What are the different types of anesthesia?

There are 3 major categories of anesthesia: local, regional, and general. Each has its own advantages depending on your medical condition and the surgical procedure. Within each category, there are many different techniques and approaches. Sometimes techniques from different categories of anesthesia are combined to get the best of both worlds. 

What is the difference between an epidural and a spinal anesthetic?

Spinal anesthesia involves injection of a very small dose of local anesthetic directly into the spinal fluid, using a very small needle. It is usually a one-shot” approach without a catheter (tiny plastic wire-like tube) for repeat dosing. The lower part of your body will usually get very numb immediately. Epidural anesthesia involves placing a small catheter through a needle into a space called the epidural space, which can be thought of as a sheath around the spinal cord and spinal nerves. The needle is removed but the catheter stays in place in order to allow continuous or repeated dosing as needed. The onset of epidural anesthesia is slower than spinal anesthesia, about 10-20 minutes. Epidural anesthesia is most commonly used when repeated dosing is likely to be necessary (such as during labor, or for longer surgery) because the catheter makes repeat injections easy. The risks of spinal and epidural anesthesia are similar, and the procedures usually feel quite similar to the patient (numbing the skin of the lower back, placing the needle, injecting medication). In almost all cases, the skin and tissues beneath the skin are well-numbed using a tiny needle and local anesthetic, so that both spinal and epidural procedures are painless or cause only very slight discomfort. 

What are the risks of anesthesia?

While all operations and all anesthesia carry some risk, the specific risks of anesthesia vary with the type of surgical and anesthetic procedures and the condition of the patient. You should ask your anesthesiologist and nurse anesthetist about any risks that may be associated with your anesthesia. Overall, anesthesia today is remarkably safe due to powerful scientific and technical advances, rigorous training and qualification requirements for anesthesia professionals, and an emphasis on vigilance and patient safety for which the specialty is renowned throughout the medical world. Adverse events are rare, and healthy patients undergoing elective surgery are far more likely to be injured while driving to the hospital than undergoing anesthesia. 

Why do I have to fast before anesthesia and surgery?

We take numerous precautions to prevent any problems due to vomiting while under anesthesia. As a result, complications from vomiting during anesthesia are extremely rare. Among the many precautions we take to decrease the risk of vomiting is to have you fast for up to 8 hours before surgery in order to decrease the volume and acidity of your stomach contents. 

Will I vomit after surgery?

Sometimes patients are nauseated and may vomit after surgery. This is most common with abdominal procedures, gynecologic surgery, and eye surgery. It is more common in women than men, and more common in people who are prone to motion sickness. We take numerous measures to prevent nausea and vomiting after surgery, including using anesthetics that have an anti-nausea effect and administering anti-nausea medications before, during, and after surgery. 

Should blood pressure medicines be taken on the morning of surgery? 

Doctors may differ in their opinions on this question.  As a general rule, we advise patients to take all blood pressure medications at the usual time on the day before surgery.  But we prefer for my patients not to take any medications on the morning of surgery.  Fluid pills such as hydrochlorothiazide may cause dehydration, and other blood pressure medications such as lisinopril (Zestril) or valsartan (Diovan) may contribute to dangerously low blood pressure under anesthesia.   If a patients blood pressure is high on the day of surgery, we can use I.V. medications to bring it to a safe level. 

Should all blood thinners be stopped a week before surgery? 

This is a complicated issue, and the answer depends on which blood thinner has been prescribed and why.  If you have coronary artery stents, for example, you may be told to stop clopidogrel (Plavix) a week before surgery, but continue taking baby aspirin.  If you are taking warfarin (Coumadin) for an irregular heartbeat or an artificial heart valve, you may be advised to stop taking it and switch to a shorter-acting blood thinner for a few days.  Your surgeon and your cardiologist should agree on the best plan for your situation.  Dont just follow pre-printed instructions that the office staff may give you; talk to all your physicians in advance to be clear about the safest plan for you. 

Should I bring a list of my medications with me, or can I assume that the hospital will have all the information? 

Unfortunately, communication between doctors offices and hospitals isnt always perfect, and your medical records may not be complete when you arrive for surgery.  Its always a great idea to bring a list of your medications and doses, as well as a written summary of your medical conditions and previous operations you may have had. 

Will I dream during anesthesia?

Dreaming during general anesthesia is uncommon, due to the fact that the anesthetic state differs from normal sleep. The stage of sleep where dreaming normally occurs, called REM (for rapid-eye-motion) sleep, is suppressed during general anesthesia. When dreams or dream-like memories do occur, they generally occur at the end of anesthesia when you are waking up.” Such very brief dreams or dream-like memories are similar in content and tone to normal dreams, and studies have shown that they are reported as neutral or pleasant. During local or regional anesthesia with sedation, patients commonly drift off to sleep and dreaming is more common than with general anesthesia but rarely unpleasant. Certain drugs, such as propofol and ketamine, are more likely to be associated with dreaming. These drugs are commonly used because they have many beneficial effects, including allowing a rapid return to wakefulness with a positive mood and no nausea. 

Will I “wake up” during general anesthesia?

Awareness under general anesthesia is rare during routine elective surgery. We use many techniques to prevent this rare and very serious event from occurring. Clinical reports and research in this area have shown that patients who believe they were or might have been awake during general anesthesia benefit greatly from discussing this with their surgeon and anesthesiologist as soon as possible, and if necessary they can be promptly referred for therapy to prevent the incident from causing further distress. Waking up patients at the end of general anesthesia is intentional and necessary, and some patients may have brief recollection of the final waking-up stages, though this too is rare. The rare patient who remembers waking up at the end of a general anesthetic usually is not distressed by it. 

Do I have to discuss how much I drink or smoke?

If youre uncomfortable discussing your current use of alcohol, tobacco, pain medications, marijuana, sedatives, or anything else while family members are present, just say goodbye to them and send them to the waiting area so that you can have a private conversation with your physician anesthesiologist and nurses.  We arent judgmental, and we really do need to know.  Routine use of alcohol, pain medications or sedatives can affect the amount of anesthesia you may need.  Smoking damages the lungs so please be honest with us about your current habits.  You may safely keep to yourself how much of anything, legal or illegal, you smoked in your youth. 

Are older patients at risk for confusion after anesthesia? 

Older patients who already have signs of confusion or dementia are at risk for increasing confusion (also known as postoperative delirium) after anesthesia and surgery.  Patients who have had a stroke or a mini-stroke (TIA) are also at higher risk.  If this is a concern, speak with the physician anesthesiologist, who can explain more about anesthesia techniques and monitoring that will reduce the chance of problems.  The physician anesthesiologist may recommend regional anesthesia (spinal, epidural or nerve block) if it is appropriate for the surgery. 

Why is it important not to eat or drink anything after midnight? 

The answer to this question is the same for patients of any age.  When a patient is unconscious or sedated, food or liquid in the stomach could come back up into the throat and get into the lungs, causing dangerous pneumonia.  Solid foods and creamy liquids are the worst offenders.  If your surgery is scheduled later in the afternoon, you may be permitted to have water or clear liquids up to six hours before the procedure. 

If you have special concerns or risk factors for anesthesia, your surgeon or your hospital should be able to arrange for consultation with a physician anesthesiologist ahead of time.  Otherwise, you will meet your physician anesthesiologist on the morning of surgery, and he or she will explain the anesthesia plan and answer any questions you and your family may have.  Check your hospital’s website; many have information about the physician anesthesiologists who practice there. 

For more information about anesthesia, please visit the American Society of Anesthesiologists website or the American Association of Nurse Anesthetists website for patients and families. 

Sally Allbright – Administrator
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