for patients

anesthesia FAQs

a note to you

What is anesthesia?
Who gives my anesthetic?
How do I prepare for anesthesia?
What happens during the procedure?
- Local
- Spinal / Epidural
- General
What happens after the procedure?
What are the risks associated with anesthesia?
What will happen to me when I go home?

What is anesthesia?

Anesthesia is the state of being free of pain, relaxed, often unconscious and having no memory of the event. Anesthesia involves the administration of drugs to achieve this state. The main types of anesthesia are local, regional, and general.

Local anesthesia is the state of being pain free only in the area which is being operated on. It is commonly referred to as being "frozen". This is usually used by doctors in their offices for simple procedures such as sewing up a cut or removing a small skin growth although it is often used in conjunction with sedation in hospitals or clinics. With this type of anesthesia there is no unconsciousness achieved.

Regional anesthesia is similar to local anesthesia in that the patient remains awake but the frozen area is much more extensive and often involves a whole "region" of the body. Hence regional anesthesia can be used for more extensive procedures than local anesthesia. As well, a sedative is often given because the procedure is more extensive and it is more difficult for a patient to lie still for the period of time that the more extensive procedure requires.

Two commonly used types of regional anesthesia are spinal anesthesia and epidural anesthesia. These are administered by an anesthesiologist.

Spinal anesthesia can be used for many operations below the navel such as rectal surgery, bladder surgery and prostate operations as well as procedures on the legs. It involves a single injection of a small amount of local anesthetic into the spinal fluid through a very think needle through the back.

Epidural anesthesia can be used for many of the same procedures as spinal anesthesia and is similar in its approach. Epidural anesthesia, unlike spinal anesthesia, allows for easy re-injecting of the anesthetic during longer procedures as a small thin plastic tube is left in place to allow top-ups to be given throughout the procedure. This type of anesthetic procedure is often used to treat pain for several days after a major operation in hospital.

General anesthesia is achieved by the administration of drugs that effect the brain. It is a state of sleep which is deep enough to eliminate pain and relax the muscles. It is always administered by an anesthesiologist.

Who gives my anesthetic?

The term "anesthetist" originated in Great Britain and used to refer to anyone who administered an anesthetic. This term is largely used now in the same manner in Britain but is used to refer largely to nurses who administer anesthetics under supervision in the United States. An anesthesiologist is a specialist physician in Canada or the United States who has done additional post graduate training in medicine, anesthesiology and intensive care. In Canada, the term "anesthetist" is no longer used.

How do I prepare for anesthesia?

Preparation for anesthesia varies depending upon what type of surgery or medical procedure the patient is having. Appropriate directions from the referring physician will be given to patients depending upon the type of anesthetic to be given and the type of surgery, which is to be undertaken. The clinic will provide literature through the surgeon's office to provide guidelines.

What happens during the procedure?

Local

Local anesthetic is usually administered by the surgeon by injecting a specific volume of local anesthetic into the area in which the surgery is to be undertaken. It can also be administered in the form of nose drops or spray for surgery in that area. Patient remains fully conscious although occasionally sedation is given for very anxious patients.

Spinal / Epidural

Spinal anesthesia is achieved by injecting a small amount of local anesthetic agent into the fluid filled space surrounding the spinal cord. This injection is only mildly uncomfortable. Freezing usually occurs quickly and lasts one to two hours. The process of doing an epidural anesthetic is similar to that of a spinal anesthetic but the needle is inserted slightly less deeply and a larger volume of freezing solution is injected just outside the sac that contains the spinal fluid. Sometimes a small plastic catheter is left in place so that top up injections can be given thereafter.

General

For a general anesthetic the anesthesiologist reviews the patient's medical history and examines the patient's heart and lungs in order to decide what type of anesthetic is to be given and the dosage to be used. When surgery begins, the drugs are given by injection into a vein. In addition, once the patient is asleep, a gas is given through a mask which covers the nose and mouth, or through a tube which is inserted into the throat. The patient's heart rate, blood pressure, breathing, oxygen levels and electrocardiogram are monitored throughout the procedure. Drugs to counteract pain and nausea are usually given before the patient wakes up.

What happens after the procedure?

Once the procedure is over the patient is taken to the recovery area. In this area the same monitoring occurs as occurred in the operating room and the patient is cared for making sure that the blood pressure, breathing, heart rate and other signs are all stable until the patient is awake and alert. Any discomfort or nausea that occurs at this time is dealt with in order to make the patient as comfortable as possible. Once the patient is able to walk and is alert enough to be able to sit unattended, the patient will be moved to a comfortable chair where a full recovery will be attained. This process usually takes between a half an hour to an hour.

What are the risks associated with anesthesia?

At the outset it should be stated that the risks from anesthesia are quite uncommon. They very from minor to major. The major risks and complications are extremely rare.

Risks from local and regional anesthesia include:

• Some minor discomfort because the anesthetic may not have numbed the area effectively.
• Allergic reactions which can vary from minor rashes to severe drops in blood pressure, asthma or swelling. This very rarely occurs from local anesthetic agents.
• Side effects from anesthetic agents such as increase in heart rate. This often occurs from the adrenalin which accompanies the local anesthetic.
• Toxic effects can occur from inadvertent intravenous injection of local anesthetics which can result in unconsciousness, slowing of the heart and occasionally seizures. Again this is extremely rare but is not unknown.

Risks from general anesthetic includes:

• Nausea or vomiting (common)
• Sore throat reasonably (common)
• Muscle pain (uncommon)
• Some breathing difficulties which can include asthma
• Occasionally nerve damage, cardiac arrest, eye abrasions, broken teeth can occur, although these are very rare. Irregular heartbeats called cardiac arrhythmias are common but rarely serious. On very rare occasions, heart attacks, strokes and brain damage can occur but, again, these are extremely rare. The incidence of these complications needs to be put into perspective. The chance of a major complication under a general anesthesia for people who are healthy is hard to predict based upon statistics available in the literature. It appears that risk of mortality under anesthesia for a healthy patient is approximately one per one hundred thousand patients.

What will happen to me when I go home?

The anesthetic agents that are given during the course of the surgery are virtually all short acting and the effects from these will be minimal by the time the patient is ready for discharge. Patients need to be sent home in the company of a responsible adult. It is advisable for patients to be cared for overnight by a responsible adult. Children should be sent home in the company of a responsible adult who's sole role is to look after that patient on the way home. It is very difficult for a parent driving a car to look after a sick child at the same time. The surgeon will have left orders and a prescription for pain medication. If any concerns should arise during the evening or the following day, the patient should immediately attend the nearest emergency department rather than the clinic.

The clinic will be contacting the patient for follow up, likely the following morning.