What you need to know about anesthesia

If you’re planning to have surgery or a medical procedure in the near future, you probably have questions. People often wonder if their procedure will be painful, whether they’ll be awake, and how long it will take for them to return to their usual routine.

The answers will depend, in large part, on the type of anesthesia your surgical team uses. We asked Lisa Nocera, MD, an anesthesiologist and pain management specialist at St. Mary Interventional Spine and Pain Center in Langhorne, Pennsylvania, to explain how each type of anesthesia works and to offer insight on common pre-surgery questions. (An anesthesiologist is a medical doctor specially trained to provide anesthesia and pain relief.)

What is anesthesia?

Anesthesia is an umbrella term used to describe a number of medications that are often given before surgeries and medical procedures. Anesthesia medication may be used to:

• Sedate you, or make you feel relaxed and sleepy
• Prevent or reduce pain
• Keep you from moving, so your surgical team can operate safely
• Put you into a deep sleep, in which you won’t see, feel, hear, or remember anything

“The type of anesthesia you receive is based on a number of different factors including the type and location of your surgery, whether or not you’re a smoker, the medications you’re taking, as well as any medical issues you may have such as heart or lung issues,” explains Dr. Nocera.

What are the different types of anesthesia?

There are numerous anesthesia medications, but most of them fall into these categories:

Local

Local anesthesia is used to numb a small area of your body. It can prevent pain during minor procedures like a mole removal. It may be given in the form of an injection, cream, or spray.

Regional

“Regional anesthesia numbs an area around your spinal cord, which then blocks sensation to an entire region, like your arms or legs,” says Nocera.

It’s also possible to inject numbing medication around nerves that are closer to the surface of your body to block sensation to smaller areas. For example, your surgeon could numb the area around your collar bone to block sensation to your arm.

Another type of regional anesthesia is the epidural block, which is often used during childbirth or surgeries involving the lower limbs. An epidural involves inserting a small tube (or catheter) into an area around the spinal cord, called the epidural space. The epidural space contains nerves that send signals that indicate lower back and labor pain.

Medications are then pumped through the catheter into the epidural space to numb those nerves and block sensation to parts of your lower body.

Sedation

Sedation is a drug-induced drowsiness or sleep that prevents pain and anxiety during medical procedures. It may be a light, moderate, or deep sleep, depending on the procedure you’re having. For example, it’s typical to undergo deep sedation during a colonoscopy.

Sedation is also sometimes used alongside regional anesthesia. Your anesthesiologist may give you sedating medication to help you relax before injecting your back with the numbing medication.

General

General anesthesia involves a combination of medications that cause you to go unconscious during major surgeries like open-heart or brain surgery. It's either given intravenously or through a breathing tube that releases medication into your lungs, explains Nocera. General anesthesia allows you to undergo surgery without feeling anything or remembering anything afterward.

Who can administer anesthesia?

Anesthesiologists and certified registered nurse anesthetists (CRNAs) are licensed to give anesthesia. Your anesthesia specialist will determine how much medication you need based on your age, weight, and medical history, along with the length and type of surgery you’re scheduled for.

“The anesthesiologist will monitor your vital signs, including your blood pressure, heart rate, oxygen level, and breathing during the procedure itself. That helps them determine whether or not you have a sufficient amount of anesthesia in your system,” says Nocera. If your vital signs indicate that you need more medication, the anesthesia specialist will adjust your dose.

What are the side effects of anesthesia?

Every year, millions of Americans undergo general anesthesia safely. But as with any medication, there are possible side effects.

“The risks of general anesthesia include cardiac (heart) problems, pneumonia, nausea, and vomiting, as well as a sore throat,” says Nocera. Other side effects could include:

• Irritation to your throat or tongue
• Confusion when you wake up
• Rarely, stroke or heart attack
• In extremely rare cases, death. (This occurs in fewer than one out of every 200,000 to 300,000 cases.)

For local and regional anesthesia, the risks include infections and bleeding at the injection site, says Nocera. That’s why it’s so important to tell your surgeon if you take blood thinners like warfarin. That way, they can take precautions to prevent excessive bleeding.

What can you expect before and after general anesthesia?

Your surgeon and anesthesiologist will discuss the benefits and risks of your procedure with you in advance. Make sure that they’re aware of your full medical history, including:

• How well you tolerated anesthesia and prescription pain medications in the past
• If you could be pregnant
• If you’re taking any prescription medications like narcotic pain medicines or blood thinners
• If you’re taking any supplements or medicinal teas
• If you’re using any illicit drugs or non-prescription pain medications. Speaking up could save you from deadly drug interactions.

You’ll receive pre-operation instructions from your surgeon, says Nocera. Your instructions will include how long you should avoid food and drink before surgery, as well as any medications to take or skip on the morning of your procedure.

“It’s incredibly important to follow these instructions because if there’s food in your stomach as you're going off to sleep, particles can come up through your esophagus, and then down into your lungs. That can cause very serious problems, such as a type of pneumonia or choking,” she explains.

How quickly you wake up from anesthesia will vary depending on a number of factors, including the amount of medication you received and the length of the procedure. After you wake up, a nurse will continue to monitor you closely. Tell them if you experience any side effects such as pain or nausea, so they can keep you as comfortable as possible.

Still have questions? Reach out to your surgeon or anesthesiologist to make sure you are well-informed before and after your procedure. Learn more from the American Society of Anesthesiologists.