What is general anesthesia?
People think of general anesthesia as "going to sleep." It is carefully controlled unconsciousness, and affects the whole body. The drugs used to create a state of general anesthesia are potent, and affect all of the body's organs at once. They are administered through intravenous (IV) or gas inhalation so they work quickly and smoothly. The anesthesiologist monitors your vital signs constantly to avoid side effects of the drugs.
How do I receive general anesthesia? Will it hurt?
You will be awake, yet relaxed, when you enter the operating room. Often you will help move yourself and lie down on the operating room bed. The anesthesiologist and nursing staff will work to place you in a position where you are comfortable, and that allows the anesthesiologist to have access to your head and neck. You will have monitors placed on your body to record vital signs such as blood pressure, pulse, heart rhythm and oxygen level. The blood pressure cuff will squeeze your arm tightly at first, until it senses your body's usual pressure level. You may hear the "beep" of your heart rate on the monitor in the background.
The anesthesiologist will ask you to breathe deeply, or breathe into a mask with oxygen. During this time s/he is giving you a combination of drugs through the IV tubing. You may feel these drugs pass through the IV and up your body as a brief stinging sensation. The anesthesiologist may press the breathing mask firmly on your face as you become more relaxed; just keep breathing deeply. As the drugs take full effect, you will become unconscious.
During the operation, the anesthesiologist will use a combination of IV and inhaled gas medications to keep you anesthetized. The anesthesiologist monitors and adjusts drug dosages constantly to maintain the desired effect. The anesthesiologist wants to maintain the level of anesthesia only as long as necessary, and then awaken you as soon as it is safe.
Will I feel anything while I am under general anesthesia?
No, you do not feel pain under general anesthesia. The drugs used for general anesthesia depress the parts of the central nervous system that control pain awareness.
Will I wake up during the surgery?
No, when you are under general anesthesia you remain unconscious. The anesthesiologist is constantly monitoring your level of anesthesia and maintaining it to keep you safe, asleep and pain free.
Will I remember anything while I am under general anesthesia?
No, patients report that they do not remember anything about their experience in the operating room. One of the effects of anesthesia drugs is amnesia, or the inability to remember events. The next day, you may recall only coming into the hospital before surgery and waking up after the operation. Only in extremely rare circumstances can someone recall events that happened during their operation.
In some instances, and usually if you are already in poor health, the anesthesiologist may be required to keep you less deeply unconscious under anesthesia. The amnesia effect is reduced, but this is for your safety.
When I receive general anesthesia, will I have a tube put in my throat?
Yes, in most circumstances, you will. General anesthesia drugs relax the natural reflexes that control your breathing, coughing and swallowing. The breathing tube (endotracheal tube) is placed down your throat and windpipe (trachea) after you are unconscious. It ensures that you have a safe passageway for your lungs to receive oxygen and anesthesia medications during your operation. If circumstances permit, the anesthesiologist may use a different breathing tube (called an LMA, or laryngeal mask airway) that does not enter the trachea but still ensures a safe passageway for you to breathe.
The breathing tube is usually removed just as you are waking up. You may have no memory of the tube or of feeling any pain as it was placed, but your throat may feel sore or hoarse for a short time as you recover.
For some large or complex operations, or if you are already in poor health, the surgeon and anesthesiologist may decide that the breathing tube must remain in place as you recover. Although the tube is not comfortable, please remember that it helps you breathe safely.
What are the side effects of general anesthesia?
The usual side effects you may experience after receiving general anesthesia include nausea, a sore throat, or feeling weak and tired. These effects should pass quickly as you recover from surgery.
There can be several other side effects from general anesthesia, and what you experience can depend on: your age and gender, general health, surgical procedure, body position during surgery, and type and amount of anesthesia drugs used. Your anesthesiologist is prepared to discuss these issues with you before your surgery.
What is Regional Anesthesia?
Regional anesthesia involves making a particular region of your body numb, or insensitive to pain. The region is usually large, like a limb, or your lower body. Anesthesiologists may refer to this as "giving a block," because they inject local anesthetics near a nerve or nerve bundle to block sensation. For surgical procedures, this is the most commonly used alternative to general anesthesia.
Particular forms of regional anesthesia include spinal, epidural, arm or shoulder blocks.
Why would my anesthesiologist want to use or recommend regional anesthesia?
For some patients, or some operations, it may be the most convenient, the best tolerated and the safest way of providing anesthesia. Factors include:
- Your health history or current state of health.
- Your anesthesiologist's plan to avoid stress of general anesthesia on certain body organs.
- Type of surgical procedure.
- Arm or leg surgery, even total joint replacements.
- Lower body surgery, like hernia or urinary procedures.
- Your desire to avoid loss of control, or loss of consciousness.
- Your desire to avoid side effects of general anesthesia, such as nausea or sore throat.
- Your desire for more prolonged pain relief after surgery.
Both types of anesthesia have advantages; can I receive both?
Your anesthesiologist may offer a plan that combines the two types of anesthesia. In this situation, the regional anesthesia portion may focus more on relief of pain during your recovery.
Are spinal and epidural anesthesia the same?
Both types of anesthesia are used to numb the lower half of the body for many surgical procedures. Both begin with a needle placement into one of the spaces between the backbones of the spine, and both use a combination of local anesthetic and narcotic drugs to achieve their effects. Health professionals use the two terms to distinguish exactly where the drugs are placed near the nerves. Epidural means "above the dura,", which is the outermost layer that covers the spinal cord and nerve roots. They have different effects: Spinal anesthesia affects more nerves that control movement (motor nerves) than epidural, while both affect nerves that control pain and feeling (sensory nerves).
Usually the epidural anesthesia involves a plastic tube (catheter) being left in place near the target nerve roots, so anesthetic medication for pain relief can be given directly while you are recovering.
How do I receive spinal or epidural anesthesia? Does it hurt?
First, monitors will be placed on your body to check vital signs, and you will have an IV started. If possible, you will be given medicine to help you relax. The anesthesiologist will position your body to make it easier to place the needle in the space between backbones (vertebrae). You can be placed sitting up, or lying on one side. Support staff may help hold you in position.
The anesthesiologist applies disinfectant and a sterile drape to your lower back. S/He injects local anesthetic under your skin. You will feel this, but it will last for only a few seconds as it begins to numb the area. Most patients say that this was the most uncomfortable part of their procedure.
Once the area is numb, the anesthesiologist will insert and slowly advance the needle. During this period, staff will remind you to relax and not move. If you feel anything, tell the anesthesiologist, and don't try to move away. After the needle is in place, anesthetic medication is injected, or the epidural catheter described above is inserted, followed by medication. Then the placement needle is removed.
As the medication begins to work, most patients report a warm sensation in their legs or feet. As it progresses, numbness will set in. Your legs will feel weak, then not move as you command them. The extent of the numbness depends on the surgical procedure and the medication used for the anesthesia. This also determines how long the anesthesia effect will last. Feeling and strength return gradually to your legs as the medication is used up.
What are the risks of spinal or epidural anesthesia?
Many people fear that the needle penetrates the spinal cord, and can cause paralysis. Regional anesthesia places needles and medications near spinal nerve roots or peripheral nerves; the spinal cord is not entered.
As with general anesthesia, some side effects can occur that vary with individual patients. Some have a short-term backache, and occasionally patients feel a headache. Your anesthesiologist is prepared to discuss regional anesthesia, including the potential risks, side effects and their treatments with you before proceeding.
I have been told that I have to lie flat for several hours after spinal anesthetic, is that true?
No. In the past, anesthesiologists felt that lying flat would help prevent the chances of getting a headache. Improved techniques and equipment reduce the chances of headache today, so you will have some freedom of movement afterward.
What about arm or shoulder blocks?
The process is very similar to the one described above for spinal anesthesia. A needle is placed close to the nerves that control the arm or shoulder, then those nerves are surrounded with anesthetic medication to block pain sensation.
Do I always have the option of regional anesthesia?
Some surgeries cannot be performed successfully using regional anesthesia alone. Your health history or current state of health may not make it safe for us to offer you this type of anesthetic. Some reasons could be: bleeding disorders, previous back surgery, unique anatomy of your back, or if you are unable to remain in position while anesthesia is delivered.
Monitored Anesthesia Care (MAC)
What is monitored anesthesia care? Is this the same as local anesthesia?
Giving local anesthesia is only part of this method. Monitored anesthesia care means that the anesthesiologist is with you at all times during your procedure. The anesthesiologist will monitor your vital signs, give you oxygen to support your breathing and at the same time give you medications through your IV to help you relax. The surgeon will inject local anesthetics to numb the area where the incision and surgery will take place.
If for some reason you experience any discomfort during the procedure, let us know. The anesthesiologist will give you additional drugs to make you comfortable, or the surgeon can inject more local anesthetic to numb painful sensations.
Obstetrical Care Anesthesia
Will I experience pain in labor?
Most women find the experience of childbirth uncomfortable at some point. This discomfort varies greatly from person to person. Some women use relaxation or other techniques during the labor process and want minimal assistance with pain relief while others use one of the anesthesia options listed below.
Do I need to make my decision about the use of pain relief ahead of time?
Many women have researched this topic and already decided what type of pain relief they prefer. Some take a "wait and see" approach about pain relief. We do encourage you to educate yourself about the options available. This allows you to make an informed decision at the necessary time. Trying to make a knowledgeable decision while under the stress of labor is difficult.
Information on this topic can be obtained from many places, which include the following:
- Your midwife, obstetrician or family practice physician.
- Overlake’s childbirth classes.
What choices are available for labor pain relief?
The ones listed below are felt to be the most effective and safest for you and your newborn.
Intravenous (IV) pain medication:
IV medications can assist in the management of labor discomfort. Stadol and Nubain are commonly used medications. They are given intravenously and usually only achieve partial pain relief, but this is often sufficient for you to tolerate the labor process. These medications can make both mother and infant somewhat sleepy. This is why your healthcare provider will usually prescribe these medications only in the early stages of labor, and will limit the total amount you receive.
The most common types of regional blocks used in labor are epidural or a combined technique of a spinal and epidural. These methods are all administered at Overlake by an anesthesiologist. Local anesthetics, often in combination with narcotics, are injected near and around the spinal nerves of the lower back. These cause a numbness of these nerves and reduce labor pain. These techniques all have optimal times to be given in the labor process. At Overlake, epidural anesthesia is the most common method used to control labor discomfort.
What is involved in getting spinal or epidural anesthesia?
As with any type of anesthesia, you will need to be monitored during the procedure. Also, an IV is necessary ahead of time. Sometimes lab work is needed and extra IV fluid is given just before your epidural. The epidural is administered while you are lying on your side or in the sitting position. After cleansing your skin, a local anesthetic is placed into the skin and deeper tissues using a very small needle. This sometimes produces a mild burning sensation but lasts only a few seconds. A spinal or epidural needle is then advanced through the numb tissues into the proper position. When the needle enters the epidural space you may feel a strange sensation in the pit of your stomach.
As the spinal or epidural anesthetic takes effect, a warming sensation is usually felt beginning in your legs and spreading onto your belly. Numbness begins soon after the warmth, and how numb you become depends on the type of medication and amount used. You usually will also lose some muscle strength in your legs; however, in most cases this is minimal, leaving enough strength for you to help during the pushing phase of labor.
How soon will my epidural take effect? How long will the epidural last?
Starting the epidural takes 15 to 20 minutes, and significant pain relief usually occurs in about 30 minutes. After the epidural is working, we attach you to an epidural medication pump. A small amount of anesthetic solution is continuously pumped into the epidural space until your labor is over. The intensity of pain relief can vary throughout the labor process. Most often you will feel a pressure sensation in your birth canal, which will be helpful when you need to push.
What are the effects on my baby?
Epidural anesthesia has a long record of safety for you and your baby. The effects of the epidural on your baby are minimal in the vast majority of cases. However, we carefully monitor you and your baby and are prepared to take care of problems if they occur.
What are the risks of a spinal and epidural?
Just like any anesthesia technique, side effects can occur. However, we rarely see more than the few discussed below. For more information on side effects, ask your anesthesiologist.
Lower back tenderness and backaches can result after childbirth. The discomfort is usually minimal and lasts only a short time. Medications prescribed by your obstetrician for discomfort from your birth are almost always sufficient to relieve back discomfort.
A headache (commonly called a spinal headache) can develop from a spinal or epidural and usually occurs within 48 hours. This headache usually becomes apparent when you stand and gets better when you lie down. Spinal headaches sometimes go away without any treatment; however, if the headache is severe, your anesthesiologist can do an epidural blood patch, which takes away about 95 percent of these headaches. Talk with your anesthesiologist if you have more questions.
The epidural space contains small blood vessels and on occasion after the epidural is first placed medication can be injected into them. To prevent this from occurring we will use a test dose (a very low dose of the epidural medication) to make certain the epidural catheter is in the right place.
Is the option of spinal or epidural anesthesia in labor always available?
A few patients, including those with bleeding disorders, certain infections, previous back surgery, or extreme obesity, may not be candidates for epidural/spinal anesthesia; however, the vast majority of patients are.
What are my anesthesia options for cesarean delivery (c-sections)?
You and your anesthesiologist will make the decision of anesthesia type based on the urgency and nature of the reason for the surgery planned. Cesarean births are usually done either on an elective basis (i.e., for twin delivery or breech) or an emergency basis. The timing often has the most influence on the anesthesia type chosen.
If previously placed for labor, epidural anesthesia can be used for a cesarean birth. This involves changing the medication given through the previously placed epidural catheter. In an emergency situation, epidural anesthesia may take too long to be effective and some other form of anesthesia (spinal or general) may need to be used. If an elective, non-emergency cesarean birth is planned, epidural anesthesia is a frequently used.
This is used for both elective and emergency cesarean birth. If you do not have an epidural in place for labor, this is often the method of choice in the emergency situation. Spinal anesthesia is usually effective very rapidly.
Because epidural/spinal anesthesia is safer for both mother and baby, general anesthesia is usually only used in emergency cesarean births (or where regional anesthesia is not possible). This type of anesthesia can be achieved faster than most regional anesthetics.
Will the anesthesiologist be available when I need their help?
Our primary responsibility is to be immediately available to the needs of the patients in the obstetrical suite and we take that responsibility very seriously.
Please note: all information presented above is appropriate for the majority of obstetrical patients at Overlake. However, this information may not pertain to all of you. Please contact your healthcare provider’s office or the Anesthesia Hot Line (425-646-5825) if you have any further questions.