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If you are going to be having an invasive surgery, i.e. an operation entering the body, then you will most certainly be given some type of anesthesia to help you through the procedure.
Anesthesia is common, upwards of 40 million anesthetics are delivered annually in the US. Most of today’s advancements in surgical techniques are, in fact, afforded by improvement of anesthetic care. Anesthesia at its core is a highly scientific use of medical agents to render human body into a condition that allows a surgical procedure to occur.
As an anesthesiologist, I often get questions from friends and family asking what to expect as well as what goes on in the operating room during a procedure. First, it’s important to note that every surgery is different with unique challenges and sometimes unforeseen complications; but overall you’re in great hands, as the vast majority of anesthesia is safe. In fact, the operating room has become the safest room in the entire hospital.
That said, today’s post is an overview of anesthesia and some of its interactions on the body.
What’s the difference between Local, Regional, and General Anesthetics?
First, for terminology sake, let me point out that “anesthesia” is the partial or total loss of sensation in a body part or the whole body. An “anesthetic” is the drug or agent used to induce or maintain the anesthesia.
Local anesthetics: as the name implies, are applied directly to a specific location and are intended to provide a loss of sensation directly to that immediate area.
Regional anesthetics: provide anesthesia to a bodily region that contains the wound or surgery site. For example, a regional anesthetic for an ACL surgery, (see our 3-part blog series on that topic) would be applied to your spine, epidural space, or directly to the nerves carrying sensation and pain to the brain from the surgery site. Regional anesthetics block these sensations from ever reaching the brain. Someone under regional anesthesia can sometimes choose to be completely awake for major surgery or they can elect to be sedated for comfort.
General anesthetics: creates a total loss of sensation and consciousness throughout the body. General anesthesia involves sedation and anesthetics at higher doses which typically render a human without an ability to properly breathe on their own, and often involve breathing devices that can assist or take over breathing functions.
Because general anesthetics are given at higher doses than local or regional techniques, they can cause the negative side effects more commonly associated with anesthetics. These can include: nausea, vomiting, sore throat, and the “hangover feeling”. In general, it also requires a longer post-surgery recovery time.
For the most part, regional anesthetics are preferred over general anesthetics for these reasons. Not only will you be more comfortable following the surgery leading to a smoother post-surgery recovery but it can also lead to earlier discharge from the hospital. In fact, some estimates have claimed that nearly “98% of ambulatory surgical procedures will use regional anesthetics.1” So it’s likely you will encounter a regional anesthetic unless the anesthesiologist deems otherwise for your particular case, which could occur because of the nature of surgery itself or due to your medical conditions.
Preparing for Anesthesia
In general, your anesthesiologist or someone from the team will contact you a few days (potentially even weeks) before surgery and meet with you again right before the surgical procedure. During these conversations, the doctor wants to know what medications and substances (natural and unnatural) you have been taking plus any food consumption right before surgery.
These are critical conversations - so be accurate and thorough with your responses. If your anesthesiologist asks that medications and substances (ex: Vitamin E, K, your daily multivitamin, or herbal/homeopathic medications) be stopped prior to surgery, do so. These substances can cause bleeding during surgery and other surgery complications with the anesthetic.
The same applies to medications, where each can add a certain level of risk that should be avoided. Similarly use of Alcohol, Tobacco, or other substances should be mentioned. We won’t judge your lifestyle choices, but it’s crucial for us to know as some substances can affect the management of your anesthesia during the operation.
That said, it is important to make sure your body is replete with key ingredients for surgery recovery that can pass an anesthesiologist’s approval. The HealFast Surgical and Injury Recovery program is one example of a product that will give the body the key nutrients it needs without endangering a patient with surgery complications (ex: aspiration risk).
Remember to stay hydrated, nutritionally replete (without food and approved supplements), relaxed, and get a good night’s sleep the day before surgery and things should go fine.
How will my anesthetic be administered?
First, as mentioned, on the day of surgery you will have some consultations prior to the procedure. I would be one of them if I were your anesthesiologist. Here we would talk about anything you’ve eaten, your pre-surgery nutrition, and do a final confirmation of any medications you are taking (and may have been asked to stop) prior to surgery.
Once all the details are agreed on and signed off, a patient generally follows these steps (but not always).
Intravenous line (“IV”) inserted to provide a passage for medications, fluids, sedatives, antibiotics, etc.
Initial sedation. While sometimes you may be kept awake behind a curtain, you may receive an initial sedation to reduce anxiety, tension, and any pain from application of the regional anesthetic. Sometimes the sedation might put you to sleep for the duration of the procedure. Other times you may be relatively awake, but the anesthesiologist’s job is to help you be calm and comfortable. Sometimes sedation will be provided for placement of a regional anesthetic block, such an epidural, spinal, or peripheral nerve block.
Administering the Regional Anesthetic. A small amount of local anesthetic can be injected into the either near the spine or around a peripheral nerve. This can be done either by locating anatomical landmarks or via the use of ultrasound to pinpoint exactly where the nerve structures run. Sometimes a small catheter is inserted to provide the agent for the rest of the surgery and may remain in place after the surgery to provide continuous pain control. For certain techniques for peripheral nerves, the catheter may even be left in place when you are discharged home, and you will be given instruction on it’s removal yourself (do not worry, it is easy and painless). After the regional nerve block is administered, you will gradually lose feeling in the surgical area.
Administering further sedation. Whether the operation can be done under regional anesthesia or local anesthesia, sometimes sedation is desired. Typically sedation can be administered as a continuous infusion through your IV. If general anesthesia is required, more anesthetic will be titrated in, and once you have lost consciousness, a breathing device is inserted. At this point, there are many anesthetic techniques that can be incorporated into induction or maintenance of general anesthesia, and we would encourage you discuss these with your provider. For most surgeries, the breathing device will be removed before you fully wake up, thus you will have no recollection of it being in place, but you may have some sore throat or hoarseness in your voice for the next several days from the device being in place.
During Surgery: what does the Anesthesiologist do?
In the future, we may write a more technical post on the specifics, intricacies and balancing act that anesthesiologists handle during surgery; for now I will keep it high level.
While the procedure is occurring, the physician anesthesiologist is monitoring the patient's body functions, level of sedation, and vital signs to determine what changes to the anesthetic agent or physiological support are needed. Some of the vitals we check and monitor are: blood pressure, heart rate and rhythm, levels of CO2 and anesthetic gas in a patient’s exhale, blood oxygen content and electroencephalography (brain waves allowing us to determine the level of consciousness and sedation). Sometimes, we have to do more invasive monitoring, but those are the basics.
Many anesthetic agents routinely change physiological functioning of the body. Compounded with responses to surgery, we often have to use various medications and intervention to maintain your hemostasis during surgery.
Ultimately, the anesthesiologist makes the medical decisions on any changes to a patient’s condition. Your consent for anesthesia typically includes all potential interventions and medications that we would deem necessary to keep you safe.
After the surgery.
Once the surgery is completed, you will be closely monitored in the recovery unit as the effects of the agents wear off. Some of the things we look for are to ensure you can move without getting light headed, tolerate food and water, go to the bathroom, and that your pain and nausea are controlled. Once the criteria has been met, you may be discharged from the post-op area.
Usually anesthesia wears off quickly after the surgery because it is monitored closely and dosages typically coincide with the length and stimulation intensity of the surgery. Therefore, pain management and ultimately a prescription for pain medication will be given shortly thereafter. Apart from pain medication, the next best thing to ease post-surgery recovery will be ice, nutrition, rest, and time.
Hopefully this post has cleared up some common questions regarding anesthesia and what anesthesiologists do during surgery. If you have more questions or want other topics covered, drop a comment below or send us an email to firstname.lastname@example.org.
Hospital for Special Surgery medical recovery
General Disclaimer: All information here is for educational purposes only and is not meant to cure, heal, diagnose nor treat. This information must not be used as a replacement for medical advice, nor can the writer take any responsibility for anyone using the information instead of consulting a healthcare professional. All serious disease needs a physician.