Anesthesia: Risks and Reality


In movies about the old west, a cowboy getting a bullet taken out might get a shot of whiskey or a rag to bite down on. Anesthesia has come a long way since then. Doctors now have a wide array of medicines to help prevent pain during medical procedures.

What are the types of anesthesia?

Local anesthesia is used to numb only a small area. It doesn’t put you to sleep. It may be used if you get stitches or have a skin growth removed. It’s usually given as a shot into the area that needs to be numbed.

Conscious sedation uses medicines that relax you and relieve pain. You’re awake, but do not feel pain. You can usually answer questions. Later, you won’t remember what happened.This type of anesthesia is used for procedures such as colon exams (colonoscopy) and vasectomy. Conscious sedationis usually given through an IV line into a vein, but it can also be given as pills or suppositories.

Regional anesthesia numbs a larger area, such as the lower part of your body. As with local anesthesia, you’re awake, but you may also be given conscious sedation to help you relax. Regional anesthesia includes:

•Nerve blocks. These are used to block pain signals from one nerve or group of nerves, such as one supplying a hand, arm, or leg.
•Spinal anesthesia and epidural anesthesia. These are injected into or near the spine to numb the lower part of the body. These types are commonly used for childbirth and prostate surgery.
General anesthesia is used for major surgery. It keeps you still and asleep during the procedure so you won’t feel any pain. It affects your whole body, including your brain and reflexes. You’ll need a breathing tube or mask to keep you breathing properly.

General anesthesia may be given through an IV line or inhaled through a mask. An anesthesia specialist (an anesthesiologist or a nurse anesthetist) will carefully monitor your condition and control the flow of the medicines.

Because of its broad effect on your body, general anesthesia has a higher risk of complications than other types and is more likely to cause side effects.

Is anesthesia risky?
New drugs and better monitoring devices have made anesthesia safer than ever. It can cause side effects, but most of them are minor and temporary. For example, some of the most common side effects of general anesthesia are nausea, vomiting, headache, a sore throat, and bruising at the injection site. More serious complications are possible, but rare. These include an allergic reaction to the medicine, infection, and heart or lung problems.

Your risk will depend on a number of factors. These include your overall health, the type of anesthesia used, and how you respond to the medicines. Your doctor can help you understand your personal risks.

Could I wake up during surgery?
Some people worry that they will wake up while under general anesthesia. This problem is called anesthesia awareness. It is real, but it’s very rare and generally not traumatic.

•Experts estimate the risk is only about 1 in 1,000.
•Those who have anesthesia awareness usually only have a few vague memories. Very few feel pain, although this can happen.
Giving general anesthesia is a delicate balance. The doctor has to keep you asleep so you don’t feel pain, but not too deeply asleep, which could be bad for your brain. Doctors use brain function monitors to measure brain activity and assess the depth of anesthesia. This decreases the chance for brain injury. If you have concerns about anesthesia, discuss them with your doctor or anesthesiologist. Your doctor’s goal is to keep you safe and comfortable.

How can I reduce my risk of problems?
Many factors can affect your response to anesthesia. To plan your care, your doctor will need to know about:

•Any health problems you have
•All the medicines you take, including any herbs, supplements, and over-the-counter drugs
•Any food or drug allergies you have
•Any past reactions to anesthesia
•Whether you smoke, drink alcohol, or use illegal drugs
Your safety depends on your answers. Be honest and thorough with your doctor.

It’s also important to follow any instructions your doctor gives you to prepare for anesthesia. For example, you may be told not to eat or drink anything for several hours before your procedure. If you were not able to do this, be sure to tell your doctor. It may be best to postpone your procedure.

Also, call your doctor if you get sick in the days before you are scheduled for surgery. Depending on the procedure and the type of anesthesia, your surgery may have to be put off until you feel better.

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