Anaesthesia

Anesthesia is freedom from pain. Each year, millions of people in the United States undergo some form of medical treatment requiring anesthesia. Anesthesia, in the hands of qualified professionals like Certified Registered Nurse Anesthetists, is a safe and effective means of alleviating pain during nearly every type of medical procedure.

Anesthesia care is not confined to surgery alone. The process also refers to activities that take place both before and after an anesthetic is given.

There are three basic types of anesthesia:

General anesthesia produces a loss of sensation throughout the entire body, causes loss of consciousness prior to and during the operation. During general anesthesia anesthetic medications are injected into the bloodstream after placement of an intravenous line, and/or anesthetic gases may be breathed into the lungs. When these medications are carried to the brain by the blood, they produce unconsciousness. Other medications are given to prevent pain and there may be medications given to relax the muscles of the body. During general anesthesia, it is always necessary to support patient breathing because of the depression of breathing activity from unconsciousness. In this case there will be a breathing tube or other artificial airway device placed in the patient’s mouth or throat after the loss of consciousness. At the end of surgery, as the anesthetic drugs are stopped and begin to wear off, the patient regains consciousness and normal muscle strength.

Regional anesthesia produces a loss of sensation to a specific region of the body. is the injection of local anesthetic to numb the lower part of the body.

Local anesthetic drugs are injected near to the bundles of nerves which carry signals from that area of the body to the brain. The most common regional anesthetic techniques are spinal and epidural anesthesia.

This type of anesthesia may be indicated for any surgical procedure done below the level of the chest, such as Caesarean section or surgery on the lower extremities. Other types of regional anesthesia may be used for shoulder, arm and hand procedures. During a regional anesthetic, the patient remains conscious, and cannot feel or move the lower portion of the body. Additional sedation may be given if needed to relax or make the patient sleep comfortably, but no airway device is usually necessary.

MAC (Monitored Anesthesia Care) is a term referring to the use of intravenous administration of sedative drugs. This technique is most appropriate for procedures requiring sedation but not unconsciousness. During the procedure, the anesthesiologist / anesthetist will deliver varying amounts of sedative medication through an intravenous (IV) line, monitoring the patient’s comfort level and increasing or decreasing medication as needed. This type of anesthesia is commonly referred to as “twilight sleep”, and does not provide the same deep unconsciousness as general anesthesia. No airway device is usually needed, but the patient may dream, or have some recollection of conversation, movement, or music.

Local anesthesia produces a loss of sensation to a small specific area of the body. is a technique where local anesthetic medication is injected before a procedure to dull the pain. It is given as a shot in several places in and around the surgery area. The shot helps to numb the small nerves in that area. Under local anesthesia, the surgeon injects the area just before the start of the operation. The patient may remain awake or be sedated, depending on what is needed. Any sedation is provided intravenously by an attendant anesthesiologist or anesthetist. Local anesthesia lasts for a short period of time and is often used for minor outpatient procedures.

PERIPHERAL NERVE BLOCKS and PLEXUS BLOCKS are an injection of local anesthetic given around the nerve or nerves supplying the feeling to the area being operated on. It is usually administered as a single injection. The duration of the numbness in the area depends on the local anesthetic chosen, but can be from two to eighteen hours. These nerve blocks are usually used to decrease pain after surgery. The nerve that is blocked depends on the location of surgery you are having. Usually additional sedation or a general anesthetic will be used as well to allow the patient to be asleep or relaxed.

INTRAVENOUS REGIONAL ANESTHESIA is an injection of local anesthetic given into the veins of an extremity (arm or leg) while a tourniquet is applied above the injection site to keep the anesthetic within the area below the tourniquet. When the tourniquet is released at the end of the surgical procedure, feeling and movement return to the area immediately. Additional sedation is usually required to ensure the patient is relaxed and comfortable. This technique is best used for minor superficial procedures on the hand or foot, and should not be used for procedures lasting more than an hour.

Before Anaesthesia

Anesthesia professionals make many preparations for you before surgery. You can—and should—take an active role in these preparations by communicating and cooperating with your anesthesia professional and surgeon.

Different Types of Patients or Procedures May Require Different Types of Anesthesia

Pregnant patients should prepare before the onset of labor for the possibility of having an anesthetic, even if a natural childbirth is planned. During pregnancy, keep accurate records of allergies, high blood pressure, prescriptions, and over-the-counter medications. The use of drugs, including recreational drugs and alcohol, can increase the risk of anesthetic complications for both mother and baby.

Older adults go through complex physical changes while aging that may affect their body’s response to anesthesia. You or your family can assist your anesthesia professional by providing a detailed list of all medications, including aspirin, taken regularly. Patients with hereditary disorders, such as diabetes and sickle cell anemia, need special attention. These conditions can be managed properly if their anesthesia professional knows about them before a procedure.

Children should be specially prepared for anesthesia, and for surgery in general. Allow them to bring favorite toys along for their stay. Make frequent references to things children will enjoy after the procedure. If possible, take children on a hospital tour and let them talk with hospital personnel, particularly their anesthesia professional.

Anesthetic agents can be started in several ways. Most commonly in adults, anesthesia is started by an intravenous injection so the patient becomes unconscious rapidly. This is also a method that can be used for children. Another method of beginning anesthesia is to let your child breathe anesthetic agents until losing consciousness. This is called a mask or inhalational induction. With this approach, your child will be asked to breathe through a “space mask” quietly, and no needlesticks will be performed until after your child is sound asleep. The choice of which method to begin anesthesia will be made by the anesthesiologist based on many factors.

Remember . . .

Speak frankly. Ask questions. Follow instructions. Provide your anesthesia professional with a medical history. And notify your anesthesia professional or surgeon immediately of any change in your physical condition prior to surgery. Communication and cooperation are essential to the anesthesia process.

After Anaesthesia

Do

Do leave the healthcare facility accompanied by a responsible adult.

This person will ensure that you travel home safely, as well as provide immediate care at home. You should continue to have this adult with you for 24 hours after surgery.

Do remain quietly at home for the day and rest.

You need rest because you have received anesthesia and because you have undergone a surgical procedure—even one that is considered minor. If, after a day, you still do not feel recovered, you may want to continue your rest for an additional day or two. Discuss your planned return to work with your physician.

Do arrange for someone to care for your small children for the day.

Even if given instructions to play peacefully and not overtax you, children sometimes forget such directions or have trouble staying quiet for an entire day. The most predictable course of action is to leave small children and babies in the care of another responsible individual.

Do take liquids first and slowly progress to a light meal.

Heavy foods can be difficult for your system to digest, thereby increasing the chance for discomfort. For your nourishment, start by taking liquids, then eat light foods, such as broth or soup, crackers or toast, plain rice, jello, and yogurt.

Do call your anesthesia professional or the facility where you were treated if you have any questions

These professionals are interested in your welfare and want your care to go as planned. If you have questions, or feel your recovery is not progressing to your satisfaction, call them.

Don’t

Don’t drive a car for at least 24 hours.

After anesthesia, your reactions and judgment may be impaired. Such impairment makes driving a car dangerous to you and to others. It is especially important that you don’t forget to make arrangements for someone else to drive you home from the healthcare facility.

Don’t operate complex equipment for at least 24 hours.

The same logic that applies to driving a car applies to the operation of other equipment. This includes equipment used at home, such as a lawnmower, as well as that which is used on the job, such as a forklift.

Don’t make any important decisions or sign any legal documents for the day.

The potential for impairment relates not only to physical activities, but to your mental state as well. Moreover, the anxiety that frequently accompanies important decisions is to be avoided. The day should be spent resting.

Don’t take any medications unless prescribed by or discussed with your physician.

Some medications may adversely interact with anesthetic drugs or chemicals remaining in your body. Included are prescription drugs, such as sleeping pills or tranquilizers, and over-the-counter medications, such as aspirin.

Don’t drink alcohol for at least 24 hours.

Alcohol is also considered a drug, meaning that an alcoholic drink has the potential to react negatively with the anesthetic in your system. This includes hard liquor, beer, and wine.

Side effects of anesthesia

Nausea and vomiting

Nausea and vomiting are common after any type of anesthesia. Nausea and vomiting are more likely with general anesthesia and lengthy procedures. In most cases, nausea after anesthesia does not last long and can be treated with medicines called anti-emetics.

Low body temperature (hypothermia)

You may feel cold and shiver when you are waking up. A mild drop in body temperature is common during general anesthesia because the anesthetic reduces your body’s heat production and affects the way your body regulates its temperature. Special measures are often taken during surgery to keep a person’s body temperature from dropping too much (hypothermia).

Impaired coordination or judgment

Because general anesthetics affect the central nervous system, patients may feel drowsy, weak, or tired for as long as a few days after having general anesthesia. Fuzzy thinking, blurred vision, and coordination problems are also possible. For these reasons, anyone who has had general anesthesia should not drive, operate machinery, or perform other activities that could endanger themselves or others for at least 24 hours, or longer if necessary.

How is pain controlled after surgery?

The anesthesiologist may be consulted to help manage your pain following the surgery. Although “painkilling” injections are still commonly used, other forms of pain management may also be chosen to provide comfort. For instance, patient-controlled analgesia (PCA) allows to self administer a controlled dose of pain-relieving medicine when needed. A small, computerized pump is programmed by the anesthesiologist, and some may be instructed on pump use depending on the circumstance. Another approach is the insertion of a tiny epidural catheter in the back through which a small dose of medication for pain relief can be given. This allows the patient to be more awake and lessens the chance for complications from the use of other pain medications. Sometimes, the epidural pain relief can be continued for several days after the operation.