Anesthesia
Types of anesthesia
During surgery, you will be given some form of anesthesia -
medicine administered for the relief of pain and sensation during surgery. The
type and dosage of anesthesia is administered by the anesthesiologist. When a
patient faces surgery, he/she will meet with the anesthesiologist or nurse
anesthetist 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 anesthesia. The type of anesthesia
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 anesthesia include the following:
Local anesthesia - local anesthesia is an anesthetic
agent 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 use to regional anesthetics.
Regional anesthesia - regional anesthesia means numbing
only the portion of the body which 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 - a spinal anesthetic is used for lower
abdominal, pelvic, rectal, or lower extremity surgery. This type of anesthetic
involves injecting a single dose of the anesthetic medication into the
subarachnoid space, which surrounds the spinal cord. The injection is made into
the lower back, below the end of the spinal cord, and causes numbness in the
lower body. In some situations, such as a prolonged procedure, continuous spinal
anesthesia may be used. A thin catheter (hollow tube) is left in place in the
subarachnoid space for additional injections of the anesthetic agent, which
ensures numbness during the length of the procedure.
-
epidural anesthetic - the epidural anesthetic is similar
to a spinal anesthetic and is commonly used for surgery of the lower limbs and
during labor and childbirth. This type of anesthesia involves continually
infusing an anesthetic medication through a thin catheter (hollow tube). The
catheter is placed into the space that surrounds the spinal cord in the lower
back (just outside the subarachnoid space), causing numbness in the lower body.
Epidural anesthesia may also be used for chest surgical procedures. In this
case, the anesthetic medication is injected at a higher location in the back to
numb the chest and abdominal areas.
General anesthesia - general anesthesia causes a patient
to induce unconsciousness during surgery. The medication 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 anesthesia 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.
Prior to surgery, the anesthesiologist will evaluate the
patient's medical condition and formulate an anesthetic plan which 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/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 you felt nauseated
when you woke up or the amount of time it took you to wake up, etc.
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 two to three weeks prior to 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 medications 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 prior to surgery. In addition, as
many people take a daily aspirin to prevent heart attack, and certain dietary
supplements, 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 prior to surgery.
Undergoing surgery can be a good motivator to quitting 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/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
anesthesia possible.
Meeting the anesthesiologist before the surgery
Because anesthesia and surgery affect every system in the body,
the anesthesiologist will conduct a preoperative interview. Sometimes this is
done in person; in other cases, the anesthesiologist will interview you over the
telephone. During this interview, the anesthesiologist will review your medical
history, as well as discuss the information mentioned above. He/she will also
inform you about what to expect during your surgery and discuss anesthetic
choices with you.
If you have not personally met during the preoperative
interview, the anesthesiologist will meet with you immediately before your
surgery to review your entire medical history as well as results of any medical
tests previously conducted. By this time, he/she will have a clear understanding
of your anesthetic needs.
How are other existing pre-existing medical conditions handled
during surgery?
If you have a pre-existing medical condition such as diabetes,
asthma, heart problems, arthritis, etc., your anesthesiologist will have been
alerted to this and will be well prepared to treat these conditions during your
surgery, as well as immediately afterward. Anesthesiologists are trained to
handle sudden medical problems related to the surgery, as well as any chronic
conditions that may need attention during the procedure.
How is the patient's condition monitored during surgery?
Monitoring is one of the most important roles the
anesthesiologist handles during surgery. Second-by-second observation of even
the slightest changes in a wide range of body functions gives the
anesthesiologist a tremendous amount of information about the patient's
well-being. In addition to directing your anesthesia, the anesthesiologist will
manage vital functions such as heart rate, blood pressure, heart rhythm, body
temperature, and breathing. He/she will also be responsible for fluid and blood
replacement, when necessary. Sophisticated technology is used to monitor every
organ system and its functioning during surgery.
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