesthesia. If indicated, the anesthesiologist will decide on the type of anesthesia and dosage to be used. An injection of a premedication drug may be given to relax you before you go to the surgical area. When surgery begins, drugs are given by injection into a vein. If gas is used, it is given through a mask covering your nose and mouth, or through a breathing tube in your throat. In some cases a muscle relaxant is given in addition to the anesthesia. Your heart rate, breathing, blood pressure, and other signs are watched carefully during the procedure.

What happens after the procedure?

Each procedure or type of surgery requires different follow-up. Check with your doctor about what you need to do.

What are the benefits of anesthesia?

The procedure helps to relieve pain and create numbness or a state of unconsciousness during surgery.

What are the risks associated with anesthesia?

Risks from local and regional anesthesia include:

• You may feel some minor discomfort because the anesthetic may not numb the area enough.
• You may have an allergic reaction to the anesthetic, causing fever, nausea, and vomiting.
• You may have long-term damage to the nerves.
• You may have trouble breathing because the anesthetic can affect the respiratory system.
• Rarely, you may react by having seizures, cardiac arrest, dizziness, or loss of consciousness.

Risks from general anesthesia include:

• After the anesthesia, you may have nausea and vomiting, sore throat, and muscle pain.
• You may have low blood pressure.
• You may have stress on the heart.
• You may have an irregular heartbeat (arrhythmia).
• In rare cases, you may have a heart attack, stroke, or brain damage, which could result in death.
• You could have confusion that could last from days to weeks.

The probability of the above risks is low, although serious injury can result. Because general anesthesia affects all areas of your body, such as the heart and lungs, side effects are more common than with local or regional anesthetics. Local and regional anesthesia are considered safer than general anesthesia. However, most side effects from general anesthesia do not last long and are easily relieved by the anesthesiologist or nurse anesthetist who stays with you throughout the operation.

Confusion is one side effect in the elderly that can last for an extended period after the operation. Discuss with your doctor any concerns you may have.

When should I call the doctor?

If you feel anything unusual while you are recovering from the procedure, tell the doctor or a nurse immediately.

Call the doctor during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.