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When it Comes to Anesthesia, There Are Many Considerations

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When you need surgery, you have likely had the chance to meet your surgeon and discuss the procedure beforehand and spend several days or weeks getting used to the idea. However, you might not meet your anesthesiologist or discuss your anesthesia plan until the day of surgery, which can feel a little nerve-wracking.

“Before any procedure your surgeon and your anesthesiologist will have discussed what is needed both in terms of the procedure and you,” said Toshio Nagamoto, MD, a surgeon at Samaritan Surgical Specialists and program director of the general surgery residency program at Samaritan. “Your anesthesiologist may meet with you briefly right before a surgery, so it might feel fast, but there has been a lot of prep work behind the scenes that you may not be aware of.”

After reviewing your medical history, the anesthesiologist considers your overall health, medical conditions, medications you take, and the length and type of surgical procedure you are having to determine the right mix of anesthesia for you.

There are four categories of anesthesia that may be involved.

General Anesthesia

This is what most people think of when they hear “anesthesia” and is used for most major surgeries or procedures that may take a long time. General anesthesia may be referred to as going to sleep, but it is a medically induced reversible deep sleep that allows you to have surgery without experiencing pain.

General anesthesia is usually a mixture of several drugs which are used at different times during the surgery; some decrease awareness while others maintain deep sleep. The anesthesiologist considers the length and type of surgery, and any potential interactions or complications from a given drug with medical conditions you have like obstructive sleep apnea or heart conditions, medications you are on and allergies.

Your unique drug cocktail may be injected through an IV in a vein or as gas breathed in from a mask. You may need a breathing tube placed to make sure you are getting enough oxygen. The anesthesiologist will monitor your heart rate, breathing and blood pressure to make sure you remain safely unconscious.

General anesthesia is very safe. Researchers examining anesthesia over a period of six years found that of nearly 107 million surgical discharges there were 34 deaths from anesthesia, or 0.0000003%. Common side effects include nausea, fever and chills. Nausea is the most common and affects about 35% of people, so depending on your procedure the anesthesiologist may administer anti-nausea medication as you wake up.

Be sure and follow fasting recommendations before surgery. Since the muscles, including the digestive tract, are relaxed and reflexes are stopped it is possible for food or drink to come up from the stomach and be inhaled into the lungs. This can hinder breathing or damage the lungs.  

Monitored Sedation

Monitored sedation is used for shorter surgeries or procedures where you may need to be aware. Biopsies and scoping procedures like colonoscopy or endoscopy often use this type of anesthesia. Sedation may be mild, where you can talk, or deep where you will be asleep with no memory of the procedure. However, you will not be fully unconscious like you would be with general anesthesia. You may need to follow fasting recommendations as you would for general anesthesia. 

Sedation is considered safer than general anesthesia with fewer side effects.

Local Anesthesia

Local anesthesia numbs a small and specific part of the body, like when you are at the dentist. Local anesthesia is injected in the area to be operated on and may be used for in-office procedures to enhance the localized numbing effect, or in combination with general anesthesia or sedation.

Regional Anesthesia

Regional anesthesia numbs a large part of the body, like from the waist down. An epidural given during childbirth is a common example. The medication is given through a small tube and injected near the spinal cord or the bundle of nerves in the surgical area. Regional anesthesia may be used in combination with general anesthesia or sedation during surgery. This can help control pain and lessen the amount of general anesthesia or sedation you need. In some cases, a catheter may remain attached to a bulb to deliver a local anesthetic to the region to enhance prolonged numbing effect.

Dr. Nagamoto recommends taking advantage of your time with the anesthesiologist and asking questions about your care during surgery. It will help you understand what will happen, so you may feel less nervous. Be upfront about any health concerns you have and medications you are on, marijuana and street drugs you use, and how much alcohol you consume. All these factors can influence how your body responds to anesthesia.

“There is always some risk with surgery, but it has come a long way in the last 50 years,” said Dr. Nagamoto. “Surgery is safer now than it has ever been.”

Learn more about surgery and surgical options at Samaritan.