ANESTHESIA

 Anesthesia is the administration of medication to allow medical procedures to be done without pain, and in some cases,
without the patient being aware during the procedure. There are a variety of types of anesthesia, as well as several
different medical professions that are able to give anesthesia.
 Anesthesia is used in a wide range of procedures, from highly invasive surgeries, such as open-heart surgery, to minor
procedures such as having a tooth extracted.

TYPES OF ANESTHESIA
1. General Anesthesia
o General anesthesia is a combination of medications that are intended to make the patient unaware of what is
happening around them, to prevent pain, and to paralyze the body during a procedure. Typically used during
surgery, general anesthesia allows a physician to provide treatments that would be extremely painful if the patient
were awake and able to feel.
o General anesthesia not only makes the person unaware, it also paralyzes the muscles of the body including the
muscles that make it possible to breathe. For this reason, patients who receive general anesthesia require a
ventilator to do the work of the diaphragm and other muscles that help make it possible to inhale and exhale.

Risks of General Anesthesia

The risks associated with anesthesia vary widely from from procedure to procedure, and between different patients. As
you can imagine, each patient has their own individual risk level, as no two people are exactly the same. For example, a
90-year-old patient will have a completely different level of risk when having an appendix surgery than a 12-year-old
patient. Here are some of the possible risks:

 Nausea/vomiting: This is the most common issue patients face after general anesthesia, and is far easier to
prevent than treat. For this reason it is important to mention a history of nausea caused by anesthesia prior to
surgery.
 Anesthesia awareness: This is a condition that occurs when the patient isn’t completely unconscious during
general anesthesia.
 Sore throat/hoarseness: Caused by the breathing tube, this irritation is typically minor.
 Dry mouth: A minor issue that typically goes away when the patient is able to drink fluids.
 Shivering/chills: This typically lasts for a short time after surgery and goes away when the patient is awake and
moving.
 Sleepiness: This is common after surgery and resolves when the body has eliminated most of the medication
used for anesthesia.
 Muscle aches: Caused by the medication or by lying still during a procedure, this condition is typically temporary
and goes away within hours or days of having surgery.
 Itching: Pain medication is often to blame for itching, and this issue typically goes away when pain medication is
no longer necessary.

 Confusion: The patients who are most likely to have confusion after surgery are elderly, have Alzheimer’s
disease, dementia, or another condition that contributes to confusion on a regular basis.
 Difficulty urinating/inability to urinate: This is more common in patients who have a urinary catheter during
surgery and it can take hours or even days for the bladder to return to normal.
 Ileus: This is a condition where the intestines do not wake as quickly as expected after surgery and movement is
very slow or is absent.
 Difficulty getting off the ventilator: Weaning from the ventilator is more challenging in very sick patients or
patients who have a breathing problem.
 Aspiration/pneumonia: Accidentally swallowing food or fluids during surgery is a known risk of surgery and is the
reason why eating immediately prior to surgery is forbidden.
 Blood clots: This issue is more common after surgery because the patient is still for an extended period of time,
which is a known risk factor for blood clots.
  Malignant hyperthermia: This is a potentially life-threatening condition that causes a severe reaction to
anesthesia. It typically runs in families.

2. Regional Anesthesia

Regional anesthesia is a method of pain prevention for surgeries and procedures. In regional anesthesia, only the area
of the body that would feel pain is numbed, allowing the patient to have the procedure while awake or while sedated
but still conscious.

Spinal or edipural blocks are examples of regional anesthesia. They are injected near the spinal canal to block sensations
in the lower body or limbs.

Regional anesthesia is different from general anesthesia, which works on the entire body, not just the surgery site, and
the patient sleeps through surgery. It differs from local anesthesia in that a larger region of the body is numbed.

Why Regional Anesthesia Is Used

One benefit of a regional anesthetic is the patient can be consciously sedated or be fully conscious. A C-section is an
example of a procedure performed with the patient awake, with regional anesthesia (epidural) used to control the pain
of the surgery. The patient can feel things above the abdomen, and she is able to carry on a conversation and see her
newborn immediately after the birth.

How Regional Anesthesia Is Given

Epidurals and other types of regional anesthesia are typically provided by an anesthesiologist or a nurse anesthetist
(CRNA). Depending on the need, the anesthesia may be given with a needle or a needle may be used to insert a flexible
catheter line through which anesthetics and other medications can be administered as needed. may be used to insert a
flexible catheter line through which anesthetics and other medications can be administered throughout the procedure.

Regional anesthesia is provided by injecting specific sites with a numbing medication that works on the nerves of the
body, causing numbness below the injection site. If you are having a hand surgery, your anesthesia may numb your
entire arm and hand, or the numbness may be mostly limited to your hand.

Epidurals or spinal blocks are given on your back. With an epidural, a flexible epidural catheter is placed in position with
a needle and taped in place. Medications can then be administered as needed through the catheter to block pain. Spinal
blocks are given with a needle to the spinal sac, with the medication entering the cerebrospinal fluid. It uses a finer
needle than an epidural.

A peripheral nerve block may be given in the shoulder-arm, back, or leg regions. By choosing the site, different levels of
the limb may be numbed. The anesthetic solution doesn't enter the nerve but is injected near it. A nerve stimulator or
portable ultrasound device might be used to locate the nerve that is the target. Specific nerve blocks include the
brachial plexus block, paravertebral block, femoral nerve block, sciatic nerve block, and popliteal nerve block.

Procedures

 Gastrointestinal and liver surgeries including colon resection and stomach surgery
 Gynecologic surgeries including hysterectomy and Cesarean section
 Orthopedic procedures for bones and joints
 Thoracic surgery, especially for pain control after procedures on the chest or esophagus.
 Urological surgery including prostatectomy, nephrectomy, and bladder surgery
 Vascular surgery on arteries and veins
 3. Local Anesthesia
Local anesthesia is a type of pain prevention used during minor procedures to numb a small site where the pain is likely to
occur without changing the patient's awareness. You are likely familiar with local anesthetics being used for dental
procedures and for numbing an area that needs to be stitched.

Procedures Using Local Anesthesia

Local anesthesia is most commonly associated with minor procedures that may be painful but are not serious. Some
examples of when local anesthesia is appropriate:

 Dental procedures, such as filling a cavity or procedures where the gums must be numbed
 Suturing a wound
 Removing an ingrown toenail
 Some pediatric hospitals numb the site where an IV will be placed to decrease pain.
 To numb the skin before a biopsy is performed

4. Monitored Anesthesia Care (MAC)

Monitored Anesthesia Care (MAC), also known as conscious sedation or twilight sleep, is a type of sedation that is
administered through an IV to make a patient sleepy and calm during a procedure. The patient is typically awake, but
groggy, and are able to follow instructions as needed.
This type of sedation is used for outpatient procedures, such as a colonoscopy, where the patient is expected to go
home after the anesthesia has completely worn off.

The type of anesthesia used during your surgery typically depends on the type of surgery, your state of health, the length of the
surgery and the preferences of your anesthesia provider and surgeon.

Anesthesia Providers

There are several types of medical professionals who are able to provide anesthesia, including doctors (anesthesiologist), nurse
anesthetists, dentists/oral surgeons, and anesthesiologist’s assistants. The level of training varies between different types of
providers, with anesthesiologists having the highest level of training.