Up to date about General anesthesia

Up to date about General anesthesia

Dr. Alisher Agzamov MD PhD

General anesthesia is a treatment that puts you into a deep sleep so you do not feel pain during surgery. When you receive these medications, you will not be aware of what is happening around you.

You will receive general anesthesia in a hospital or outpatient clinic. Most times, a doctor called an anesthesiologist will put you to sleep. The doctor will give you medication into your vein. You may be asked to breathe in (inhale) a special gas through a mask. Once you are asleep, the doctor may insert a tube into your windpipe (trachea) to help you breathe and protect your lungs.

You will be watched very closely while you are asleep. Your blood pressure, pulse, and breathing will be monitored. The Anaesthesiologist and Anaesthesia technicians taking care of you can change how deeply asleep you are during the surgery. You will not move, feel any pain, or have any memories of the procedure because of this medicine.

Why the Anaesthesia Procedure is performed

General anesthesia is a safe way to stay asleep and pain-free during anaesthesia procedures that would:

• Be too painful
• Take a long time
• Affect your ability to breathe
• Make you uncomfortable
• Cause too much anxiety
• Has some postoperative side effects

You may also be able to have conscious sedation for your procedure, but sometimes it isn’t enough to make you comfortable. Children may need general anesthesia for a medical or dental procedure to handle any pain or anxiety they may feel.

Risks

General anesthesia is usually safe for healthy people. The following people may have a higher risk of problems with general anesthesia:

• Patients who abuse alcohol or medications
• Patients with allergies or a family history of being allergic to medicine
• Patients with heart, lung, or kidney problems
• Smokers

Ask your Anaesthesiologist about these complications:

• Death (rare)
• Harm to your vocal cords
• Heart attack
• Lung infection
• Mental confusion (temporary)
• Stroke
• Trauma to the teeth or tongue
• Waking during anesthesia (rare)

Before the Procedure

Always tell your Anaesthesiologist or nurse:

• If you could be pregnant
• What drugs you are taking, even drugs or herbs you bought without a prescription

During the days before the surgery:

• An anesthesiologist will take a complete medical history to determine the type and amount of anesthesia you need. This includes asking you about any allergies, health conditions, medications, and history of anesthesia.
• Several days before surgery, you may be asked to stop taking aspirin, ibuprofen, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your Anaesthesiologist which drugs you should still take on the day of your surgery.
• Always try to stop smoking. Your Anaesthesiologist can help.

On the day of your surgery:

• You will usually be asked not to drink or eat anything after midnight the night before the surgery. This is to prevent you from vomiting while you are under anesthesia. Vomiting during anesthesia can be dangerous.
• Take the drugs your Anaesthesiologist told you to take with a small sip of water.
• Your Anaesthesiologist or nurse will tell you when to arrive.

After the Procedure

You will wake up tired and groggy in the recovery or operating room. You may also feel sick to your stomach, and have a dry mouth, sore throat, or feel cold or restless until the anesthesia wears off. Your nurse will monitor these side effects. They will wear off, but it may take a few hours. Sometimes nausea and vomiting can be treated with other medicines.

Follow your doctor's recommendations while you recover and care for your surgical wound.

Outlook (Prognosis)

General anesthesia is generally safe because of modern equipment, medications, and safety standards.

Most patients recover completely and do not have any complications.

Conscious sedation for surgical procedures

Conscious sedation is a combination of medicines to help you relax (a sedative) and to block pain (an anesthetic) during a medical or dental procedure. You will probably stay awake but may not be able to speak.

Conscious sedation lets you recover quickly and return to your everyday activities soon after your procedure.

An Anaesthesiologist or Dentist, will give you conscious sedation in the hospital or outpatient clinic. Most of the time, it will not be an anesthesiologist. The medicine will wear off quickly, so it is used for short, uncomplicated procedures.

You may receive the medicine through an intravenous line (IV, in a vein) or a shot into a muscle. You will begin to feel drowsy and relaxed very quickly. If your Anaesthesiologist gives you the medicine to swallow, you will feel the effects after about 30 - 60 minutes.

Your breathing will slow down, and your blood pressure may drop a little. Your nurse or doctor will monitor you every 3 - 5 minutes during your procedure to make sure you are okay. This person will stay with you at all times during the procedure.

You should not need help with your breathing, but you may receive extra oxygen through a mask or IV fluids through a catheter (tube) into a vein.

You may fall asleep, but you will wake up easily to respond to people in the room. You may be able to respond to verbal cues. After conscious sedation, you may feel drowsy and not remember much about your procedure.

Why the Procedure is Performed?:

Conscious sedation is safe and effective for patients who need minor surgery or a procedure to diagnose a condition.

Some of the tests and procedures conscious sedation may be used for are:

• Breast biopsy
• Dental prosthetic or reconstructive surgery
• Minor bone fracture repair
• Minor foot surgery
• Minor skin surgery
• Plastic or reconstructive surgery
• Procedures to diagnose and treat some stomach (upper endoscopy), colon (colonoscopy), lung (bronchoscopy), and bladder (cystoscopy) conditions

Risks

Conscious sedation is usually safe. However, if you are given too much of the medicine, problems with your breathing may occur. A doctor or nurse will be watching you during the whole procedure.

Health care providers always have special equipment to help you with your breathing, if needed. Only certain qualified health professionals can provide conscious sedation.

Before the Procedure

Always tell your Anaesthesiologist or nurse:

• If you are or could be pregnant
• What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription

During the days before your procedure:

• Tell your Anaesthesiologist about any allergies or health conditions you have, what medicines you are taking, and what anesthesia or sedation you have had before.
• You may have blood or urine tests and a physical exam.
• Arrange for a responsible adult to drive you to and from the hospital or clinic.
• If you smoke, try to stop. Ask your Anaesthesiologist or nurse for help quitting.

On the day of your procedure:

• You will usually be asked not to drink or eat anything after midnight the night before your procedure.
• Do not drink alcohol the night before and the day of your procedure.
• Take the drugs your doctor told you to take with a small sip of water.
• Your Anaesthesiologist or nurse will tell you when to arrive at the hospital or clinic.

After the Procedure

After conscious sedation, you will feel sleepy and may have a headache or feel sick to your stomach. During recovery, your finger will be clipped to a special device (pulse oximeter) to check the oxygen levels in your blood. Your blood pressure will be checked with an arm cuff about every 15 minutes.

You should be able to go home 1 to 2 hours after your procedure.

When you are home:

• Eat a healthy meal to restore your energy.
• You should be able to return to your everyday activities the next day.
• Avoid driving, operating machinery, drinking alcohol, and making legal decisions for at least 24 hours.
• Check with your doctor before taking any medicines or herbal supplements.
• If you had surgery, follow your doctor's instructions for recovery and wound care.

Outlook (Prognosis)

Conscious sedation is generally safe, and is an option for procedures or diagnostic tests.

References

Jagannath S, Baron TH, Anderson MA, et al. Sedation and anesthesia in GI endoscopy. Gastrointestinal Endoscopy. Aug 2008;68(2).

Cohen NA, Stead SW. Moderate sedation for chest physicians. Chest. June 2008;133(6).

Sherwood ER, Williams CG, Prough DS. Anesthesiology principles, pain management, and conscious sedation. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 18.

Sherwood ER, Williams CG, Prough DS. Anesthesiology principles, pain management, and conscious sedation. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 18.