Anesthesia - Questions and Answers

Whether you’re scheduled to have a minimally invasive laminectomy or complex multi-level fusion, you will need anesthesia before your procedure. This article shares answers to common questions about anesthesia and spine surgery, including the important information you should discuss with your doctor before you reach the operating room.
Patient under anesthesiaGeneral anesthesia is a reversible state of unconsciousness and insensibility to pain.What Is Anesthesia?
Anesthesia involves the use of gasses and/or drugs to make you insensitive to pain during a medical procedure. There are 3 main types of anesthesia:

  1. General anesthesia: Most spine surgeries use general anesthesia, which causes you to become unconscious and impervious to pain during the procedure. Your anesthesiologist may use intravenous (IV) and inhaled drugs to achieve this state.
  1. Regional anesthesia: Regional anesthesia uses an injection of local anesthetic to block pain in a large area of the body. Examples of this include an injection into the brachial plexus (nerves that serve your shoulder, arm, hand) to render your arm numb. This type of anesthesia may be used for certain types of spine surgeries, including lumbar discectomy or single-level decompression procedures. You are not unconscious under regional anesthesia, and your doctor may refer to it as spinal anesthesia.
  1. Local anesthesia: Local anesthesia is used to describe an injection of local (often short-acting) anesthetic around a small area. An example of this would be an injection in the skin to numb it before suturing up a cut. You are not unconscious under local anesthesia.

Who Administers Anesthesia?
Anesthesiologists and nurse anesthetists are medical professionals who specialize in the administration of anesthesia.

An anesthesiologist is a medical doctor who pursued an additional 4 years of training after medical school to become an anesthesiologist. Anesthesiologists administer and regulate sedation levels during a procedure, in addition to monitoring your vital signs throughout surgery. A nurse anesthetist is a registered nurse who has undertaken 2 years of additional training in anesthesia and has passed a certification examination.

Do I Need to Meet with an Anesthesiologist Before My Surgery?
Generally, if you are healthy (apart from your spine problem), it is not necessary to have a pre-operative consultation with an anesthesiologist prior to surgery. However, many practices conduct assessments of all patients prior to spine surgery. These pre-operative assessments may include evaluating your airway, and cardiovascular, respiratory, and musculoskeletal systems to understand your risk for anesthesia-related complications.

If you have other illnesses apart from your spine problem or have an unstable spine, you should meet with your anesthesia team before surgery. Confirm with your medical team that your anesthesiologist knows about your current medication regimen, allergies, and any pre-existing conditions (eg, high blood pressure, diabetes, heart disease). Knowing your other health conditions and medications will help your medical team prevent potentially serious complications during your procedure.

Can I Eat or Drink Before Surgery?
In general, it’s best to avoid food and drink (including water) for at least 6 hours prior to surgery. Having an empty stomach during the anesthetic reduces the risk of vomiting during surgery and nausea and/or vomiting after surgery. If your doctor has approved medication use before surgery, you may take your medicine with a sip of water.

  • Your medical team may provide different recommendations regarding food and drink before surgery—always follow their instructions.

Can I Continue to Take My Medications Up Until My Spine Surgery?
Generally, you may still take your medications right up to the time of surgery. However, tell your doctor if you take medication that interferes with blood coagulation (eg, anticoagulant and antiplatelet drugs; warfarin, apixaban, betrixaban, dabigatran, edoxaban, rivaroxaban), as you may need to adjust your regimen prior to surgery. People with diabetes should also work with their medical team, including surgeon and endocrinologist, to clarify management strategies prior to spine surgery.

If you are taking medications, talk to your medical team before surgery about whether you need a revised medication schedule for your surgery. Your doctor and anesthesiologist will tell you which medications you can continue and which ones you should stop—along with when you can resume your normal medication schedule.

What About Premedication?
The moments before you undergo surgery can understandably cause stress and anxiety. You may receive a light sedative premedication, such as midazolam (Versed), to help calm your nerves before you go into the operating room.

What Will Happen to Me in the Operating Room?
In the pre-operative area, it is normal to start an intravenous line (IV). In the operating room, you will be connected to vital sign monitors, including temperature, electrocardiogram, blood pressure, pulse oximeter, and neuromuscular transmission monitor. You will normally be given oxygen to breathe through a mask and, generally, anesthesia is induced with an IV 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 IV anesthetic, such as propofol, ketamine, or thiopental. After the IV induction, a neuromuscular blocking agent is typically used to decrease the function of the muscles of breathing.

An endotracheal tube, or breathing tube, is then placed in the trachea (windpipe)—this is called intubation. Intubation not only supports breathing function during your procedure but also protects your airway from blood and other obstructive substances.

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 of anesthesia include sore throat, nausea, and vomiting after surgery. Fortunately, these complications resolve quickly.

Some types of spine surgery pose a greater anesthesia risk. Neck surgery, for example, may create challenges related to intubation. You can read more about this in Complex Cervical Spine Surgery and Anesthesia - Considerations Before and During Surgery.

Most people, particularly if they are overall healthy and young, have little problem undergoing general anesthesia. However, older adults take longer to eliminate the anesthesia from their bodies. As a result, they may struggle with extended bouts of grogginess and confusion for days, even weeks, after the procedure—a complication called post-operative cognitive dysfunction (POCD)1. Elderly patients and their caregivers should discuss the possibility of alternative anesthesia options, such as using regional anesthesia instead of general.

Serious anesthesia risks, including heart attack, stroke, brain damage, and death, are rare. These complications are often caused by drug reactions or problems related to other medical conditions, so make sure your surgeon and anesthesiologist know your medical history and medication regimen.

What About Pain Relief After Spine Surgery?
Once in your recovery room after spine surgery, you may receive pain relief via a patient-controlled analgesic pump. With this technology, you may push a button that triggers a release of pain medication whenever you are in pain. The system is preset so that you cannot administer an excessive quantity of pain medication.

Alternatively, IV or intramuscular pain-killing medications may be prescribed by your surgeon or anesthesiologist. If you are nauseated or feeling sick after your surgery, you may be prescribed medication to help you feel better.

Anesthesia and Spine Surgery: Your Role in Safe Sedation
Undergoing anesthesia—particularly general anesthesia—can be a nerve-wracking experience. Fortunately, most people experience little or no problems “going under.” By sharing your medications, allergies, and medical conditions with your surgeon and anesthesiologist, you’re doing your part to ensure that your spine surgery is as safe as possible.

Updated on: 01/26/19
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