- What is anesthesia?
- How do you become an anesthesiologist?
- What are the types of anesthesia?
- What happens if I receive general anesthesia?
- What happens if I receive regional anesthesia?
- What happens if I receive monitored anesthesia care?
- How does the anesthesia machine work?
- Will I wake up? Can I die from anesthesia?
- Is there any chance I might wake up during surgery?
- How will I feel after surgery? Do I get pain medicine?
- What can the anesthesiologist do for me when I have a baby?
The term "anesthesia" comes from the Greek terms: (1) "an" – without; and (2) "aesthesis" – feeling. Anesthesia has evolved over many years from the use of ether and chloroform, which led to complications or even death, to safe and effective modern anesthetic agents. Many of the improvements in safety and effectiveness are due to the high level of education required to administer anesthesia.
Anesthesiologists are physicians. Anesthesiologists must first complete four years of undergraduate pre-med education and be accepted to medical school. Each must complete four years of medical school and be accepted in an accredited anesthesia residency program. After four years of residency training each must pass a written and oral exam for board certification by the American Board of Anesthesiology. Some of our physicians go on to additional fellowship training in Critical Care, Pain Management, Pediatrics and Cardiovascular Anesthesia.
According to the American Society of Anesthesiologists (ASA), monitored anesthesia care (MAC) is a planned procedure during which the patient undergoes local anesthesia together with sedation and analgesia. Actually MAC is the first choice in 10-30% of all the surgical procedures. The three fundamental elements and purposes of a conscious sedation during a MAC are: safe sedation, control of patient anxiety and pain control. Patients undergoing conscious sedation are able to answer questions appropriately and to protect their airway. The patient consciousness evaluation is of extreme importance during the surgical procedure performed with MAC. MAC can be obtained with the association of fast half-life drugs or drugs obtaining a clinical effect which can vary according to the surgical requirements, possibly using an infusion regiment.
Local anesthesia involves the injection or application of agents that numb the affected area without interacting with the other physiological process of the patient.
Regional anesthesia includes pain blocks that involve local anesthetic injection to impede conduction of specific nerves for relief of pain to certain regions of the body. These blocks include spinals and epidurals, axillary or interscalene blocks, femoral blocks and caudal blocks to name a few.
General anesthesia is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.
Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Hence, practitioners intending to produce a given level of sedation should be able to rescue*** patients whose level of sedation becomes deeper than initially intended. Individuals administering Moderate Sedation/Analgesia (“Conscious Sedation”) should be able to rescue*** patients who enter a state of Deep Sedation/Analgesia, while those administering Deep Sedation/Analgesia should be able to rescue*** patients who enter a state of General Anesthesia
** Reflex withdrawal from a painful stimulus is NOT considered a purposeful response.
*** Rescue of a patient from a deeper level of sedation than intended is an intervention by a practitioner proficient in airway management and advanced life support. The qualified practitioner corrects adverse physiologic consequences of the deeper-than-intended level of sedation (such as hypoventilation, hypoxia and hypotension) and returns the patient to the originally intended level of sedation. It is not appropriate to continue the procedure at an unintended level of sedation.
During general anesthesia the brain is anesthetized or put to sleep. We normally think of this type of anesthetic as one in which the patient is deeply asleep, feels nothing during the operation, and remembers nothing about the operation afterward. General anesthesia may be administered by intravenous injection, by mask, or both. For adults, the preferred method is by the administration of anesthetic medication through an intravenous (IV) line. For small children, and especially children who are afraid of "shots," the preferred method is by breathing anesthesia gases through a soft clear face mask. In many cases during pediatric anesthesia, after the child is safely and soundly asleep, an IV will be started for safety and allow a route for further medicines to be administered.
If you are to receive a general anesthetic, you will be interviewed by the anesthesia provider in the pre-op area first. You will have an opportunity to let the provider know about any health issues that might cause concern and you will have the opportunity to ask any questions that you may have. Prior to proceeding you will likely first receive an anxiolytic medication in your IV in the pre-op area. You will then be brought into the operating room/procedure area and may be asked to move onto an operating room bed. Most patients do not recall this part of the process due to the amnestic (memory erasing) effects of the anxiolytics received in the pre-op area. The surgical team will place a number of monitors including EKG (heart monitors), blood pressure monitors, breathing monitors, monitors measuring oxygenation, and perhaps others. Following this, you will be given some fresh air (oxygen) via the clear mask to breathe just prior to going to sleep. When it is time to begin your anesthetic, your anesthesiologist will begin giving medicine through your IV. At first, you probably won’t even notice, but it will cause you to feel very pleasantly relaxed and then to drift off to sleep. After you are completely anesthetized, the anesthesia provider will sometimes place an endotracheal tube (breathing tube) into your trachea to allow for assisted breathing and to protect you from aspiration (breathing in vomitus while without a cough reflex). They may alternatively choose to allow you to breathe on your own or assist in providing a conduit for you to breathe using a laryngeal mask airway (LMA) or like device. Your anesthesiologist or anesthesia care team will administer many other medications and substances as required during your anesthetic course to assure that you are safe and comfortable. You may be awakened in the operating room/procedure area or taken to the recovery room (PACU) after the completion of the procedure. Your anesthesia provider will transfer care to the PACU nurse communicating any important medical history or case related information. Most patients do not recall the events between the anxiolytic medication being given in the pre-op area and awakening in the PACU.