Types of Anesthesia and Your Anesthesiologist
Types of anesthesia
During surgery, you will be given some form of anesthesia, which are medicines given
to relieve of pain and sensation during surgery. The type and dosage of anesthesia
is given by the anesthesiologist. Before surgery, you will meet with the physician
anesthesiologist or nurse anesthetist. The anesthesiologist will review your medical
condition and history to plan the appropriate anesthetic for surgery.
There are various forms of anesthesia. The type of anesthesia you get will depend
on the type of surgery and your medical condition. Sedatives (to make you sleepy)
and analgesics (to ease the pain) may also be used as part of the anesthesia process.
The different types of anesthesia include the following:
Local anesthesia is an anesthetic agent given to temporarily stop the sense of pain
in a particular area of the body. You remain conscious during a local anesthetic.
For minor surgery, a local anesthetic can be given via injection to the site, or allowed
to absorb into the skin. However, when a large area needs to be numbed, or if a local
anesthetic injection will not penetrate deep enough, doctors may use other types of
Regional anesthesia is used to numb only the portion of the body that will undergo
the surgery. Usually an injection of local anesthetic is given in the area of nerves
that provide feeling to that part of the body. There are several forms of regional
Spinal anesthetic. A spinal anesthetic is used for lower abdominal, pelvic, rectal, or lower extremity
surgery. This type of anesthetic involves injecting a single dose of the anesthetic
medicine into the area that surrounds the spinal cord. The injection is made into
the lower back, below the end of the spinal cord, and causes numbness in the lower
body. This type of anesthesia is most often used in orthopedic procedures of the lower
Epidural anesthetic. The epidural anesthetic is similar to a spinal anesthetic and is commonly used for
surgery of the lower limbs and during labor and childbirth. This type of anesthesia
involves continually infusing an anesthetic medicine through a thin catheter (hollow
tube). The catheter is placed into the space that surrounds the spinal cord in the
lower back, causing numbness in the lower body. Epidural anesthesia may also be used
for chest or abdominal surgery. In this case, the anesthetic medicine is injected
at a higher location in the back to numb the chest and abdominal areas.
General anesthesia is an anesthetic used to induce unconsciousness during surgery.
The medicine is either inhaled through a breathing mask or tube, or given through
an intravenous (IV) line. A breathing tube may be inserted into the windpipe to maintain
proper breathing during surgery. Once the surgery is complete, the anesthesiologist
ceases the anesthetic and you are taken to the recovery room for further monitoring.
About your anesthesiologist
Anesthesiologists are the doctors trained to administer and manage anesthesia given
during a surgical procedure. They are also responsible for managing and treating changes
in your critical life functions--breathing, heart rate, and blood pressure--as they
are affected by the surgery being performed. Further, they diagnose and treat any
medical problems that might arise during and immediately after surgery.
Before surgery, the anesthesiologist will evaluate your medical condition and formulate
an anesthetic plan that takes your physical condition into account. It is vital that
the anesthesiologist knows as much about your medical history, lifestyle, and medicines,
including over-the-counter and herbal supplements, as possible. Some particularly
important information he or she needs to know includes the following:
Reactions to previous anesthetics. If you have ever had a bad reaction to an anesthetic agent, you need to be able to
describe exactly what the reaction was and what your specific symptoms were. Give
the anesthesiologist as much detail as possible, such as you felt nauseated when you
woke up or the amount of time it took you to wake up.
Current herbal supplements. Certain herbal products, commonly taken by millions of Americans, may cause changes
in heart rate and blood pressure, and may increase bleeding in some patients. The
popular herbs gingko biloba, garlic, ginger, and ginseng may lead to excess blood
loss by preventing blood clots from forming. In addition, St. John's wort, and kava
kava, may prolong the sedative effect of the anesthetic. The American Society of Anesthesiologists
advises anyone planning to have surgery to stop taking all herbal supplements at least
2 to 3 weeks before surgery to rid the body of these substances.
Any known allergies. Discussing any known allergies with the anesthesiologist is very important, as some
anesthetic drugs trigger cross-allergies, particularly in people who have allergies
to eggs and soy products. Allergies to both foods and drugs should be identified.
All recent and current prescription and over-the-counter medicines. It is also important to let your surgeon and anesthesiologist know about both prescription
medicines and over-the-counter medicines you are taking, or have recently taken. Certain
prescription medicines, such as coumadin, a blood thinner, must be discontinued for
some time before surgery. In addition, as many people take a daily aspirin to prevent
heart attack, and certain dietary supplements, doctors need to be aware of these habits,
as they can prolong bleeding and interfere with medicines used by anesthesiologists.
Cigarette smoking and drinking alcohol. Cigarette smoking and alcohol can affect your body just as strongly (and sometimes
more strongly) than many prescription medicines you may be taking. Because of the
way cigarettes and alcohol affect the lungs, heart, liver, and blood, these substances
can change the way an anesthetic drug works during surgery. It is important to let
your surgeon and anesthesiologist know about your past, recent, and current consumption
of these substances before surgery.
Undergoing surgery can be a good motivator to quit smoking. Most hospitals are smoke-free
and doctors, nurses, and other health professionals will be there to give you support.
In addition, you will heal and recover faster, especially in the incision area, or
if your operation involves any bones. Smoking cessation before surgery also decreases
pulmonary complications after surgery, such as pneumonia. Quitting smoking also reduces
your risk of heart disease, lung disease, and cancer.
Use of street drugs (such as marijuana, cocaine, or amphetamines). People are often reluctant to disclose the use of illegal drug, but you should remember
that all conversations between you and your surgeon and anesthesiologist are confidential.
It is crucial that he or she know about your past, recent, and current use of these
substances, as these drugs can effect healing, and responses to anesthesia. It is
important to keep in mind that the only interest your doctor has in this information
is learning enough about your physical condition to provide you with the safest anesthesia
Meeting the anesthesiologist before the surgery
Because anesthesia and surgery affect every system in the body, the anesthesiologist
will conduct a preoperative interview. Sometimes this is done in person; in other
cases, the anesthesiologist will interview you over the phone. During this interview,
the anesthesiologist will review your medical history, as well as discuss the information
mentioned above. He or she will also inform you about what to expect during your surgery
and discuss anesthetic choices with you. This is also the time to discuss which medicines
should be stopped, and which can continue before surgery, as well as when to stop
eating before the surgery.
If you have not personally met during the preoperative interview, the anesthesiologist
will meet with you immediately before your surgery to review your entire medical history
as well as results of any medical tests previously conducted. By this time, he or
she will have a clear understanding of your anesthetic needs.
How are pre-existing medical conditions handled during surgery?
If you have a pre-existing medical condition, such as diabetes, asthma, heart problems,
or arthritis, your anesthesiologist will have been alerted to this and will be well-prepared
to treat these conditions during your surgery, as well as immediately afterward. Anesthesiologists
are trained to handle sudden medical problems related to the surgery, as well as any
chronic conditions that may need attention during the procedure.
How is my condition monitored during surgery?
Monitoring is one of the most important roles the anesthesiologist handles during
surgery. Second-by-second observation of even the slightest changes in a wide range
of body functions gives the anesthesiologist a tremendous amount of information about
your well-being. In addition to directing your anesthesia, the anesthesiologist will
manage vital functions, such as heart rate, blood pressure, heart rhythm, body temperature,
and breathing. He or she will also be responsible for fluid and blood replacement,
when needed. Sophisticated technology is used to monitor every organ system and its
function during surgery.