General Anesthesia

General Anesthesia is a technique during which the patient is rendered unconscious. General Anesthesia provides analgesia (you have no pain), amnesia (you are unaware and have no memory), and relaxation (your muscles are relaxed to give the surgeon better operating conditions).

General Anesthesia is usually started and maintained by giving the patient an intravenous drug (into a vein), an inhalation drug (a gas which you breathe), or a combination of both. The anesthesia provider will monitor the progress of the surgery and the depth of your anesthesia. The depth of anesthesia can be changed by increasing or decreasing the amount of drug given. As the surgeon finishes the procedure, the anesthesia provider reduces the depth of anesthesia so the patient will awaken at the end of the procedure or shortly thereafter.

What can I expect?

For a typical general anesthetic, you may experience the following. When you arrive, you will be changed into a gown and prepared for surgery. An intravenous line will be started. You will have the opportunity to speak with your anesthesiologist and have your questions answered. You may or may not be given a small amount of sedation in the pre-operative area.

When the operating room and your surgeon are ready, you will be taken to surgery. In the operating room, monitors for your breathing, heart, and blood pressure will be placed on you. You will be asked to breathe through an oxygen mask for a few breaths as the anesthetic is given through your intravenous line (IV). The next thing you should remember is awakening in the recovery room. You may be a little confused when you wake up in the recovery room, but that should improve as the anesthetic clears. If you have any pain, you will be given pain medications through your IV. When you have recovered sufficiently from your anesthetic, your pain is under control, and your vital signs are stable, you will be transferred to your hospital room or prepared to go home.

Spinal Anesthesia

Spinal anesthesia is a technique in which the patient is given an injection in the lower back that blocks the nerves that supply feeling to the lower half of the body. The medication is injected into a sac of fluid in your lower back (the subarachnoid space) which contains the spinal nerves. The medication blocks the nerves in the lower half of the body. The loss of feeling is temporary and should last from 1 to 4 hours depending on the medication given and other factors.

What can I expect?

When you arrive, you will be changed into a gown and prepared for surgery. An intravenous line will be started. You will have the opportunity to speak with your anesthesiologist and have your questions answered. You may or may not be given a small amount of sedation in the preoperative area.

When the Operating Room and your surgeon are ready, you will be taken to surgery. Because the spinal anesthetic works rapidly, the injection is usually given in the Operating Room. In the Operating Room the anesthesia team will place monitors on you, give you some IV sedation, and then place you in the sitting or lateral (on your side) position. The anesthesia provider will wash your back with a sterile solution. After local anesthetic is injected into the skin, a spinal needle is inserted into your lower back and into the sac of fluid that surrounds the spinal nerves. The medication is injected, the needle is removed, and the patient is allowed to lie back down. Although this may sound like a painful procedure, most patients feel only the small sting from the local anesthetic. You may or may not feel pressure in your lower back as the needle is inserted. With the sedation that is given, many patients do not even remember the injection. Once we are sure that the nerves are blocked and the patient is not feeling any pain, the surgery is started. More sedation is given, as needed, throughout the procedure. If at any time during the procedure you feel uncomfortable, simply tell your anesthesia provider so he may adjust your medication. After the surgery, you will be taken to the Recovery Room for about one hour. As the spinal block wears off, you may be given pain medications through your IV (intravenous) line, or oral medications.

Epidural Anesthesia

Epidural anesthesia involves inserting a tiny plastic tube into the epidural space. The spinal nerves (which carry the sensations from your body) pass through the epidural space. Medicine is injected through this tiny plastic tube (or epidural catheter) into the epidural space. This medicine blocks the messages of sensation that tell the brain what your body is feeling.

The epidural catheter is usually placed in the lower back for procedures below the umbilicus (belly button). The catheter may be placed higher in the back for procedures of the chest or upper abdomen. For example, for knee or hip surgery, the epidural catheter is placed in the lower back. This allows the medicine to anesthetize or block the feelings in the lower half of your body. After surgery, the medicine can be changed to control your pain or discomfort after surgery.

This anesthesia is similar to a Spinal Anesthetic. The Spinal Anesthetic is a single shot of medication which may last from 1 to 4 hours. The epidural catheter, however, allows repeated injections of the medication. This may permit many hours of anesthesia. In addition, the epidural catheter may be used after surgery for pain control.

What can I expect?

When you arrive, you will be changed into a gown and prepared for surgery. An intravenous line will be started. You will have the opportunity to speak with your anesthesiologist and have your questions answered. You may or may not be given a small amount of sedation in the preoperative area.

You will be asked to sit up or lie on your side. The anesthesiologist will wash off your lower back with an antiseptic solution and then place a paper drape over the area. After numbing the skin with a local anesthetic, he will insert a needle into the epidural space. The patient may feel a slight burning sensation with the local anesthetic, but should rarely feel more than a pressure sensation with the epidural needle. The catheter is inserted through the needle and the needle is removed. The catheter is then taped to the patient's back. You should be able to lie on back with no discomfort. You should not feel the catheter except for the tape on your back. You may feel a cold sensation down your back as the medicine is injected through the catheter.

At the appropriate time, the anesthesiologist will inject medicine into the catheter. In 5 to 15 minutes you will feel a warm sensation in your legs and gradually lose feeling in the lower half of your body. You will be taken to the operating room where you will be moved to the operating table. Blood pressure, heart, and breathing monitors will be placed on you as needed. You may be given sedation to make you comfortable throughout your procedure. Many patients do not remember most of the time in the operating room because of the sedation. If at any time during the procedure you feel uncomfortable, just tell your anesthesia provider so your medicine can be adjusted. After the procedure you will be taken to the Recovery Room until you are ready to go to your room.

If you are staying in the hospital, usually you will be started on a medication in your epidural that will control your pain after surgery. If you are uncomfortable, please tell your nurse so your medication can be adjusted. One or two days after surgery, the epidural catheter will be removed. Removal of the catheter is a painless procedure except for the few hairs that are pulled when the tape is removed.

Regional Anesthesia

Regional Anesthesia involves blocking sensations to one part of the body. By injecting local anesthetic (or numbing medicine) around a group of nerves, the anesthesia provider can block the sensation from one part of the body, such as the arm, the hand, or the foot. Most of the time the patient is given sedation before and during the procedure. A regional block can often give the patient several hours of pain relief after surgery. Regional anesthesia can be given alone, with sedation, or in combination with General Anesthesia. Your anesthesia provider may use this technique to provide anesthesia for your surgery or simply to provide pain relief after your surgery. Use of this technique will depend on the type and length of your surgery, your medical history, and your anesthesiologist and surgeon's preference.

What can I expect?

When you arrive, you will be changed into a gown and prepared for surgery. An intravenous line will be started. You will have the opportunity to speak with your anesthesiologist and have your questions answered. You may or may not be given a small amount of sedation in the preoperative area. Regional Anesthesia can be performed either in the preoperative area or in the operating room.

Common Types of Blocks:

• Axillary Block: This block is used for procedures of the hand, forearm, and elbow. An injection is given in the patient's axilla (armpit) into a space that surrounds a bundle of nerves that supply feeling to the lower arm. This is usually done with the patient awake with sedation.
• Interscalene Block: This block is used for procedures on the arm and shoulder. An injection is given into a space around a group of nerves on the side of the patient's neck. These nerves supply feeling to the shoulder and arm. This block can be done with the patient sedated prior to surgery or after General Anesthesia.
• Bier Block: This block is reserved for short procedures (60 minutes or less) on the forearm, wrist, and hand. Occasionally, a Bier Block is used for the ankle or foot. The block is performed in the Operating Room. After monitors have been applied, a tourniquet (usually like a blood pressure cuff) is placed on the upper arm. The hand, wrist and forearm will be wrapped with a tight elastic bandage and the tourniquet will be inflated. The elastic bandage will be removed. Then medication will be injected into an IV in the hand below the tourniquet. The hand and arm will feel warm to hot with a "pins and needles" feeling as the arm becomes numb. After the surgery, the tourniquet will be deflated and the feeling will return to the arm.
• Ankle Block: This block is done for procedures on the foot. The block is usually done prior to surgery. Three or four injections of local anesthetic are given around the ankle to block the nerves that supply feeling to the foot.

M.A.C. (Monitored Anesthesia Care)

M.A.C. or Monitored Anesthesia Care, refers to sedation while under the care of the Anesthesia provider. This sedation may range from mild sedation to a state of unconsciousness. Throughout this sedation, the patient's heart, blood pressure, and breathing are monitored closely by the Anesthesia provider. Additional oxygen or breathing assistance may be given if necessary. M.A.C. is usually given in addition to Local or Regional Anesthesia.

Local Anesthesia

A local anesthetic (medication which blocks nerves) is injected around the area of the surgical site. The area blocked is a smaller area than with a regional block. This block is usually saved for small, superficial surgeries, such as breast biopsy, removal of skin lesions, and placement of long term implantable intravenous lines. Occasionally, the surgeon will give local anesthesia even after general anesthesia to reduce the discomfort at the surgical site after surgery.

Frequently Asked Questions