Anesthesia

Types of Anesthesia

During surgery, you will be given some form of anesthetic, which is a medication administered for the relief of pain and sensation during surgery. The type and dosage of anesthetic is administered by the anesthesiologist. When a patient faces surgery, he or she will meet with the anesthesiologist before the procedure. The anesthesiologist will review the patient's medical condition and history to plan the appropriate anesthetic for surgery.

There are various forms of anesthetic. The type of anesthetic you will receive will depend on the type of surgery and your medical condition. Usually, an anesthesiologist will administer a sedative in addition to the anesthetic. The different types of anesthetic are as follows:

• Local anesthesia -  local anesthesia is medication given to temporarily stop the sense of pain in a particular area of the body. A patient remains conscious during a local anesthetic. For minor surgery, a local anesthetic can be administered via injection to the site. However, when a large area needs to be numbed, or if a local anesthetic injection will not penetrate deep enough, physicians may resort to regional anesthetics. 
• Regional anesthesia -  regional anesthesia means numbing only the portion of the body that will be operated on. Usually an injection of local anesthetic is given in the area of nerves that provide feeling to that part of the body. There are several forms of regional anesthetics, two of which are described below:
  • Spinal anesthetic  -  often used for lower abdominal, pelvic, rectal, or lower extremity surgery. This type of anesthetic involves injecting a single dose of the anesthetic agent directly into the spinal cord in the lower back, causing numbness in the lower body. 
  • Epidural anesthetic -  this anesthetic is similar to a spinal anesthetic and also is commonly used for surgery of the lower limbs and during labor and childbirth. This type of anesthesia involves continually infusing drugs through a thin catheter that has been placed into the space that surrounds the spinal canal in the lower back, causing numbness in the lower body. 
• General anesthesia  -  general anesthesia causes a patient to be unconscious during surgery. The medicine is either inhaled through a breathing mask or tube, or administered through an intravenous line--a thin plastic tube inserted into a vein (usually in the patient's forearm). A breathing tube may be inserted into the windpipe to maintain proper breathing during surgery. Once the surgery is complete, the anesthesiologist ceases the anesthetic and the patient wakes up in the recovery room. 

About Your Anesthesiologist

Anesthesiologists are the physicians trained to administer and manage anesthetic given during a surgical procedure. They are also responsible for managing and treating changes in your critical life functions--breathing, heart rate, and blood pressure--as they are affected by the surgery being performed. Further, they immediately diagnose and treat any medical problems that might arise during and immediately after surgery.

Before surgery, the anesthesiologist will evaluate the patient's medical condition and formulate an anesthetic plan that takes that patient's physical condition into account. It is vital that the anesthesiologist knows as much about your medical history, lifestyle, and medications as possible. Some particularly important information he or she needs to know includes the following:

• Reactions to Previous Anesthetics 
  If you have ever had a bad reaction to an anesthetic drug, you need to be able to describe exactly what the reaction was and what your specific symptoms were. Give the anesthesiologist as much detail as possible, such as whether you felt nauseated following surgery.
• Current Herbal Supplements 
  It has recently been learned that certain herbal products, commonly taken by millions of Americans, can cause changes in heart rate and blood pressure, and may increase bleeding in some patients. The popular herbs gingko biloba (an herb used for many conditions associated with aging, including poor circulation and memory loss), garlic (an herb often used for cardiovascular conditions and to help prevent colds, flu, and other infectious diseases), ginger, and ginseng (used as a general tonic to increase overall body tone; considered helpful in elevating energy levels and resistance to stress) may lead to excess blood loss by preventing blood clots from forming. In addition, St. John's wort (a popular herb used for mild to moderate depression) and kava kava (another popular herb used for depression and to elevate mood) may prolong the sedative effect of the anesthetic. The American Society of Anesthesiologists advises patients planning to have surgery to stop taking all herbal supplements at least 2 to 3 weeks before surgery to rid the body of these substances.
• Any Known Allergies 
  Discussing any known allergies with the anesthesiologist is very important, as some anesthetic drugs trigger cross-allergies, particularly in persons who have allergies to eggs and soy products. Allergies to both foods and drugs should be identified.
• Recent and/or Current Prescription and Over-the-Counter Medications 
  It is also important to let your surgeon and anesthesiologist know about both prescription and over-the-counter medications you are taking, or have recently taken. Certain prescription medications, such as coumadin, a blood thinner, must be discontinued for some time before surgery. In addition, as many people take a daily aspirin to prevent heart attack, or dietary supplements for other health reasons, physicians need to be aware of these habits, as they can prolong bleeding and interfere with muscle relaxants used by anesthesiologists.
• Cigarette Smoking and Drinking 
  Cigarette smoking and alcohol can affect your body just as strongly (and sometimes more strongly) than many prescription medications you may be taking. Because of the way cigarettes and alcohol affect the lungs, heart, liver, and blood, these substances can change the way an anesthetic drug works during surgery. It is important to let your surgeon and anesthesiologist know about your past, recent, and current consumption of these substances before surgery.
  Undergoing surgery can be a good motivator to quit smoking. Most hospitals are smoke-free and physicians, nurses, and other health professionals will be there to give you support. In addition, you will heal and recover faster, especially in the incision area, or if your operation involves any bones. Quitting smoking also reduces your risk of heart disease and cancer.
• Use of Street Drugs (such as Marijuana, Cocaine, Amphetamines, etc.) 
  Patients are often reluctant to discuss matters of illegal drug consumption, but you should remember that all conversations between you and your surgeon and anesthesiologist are confidential. It is crucial that he or she know about your past, recent, and current consumption of these substances. It is important to keep in mind that the only interest your physician has in this information is learning enough about your physical condition to provide you with the safest anesthetic possible.