There are many types and levels of anesthesia. What is appropriate for you is dependent on many factors, some of which are the type of surgery you are having, the specific medications you take at home, and other medical problems that you may have. Your anesthesia provider will talk with you about the most appropriate type of anesthesia for you. In some cases, more than one type of anesthesia may be acceptable in which case you may have a choice about which kind you want to have.
General Anesthesia
This is most commonly used for major operations, many of which are lifesaving or life-changing and would not be possible without general anesthesia. Examples are open heart surgery, lung resections, and gall bladder removal (cholecystectomy).
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- General Anesthesia is a medically induced state of unconsciousness so you will not be aware of what is happening during your surgery. Although technically different from real sleep, most people think of general anesthesia as “going off to sleep” in order to have a surgery. General anesthesia causes temporary unconsciousness for as long as is needed for a surgery and prevents a person from having reflexive movements that could interfere with the performance of a surgery.
- General anesthesia is medicine that is administered by an anesthesia provider through a mask, breathing tube or an IV. While the anesthesia is working, you will be unconscious and many of your body’s functions will slow down or need help to work effectively. A tube may be placed in your throat to help you breathe. During surgery or the procedure, the anesthesia provider will monitor your heart rate, blood pressure, breathing and other vital signs to ensure your safety while you remain unconscious and free of pain.
- Once your surgery is complete, the general anesthesia is reversed. As you return to consciousness, your breathing, circulation and oxygen levels are closely monitored. You will be transferred to the recovery room, or directly to the Intensive Care Unit (ICU) if your condition is critical. In the recovery room, nurses will continue to monitor you while your anesthesia provider is always available for assistance or questions.
- Some patients feel fine as they wake up; others experience symptoms such as nausea, vomiting or chills. Your throat may be sore from the breathing tube. Because you’ve had major surgery, you probably will have pain and discomfort from the procedure as you recover, which might get worse as the effects of the general anesthesia wear off. Your anesthesia provider is always available and has the experience to manage these problems in the recovery room, and can be consulted for further assistance once you have left the recovery area.
Regional Anesthesia
A type of anesthesia or procedure for pain relief that causes one specific part of the body to be without sensation for a number of hours, like one arm or one leg. This is also known as a Nerve Block. It is commonly used for many orthopedic surgeries and mastectomies. It is accomplished by an injection of local anesthetic that creates numbness around the nerves for the area you are having surgery. A nerve block can be used in combination with sedation, spinal, or general anesthesia. The combination depends on the type of surgery you are having and your medical condition, and will be discussed with you prior to surgery.
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- Regional anesthesia or analgesia, commonly referred to as a nerve block, numbs a specific part of the body, such as an entire arm or a foot. The medication is delivered through an injection or small tube called a catheter and is used when a simple injection of local anesthetic is not enough for adequate numbing or pain relief.
- A nerve block can be used in combination with sedation, spinal or general anesthesia. This means that you may be completely awake, drowsy, heavily sedated, or completely unconscious during your surgery. The combination used depends on the type of surgery and your medical condition. Your anesthesia provider will discuss this with you prior to surgery.
- A nerve block can be used in combination with sedation, spinal or general anesthesia. This means that you may be completely awake, drowsy, heavily sedated, or completely unconscious during your surgery. The combination used depends on the type of surgery and your medical condition. Your anesthesia provider will discuss this with you prior to surgery.
- A nerve block can be used in combination with sedation, spinal or general anesthesia. This means that you may be completely awake, drowsy, heavily sedated, or completely unconscious during your surgery. The combination used depends on the type of surgery and your medical condition. Your anesthesia provider will discuss this with you prior to surgery.
- The nerve block procedure is performed by an anesthesia provider, usually in the preoperative area, prior to surgery. Prior to the block placement, you will likely feel drowsy from sedation medication used to make you more comfortable. During the nerve block your vital signs are continuously monitored, and you may have oxygen applied.
- Typically, the nerve block is a one-time injection that provides numbness or pain relief for about 18 hours. On some occasions, a small tube or catheter is left in place with a continual infusion of local anesthesia, for up to several days following surgery. As the block wears off you will transition to other forms of pain relief, such as pain pills or Tylenol, or you may not require any continuing medicine at all.
- Nerve blocks are very safe and help avoid the potential complications and side effects that can happen with general anesthesia or higher dose narcotics that would otherwise be needed. In addition to keeping you comfortable, they are associated with lower rates of nausea and vomiting. Unfortunately no procedure is risk-free, however any serious risks, such as bleeding, infection, nerve injury or local anesthetic toxicity are extraordinarily rare. Be sure to discuss with your anesthesia provider if you are on any blood thinner medications, including warfarin, lovenox and eliquis.
Spinal Anesthesia
A type of anesthesia that causes a lack of sensation from the waist, or mid-chest, down to the feet. It is accomplished by a special injection of a single dose of medicine in the low part of the back. This is slightly different from an ‘epidural’ where a catheter is left in place. It is frequently used for knee/hip replacements and cesarean births.
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- A spinal is placed by an anesthesia provider in the operating room, just prior to your surgery. Prior to the spinal placement, you will likely feel drowsy from sedation medication used to make you more comfortable (unless you are having a cesarean birth –quick link–, in which case we avoid sedating medicines which could affect your baby.) Your vital signs are continuously monitored, and you may have oxygen applied.
- You will be asked to sit or lie on your side with your back curved outward until the procedure is completed. A small amount of medicine is inserted in the lower back into the spinal fluid. This will provide a very significant and dense block in the area of the surgery.
- A spinal is different than an epidural in that a spinal is a single injection, while the epidural has a catheter that stays in place. Sometimes a spinal injection can be combined with an epidural catheter for pain relief during labor. Although it can be used alone for labor, it is usually not ideal because it can wear off before the delivery.
- A spinal is often used in combination with sedation of varying degrees. If you are having knee/hip surgery, you may be heavily sedated and completely unaware of the surgery. If you are having a cesarean birth, you are likely to be completely awake so as to avoid medicines that could have a sedating effect on your baby.
- The medicine will wear off in several hours, and by the time you leave the recovery room, you should be able to feel & move the lower parts of your legs. Unless otherwise directed by your surgeon, you should be up and walking within the same day of surgery. Be sure to have assistance when walking in case your strength is not fully returned or you are feeling weak from surgery.
- Spinals are very safe and help avoid the potential complications that can happen with general anesthesia, and are associated with lower rates of nausea and vomiting. Unfortunately no procedure is risk-free, however any serious risks, such as bleeding, infection, or nerve injury are extraordinarily rare. Be sure to discuss with your anesthesia provider if you have had any surgeries on your spine or are on any blood thinner medications, including warfarin, lovenox and eliquis. Some patients may get a headache after the procedure that is referred to as a postdural puncture or spinal headache. Please notify your health care team if you are experiencing a severe headache, so an anesthesia provider can assess if it is related to the spinal and can discuss various treatment options with you.
Epidural Anesthesia or Epidural Analgesia
A special procedure that can provide anesthesia or analgesia (pain relief) in a large portion of the body. Epidurals are most commonly used for pain control after major surgery of the abdomen or during labor and delivery. To perform an epidural, a needle is placed into the back to a precise location. Through this needle a small, flexible tubing (catheter) is passed. The needle is removed and the catheter left in place for continuous infusion of pain relief medicine.
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- An epidural is placed by an anesthesia provider while your vital signs are continuously monitored. It is usually placed in the preoperative area, prior to surgery. Prior to the epidural placement, you will likely feel drowsy from sedation medication used to make you more comfortable. An exception is if you are in labor. –quick link— If you are in labor, the epidural will be placed in your labor room and we avoid use of sedating medicines which could affect your baby. Your vital signs are continuously monitored, and you may have oxygen applied.
- You will be asked to sit or lie on your side with your back curved outward until the procedure is completed. A small tube (catheter) is inserted through a needle and the needle withdrawn. In some cases, the catheter may touch a nerve and cause a brief tingling sensation in a hip or down a leg. The catheter is connected to a pump that continuously provides medication specifically to the nerves that sense pain in the area of the surgery or labor contractions.
- Epidurals are very safe and help avoid the potential complications that can happen with higher doses of narcotics that may otherwise be needed. In addition to keeping you more comfortable, they are associated with lower rates of nausea and vomiting, and promote return of bowel function after abdominal surgery. Unfortunately no procedure is risk-free, however any serious risks, such as bleeding, infection, or nerve injury are extraordinarily rare. Be sure to discuss with your anesthesia provider if you have had any surgeries on your spine or are on any blood thinner medications, including warfarin, lovenox and eliquis. Some patients may get a headache after the procedure that is referred to as a postdural puncture or spinal headache. Please notify your health care team if you are experiencing a severe headache, so an anesthesia provider can assess if it is related to the spinal and can discuss various treatment options with you.
IV Sedation
There are various levels of sedation that are used depending on the patient and his/her medical history, as well as the type of surgical procedure. Your anesthesia provider has the option and experience needed to adjust the level of sedation as needed throughout the procedure Sedation usually consists of medicine injected into an IV, combined with an injection of local anesthetic by the surgeon at the incision site (if there is an incision). Sedation is also frequently combined with regional or spinal anesthesia.
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- Minimal Sedation – very mild sedation during which patients respond normally to verbal commands. This level of sedation helps people feel relaxed, but they usually still feel awake. Thus, it is usually only used for minor procedures that cause little pain or discomfort.
- Moderate Sedation – a level of sedation where people receive enough medication to feel very relaxed or sleepy, but can still respond purposefully to verbal or tactile (touch) stimulation. Patients may or may not remember some or all of the procedure.
- Deep Sedation – this level of sedation makes people so sleepy that they do not respond purposefully unless there is a strong, painful stimulation. Although it is possible to be aware and remember some things while under deep sedation, most patients usually have no memory of their procedures if deep sedation is used.
- The level of sedation used for your procedure will be determined by your anesthesia provider. He or she will make this decision based on the type of procedure you are having and your health status. Your anesthesia provider has years of experience for knowing how to tailor your sedation level to your safety, comfort, and the needs of your surgeon or proceduralist.
- You may also be interested to know that along with providing deeper “sleep,” the deeper levels of sedation have more risk. The more deeply that a patient is sedated, the more likely he or she will need help from the anesthesia provider to maintain a good breathing pattern and good blood pressure. Also, it is possible that a patient’s level of sedation may move beyond the intended level to the next stage where the risk is greater. Rest assured that all anesthesia professionals are trained to provide all levels of sedation up to the point of general anesthesia.
What is MAC?
Monitored Anesthesia Care or MAC is not a separate level of sedation. It is simply another term used when an anesthesia provider is involved in the sedation of a patient.
Local Anesthesia
Numbing medicine is injected by the surgeon around the operative site that creates numbness in that area only. You will be awake, but will not feel pain once the local anesthetic takes effect. The rest of the body is not affected, and you do not receive IV sedation. It is used for surgeries that affect only a small part of the body (i.e. skin biopsy). Anesthesia providers are not present or involved in your care team for this type of anesthesia.