Understanding anesthesia
There are three types of anesthesia:
Regional anesthesia
A regional anesthesia numbs only a region or part of the body using local anesthetics. The patient remains awake, but may be sedated. The most common local anesthetics used include lidocaine and bupivacaine.
Three major techniques of regional anesthesia
- Topical: Drugs applied to the surface of the tissue to be anesthetized; i.e., eye, nose, throat, bladder.
- Infiltration: Drugs injected directly into the tissues to be numbed.
- Regional Block: Anesthetic drugs injected around a main nerve or nerves, which go to the area to be numbed. Sometimes a regional block is not adequate for surgery or fails to provide satisfactory postoperative pain relief for the patient. Under these circumstances, a general anesthetic may be necessary for safe and proper surgical care, or the regional block may need to be repeated and/or a different method of post-operative pain relief may be used.
Spinal
A spinal anesthetic is a form of regional anesthesia, most often utilized for operations on the legs, lower abdomen, perineum, or back, and occasionally for upper abdominal operations. A delicate needle is inserted between the bones of the lower spine (below the level of the spinal cord) into a sac containing cerebrospinal fluid (CSF) and exiting nerve roots. A local anesthetic is then injected, “numbing” these nerves and providing surgical anesthesia.
Epidural
An epidural anesthetic is another form of regional anesthesia used for many of the same operations as a spinal. Unlike a spinal in which a onetime dose of local anesthetic is administered, providing a fixed time period of “numbing,” a small epidural catheter is left in place just outside the fluid sac. This catheter can be reinjected during a surgical procedure or childbirth to prolong the anesthetic effect. Epidurals are frequently placed prior to major abdominal and thoracic procedures. After your surgery, these epidural catheters can be infused with a narcotic and/or local anesthetic to provide pain relief. This service is managed by the Anesthesia Department and typically runs for several days after your surgery.
General anesthesia
A general anesthetic causes the whole body to lose sensation and movement in a state of unconsciousness.
Two major techniques of general anesthesia
These two techniques of general anesthesia are usually used in combination.
- Inhalation: A gas vapor inhaled through a mask or tube. The most common gases used today are: desflurane, sevoflurane, isoflurane, and nitrous oxide.
- Intravenous: Drugs injected through IV tubing directly into the vein: i.e., sodium pentothal, propofol, muscle relaxants, sedatives, narcotics.
Monitored anesthesia care (MAC)
Sedation is provided in conjunction with infiltration of local anesthetic by the surgeon into the surgical area. This is done with mild sedatives and pain medications (usually narcotics) given through the intravenous (IV) line. You may indicate the level of sedation you desire to your anesthesia care provider.
Infrequently, a MAC anesthetic fails to provide satisfactory anesthesia for the surgical procedure. Under these circumstances a general or regional anesthetic may be necessary for safe and proper surgical care.
What are the risks with anesthesia?
The risk of complications is present any time you undergo anesthesia and surgery. Fortunately, serious or debilitating complications are extremely rare in healthy patients. However, the extremes of age, the seriously ill, and those undergoing major or emergency operations share an increased risk profile. Some major risks routinely discussed include death, myocardial infarction, stroke, allergic reactions, arrhythmias, aspiration, asphyxiation, awareness, bronchospasm, nerve damage, vocal cord damage, dental damage and corneal abrasions. Minor postoperative side effects include grogginess, muscle aches, nausea/vomiting, sore throat, hoarseness, or bruised lip. Generally, these are self-limited problems that resolve early in the postoperative period. Please alert us if you had any of these problems in the past, so that we can plan a better anesthetic experience for you.