An anesthesiologist utilizes a variety of medications, vapors and gases to ensure that patients remain relaxed, comfortable and pain free during surgery and procedures.
There are several forms of anesthesia and the kind you receive depends on your medical history and the type of procedure to be performed. More than one type of anesthesia may be appropriate for certain patients and/or procedures. Your anesthesiologist will thoroughly discuss with you the various options and together you will decide on the best plan to keep you safe and comfortable during your surgery.
No matter which type of anesthesia is administered, your anesthesiologist will be with you during the entire procedure to monitor your vital signs (heart rate, blood pressure, oxygen levels, etc.), breathing and comfort level.
General anesthesia places the entire body into a state of deep sleep or unconsciousness, during which the patient has no awareness or sensation. This means you will not feel anything or remember the surgical experience.
General anesthesia is administered by injection either through an intravenous line (IV), inhalation via a breathing mask, airway device, or tube, or sometimes a combination of these. This type of anesthesia may inhibit or stop your breathing and may requires intubation (placement of a breathing tube), or placement of an airway device to assist with breathing. The tube or device is inserted after you are completely asleep and is removed once the surgery is complete and you are breathing well on your own. Upon awakening from general anesthesia, patients may experience a mild sore throat from the breathing tube and/or disorientation.
Endotracheal tube (ET tube or ETT)
This has been the standard airway device used during general anesthesia and is what most people think of when they talk about intubation and breathing tubes. An ETT is placed into the trachea (windpipe) and allows for a reliable connection between the lungs and the anesthesia machine or ventilator.
Laryngeal Mask Airway (LMA)
This airway device consists of a tube with an inflatable cuff that is inserted into the pharynx (the upper portion of the windpipe). Your anesthesiologist may use an LMA rather than an ETT because it is quicker and tends to cause less discomfort for the patient. There are several contraindications to using an LMA, such as moderate to severe reflux, or laparoscopic surgery; its use, therefore, is not always an option.
Local anesthesia involves administering an anesthetic agent (numbing medication) to a specific area of the body. This is accomplished via injection at or near the particular site. Some physicians use this method for performing small procedures in their office. If the area is larger or a patient does not tolerate local anesthesia alone, an anesthesiologist may be asked to assist by administering sedation to help keep a patient more comfortable.
Regional Anesthesia (Nerve Blocks)
Regional anesthesia involves injection of a local anesthetic around a major nerve or group of nerves to block pain from a large area of the body, such as an arm or leg. It often involves the use of an ultrasound machine or special stimulating needle to identify the location of the nerve to be anesthetized or “blocked”. This type of anesthesia can be used alone for surgery, or combined with sedation or general anesthesia. Regional anesthesia provides post-operative pain relief that can last up 8-12 hours, depending on the medication type and dose. This can decrease the amount of pain medication a patient requires after surgery, as well as other side effects, such as nausea. In some cases, a catheter can be left around the nerve/s to be blocked and infusions can run after the procedure to allow for prolonged (days) pain relief.
Neuraxial Anesthesia (Spinal and Epidural)
Neuraxial Anesthesia is a form of regional anesthesia that involves injecting local anesthetics around the nerves of the spinal cord. This type of anesthesia can be used for most surgeries at or below the umbilicus (belly button). There are two types of neuraxial anesthesia, both of which require insertion of an IV so that proper hydration can be administered prior to their placement. Depending on the type of surgery, a patient may also be given sedation or general anesthesia to permit better relaxation and comfort.
Spinal Anesthesia: Typically used for lower abdominal, urologic (e.g. prostate), gynecologic (e.g. hysterectomy) or lower extremity surgeries, this type of anesthesia completely anesthetizes or numbs the entire lower body. It involves the placement of a needle between the vertebrae of the lumbar region (low back) and a single injection of local anesthetic, with or without narcotics, into the subarachnoid space (the sac of fluid surrounding the spinal cord).
Epidural Anesthesia: Most commonly utilized for labor, cesareans (C-sections) and occasionally surgery on the colon and gastrointestinal tract, this type of anesthesia is similar to a spinal, but usually with placement of an indwelling catheter. A needle is again inserted into the low back between the lumbar vertebrae. Once the epidural space is located (just outside the subarachnoid space used for a spinal), a thin hollow catheter is threaded through the needle. The needle is then removed and the catheter is secured in place. This allows for the continuous infusion of local anesthetics and for the anesthesiologist to have some control of the area of the body that is numbed. The catheter is often left in place to help with post-operative pain relief as well. Epidurals are sometimes utilized for pain control in surgeries of the upper abdomen and chest.
Monitored Anesthesia Care (MAC)
Monitored anesthesia care (MAC) is a type of anesthesia that involves administration of IV sedation while maintaining spontaneous respirations (the patient is fully breathing on their own). Supplemental oxygen may be administered via a nasal cannula (thin plastic prongs that rest just inside the nose) or a clear facemask during MAC. This kind of anesthesia can allow the anesthesiologist and surgeon to communicate with a patient during a procedure, but keep the patient less anxious and more relaxed. MAC is often combined with other types of anesthesia when general anesthesia is not required. This is similar to conscious sedation or “twilight anesthesia”, except that an anesthesiologist is involved and has the capability to utilize more potent sedatives.