Anesthesia - Questions and Answers
What is anesthesia?
Almost everybody understands what is meant by the term anesthesia, although it is difficult to define formally. The term was originally coined to describe the state of unconsciousness that occurred after administration of ether or chloroform. Nowadays, anesthesia is generally divided into three types: general anesthesia, regional anesthesia and local anesthesia. General anesthesia is a reversible state of unconsciousness and insensibility to pain. It can well be described as a reversible state of oblivion. Regional anesthesia is when an injection of local anesthetic is used to anesthetize specific nerves leading to regions of the body. Examples of this include an injection into the brachial plexus to render the arm numb, an injection into the cerebrospinal fluid to anesthetize the lower limbs, etc. Local anesthesia is used to describe an injection of local anesthetic around an area, without blocking specific nerve trunks. An example of this would be an injection in the skin to numb it before suturing up a cut.
What is an anesthesiologist?
An anesthesiologist is a physician who, after completing medical school, has undertaken an additional four years of postgraduate training in order to become an anesthesiologist. The American Board of Anesthesiology offers board certification for anesthesiologists.
What is a nurse anesthetist?
A nurse anesthetist is a registered nurse who has undertaken two years of additional training in anesthesia and has passed a certification examination.
How is anesthesia practiced in the USA?
There are three common modes of practice. Firstly, physicians may practice anesthesia on their own. Secondly, they may practice in a care team situation where one physician may direct the activities of two (or possibly 3) nurse anesthetists. Thirdly, a nurse anesthetist may work under the supervision of another responsible physician, such as the surgeon. It is the opinion of this author that the first two modes of practice are preferable to the third.
Do I need to see an anesthesiologist prior to my admission for surgery?
Generally, if you are healthy (apart from your spine problem), it is not necessary to have a preoperative consultation with an anesthesiologist prior to admission for surgery. However, many practices will conduct preoperative assessments of all patients prior to surgery. If you have other illnesses apart from your spine problem or have an unstable spine, a preanesthetic consultation should be arranged.
Do I need to fast before surgery?
It is generally considered preferable to have no food or drink (including water) for at least six hours prior to surgery. This is so that the stomach will most likely be empty during the anesthetic. This reduces the risk of patient vomiting during surgery and having postoperative nausea and/or vomiting.
I am taking medications. Should I continue to take them prior to surgery?
This obviously depends on what medications you are taking! Generally, most medications are continued right up to the time of surgery. One exception is the group of drugs that interfere with blood coagulation. Diabetic patients also require specific management strategies for surgery. If you are taking medications, you should consult with your anesthesiologist prior to surgery and find out which medications should be continued and which should be discontinued. An exception to the above comment about not eating and drinking prior to surgery is that it is normally considered acceptable to take your morning medications with a sip of water prior to coming into hospital for surgery.
What about premedication?
Over the last few years, anesthetic practice has changed somewhat, in that patients are not routinely receiving sedative premedication. If you are particularly anxious, discuss this in advance with your anesthesiologist and arrangements can normally be made to administer a drug such as versed (Midazolam) which will help calm your nerves prior to surgery. Often, anesthesiologists will administer versed just before you go to the operating room.
What will happen to me in the operating room?
In the preoperative area, it is normal to start an IV. In the operating room, you will be connected to all of the anesthesia monitors (electrocardiogram, blood pressure monitor, pulse oximeter, neuromuscular transmission monitor and maybe a BIS monitor). You will normally be given oxygen to breathe through a mask and generally, anesthesia is induced with an intravenous induction agent.
What drugs are used to administer an anesthetic?
A balanced anesthetic consists of several different agents. Generally, anesthesia is induced with a short-acting intravenous anesthetic such as propofol or thiopental. These drugs have a duration of action of about five minutes. After the intravenous induction, a neuromuscular blocking agent is normally used to decrease the function of the muscles of breathing. An endotracheal tube is then placed in the trachea. Anesthesia is normally maintained with a mixture of a volatile anesthetic (administered from the anesthetic machine via the endotracheal tube) as well as nitrous oxide and oxygen. A very potent opioid such as fentanyl is commonly used, as are neuromuscular blocking agents.
What are the complications of anesthesia?
Minor complications include postoperative sore throat and nausea and vomiting. These are not normally very troublesome and resolve quickly. Serious complications from anesthesia are very rare.
What about postoperative pain relief?
Often, after spine surgery, patients receive postoperative pain relief via a patient-controlled analgesic pump. With this technology, the patient is presented with a button to push, which they push whenever they are hurting. The system is preset so that they cannot administer an excessive quantity of narcotic medication. Alternatively, intravenous or intramuscular pain killing medications may be prescribed by your surgeon or anesthesiologist. If you are nauseated or feeling sick after your surgery, drugs can be used which can stop those feelings.