Anesthesia Used in Your Procedure

All types of anesthesia are administered to keep you comfortable and pain free during surgery, medical procedures or tests. But there are some key differences. The type you receive will depend on factors like the procedure, your health and your preference. The care provided by your anesthesiologist(s) will maximize your safety and minimize risk during your procedure. Every attempt is made to reduce the physical and mental stress associated with all procedures. This can enhance the perioperative experience as well as the healing process.
https://www.asahq.org/ whensecondscount/anesthesia-101/ types-of-anesthesia  

Types

General Anesthesia

General anesthesia is often offered for major operations, such as abdominal, knee, shoulder or urology surgeries and causes you to lose consciousness. Medications are administered to render the patient unconscious for the entire surgical procedure. This may require an airway device to support breathing.

Local Monitored Anesthesia Care (LMAC) / IV / Conscious or Monitored Sedation

Sedation is often offered for minimally invasive procedures like carpal tunnel, certain pain procedures or colonoscopies. The level of sedation ranges from minimal – drowsy but able to talk – to deep. Monitoring includes at least blood pressure, oxygenation, EKG Pulse and mental state, with sedation and analgesia as needed.

Regional Anesthesia (i.e, Spinal)

Regional anesthesia is often used during surgeries of the arm, leg or abdomen. It numbs a large part of the body, but you remain aware. Anesthetizing agents are injected in specific areas to inhibit nerve transmission and produce loss of sensation (numbness). Techniques include epidural, spinal and peripheral nerve blocks.

Local Anesthesia

Local anesthesia is for procedures such as getting stitches or having a mole removed. It numbs a small area, and you are alert and awake.

Effects

Please Note: Not all complications are addressed in this discussion. You will have the opportunity to ask questions or voice concerns with your surgeon and anesthesiologist prior to surgery. American Society of Anesthesiologists’ Anesthesia 101  

General Anesthesia

While this type of anesthesia is very safe, it is the type most likely to cause side effects. While at Yellowstone Surgery Center, your physician anesthesiologist will monitor you during and after your procedure to address any side effects and watch for the possibility of more serious complications.

  • Possible oral or dental damage
  • Postoperative nausea / vomiting
  • Drowsiness
  • Sore throat
  • Hoarse voice
  • Postoperative delirium
  • Muscle ache
  • Itching
  • Chills and shivering (hypothermia)
  • Urinary retention

Although rare, general anesthesia can cause more serious complications:

  • Aspiration of gastric contents
  • Brain Damage/Coma/Death
  • Drug reactions
  • Heart attack
  • Malignant hyperthermia
  • Nerve injury
  • Organ failure
  • Post obstructive pulmonary edema (fluid in the lungs)
  • Postoperative delirium or cognitive dysfunction
  • Postoperative vision loss

Local Monitored Anesthesia Care (LMAC) / IV / Conscious or Monitored Sedation

Although there are fewer potential side effects than with general anesthesia and usually go away quickly. Because levels of sedation vary, Yellowstone Surgery Center physician anesthesiologist monitor you during surgery to make sure you don’t experience complications.

  • Nausea and vomiting
  • Itching
  • Hematoma or infection at site of IV

Regional Anesthesia (i.e, Spinal)

Although there are fewer potential side effects than with general anesthesia and usually go away quickly. Because levels of sedation vary, Yellowstone Surgery Center physician anesthesiologist monitor you during surgery to make sure you don’t experience complications.

  • Difficulty urinating
  • Headache
  • Hematoma
  • Minor back pain

More serious but rare complications include:

  • Bleeding
  • Brain Damage/Coma/Death
  • Infection
  • Heart attack
  • Nerve damage/paralysis
  • Persistent weakness/numbness
  • Seizures
  • Stroke

Local Anesthesia

This is the type of anesthesia least likely to cause side effects, and any side effects that do occur are usually minor. You may be sore or experience itching where the medication was injected. If you’ve had this type of reaction to local anesthesia in the past, be sure to tell your physician. You may be given a different type of anesthetic or a medication to counteract the side effects.

Risk Factors

By having any of the following factors may increase your anesthesia risk. These items will be asked about during your Clinical Nurse Liaison (CNL) during the Patient Screening Process and reviewed by your anesthesiologist during your Pre-Op screening.

  • Personal or Family History
  • Allergies to anesthesia or a history of adverse reactions to anesthesia
  • Diabetes
  • Heart disease (angina, valve disease, heart failure or a previous heart attack)
  • High blood pressure
  • Kidney problems
  • Liver problems
  • Lung conditions (asthma and chronic obstructive pulmonary disease, or COPD)
  • Malignant hyperthermia
  • Obesity
  • Obstructive sleep apnea
  • Stroke
  • Seizures or other neurological disorders
  • Smoking
  • Alcoholic Beverages: drinking two or more alcoholic beverages a day

Nerve Blocks

Note: Not all complications are addressed in this discussion. You will have the opportunity to ask questions or voice concerns with your surgeon and anesthesiologist prior to surgery. Nerve blocks are a method to help manage pain after surgery. They differ from pain pills by temporarily decreasing the body’s ability to sense pain in the operative limb rather than affecting the whole body. Nerve blocks have existed for many years, but have become more popular due to technological advances and use of ultrasound, making them easier to perform, safer and more reliable. Your orthopedic surgeon and anesthesiologist will make this option available to you if appropriate prior to surgery.

Types

There are two types of Nerve Blocks:

  • Lower Extremity saphenous (also known as adductor canal and selective femoral), and popliteal (also known as selective sciatic).
  • Upper Extremity – axillary, supraclavicular and interscalene. The interscalene blocks the “brachial plexus” bundle for shoulder surgery rendering the arm mostly free of sensation and motion.

What Happens

Nerve blocks are performed in a designated pre-op room after patients have been readied with pre-op interview, labs and EKG if needed, and IV. The anesthesiologist will discuss options, risks and benefits, and gain consent for their services. A mild IV sedative may be offered prior to the procedure to help with comfort. Prepping the area and performing the block takes a mere 5-10mins with the block taking 15-30mins to set up. Monitors are placed which include EKG patches, BP cuff, and oxygen probe. The patient is positioned, skin is prepped, and local anesthetic is injected to numb the skin. A special needle is inserted through the numbed skin and guided by ultrasound to the nerve that innervates the limb. Occasionally a nerve stimulator is used as added guidance that will make the limb briefly twitch involuntarily. Once in position, special medication is slowly injected near the nerve bundle to “put the nerve to sleep” rendering the limb free of sensation and motion (if applicable) for 12-24hrs. on average.

Effects

Although rare and like any medical procedure, there are potential side effects or complications. Patients may have a reaction to the medication or procedure such as seizures, irregular heartbeats and cardiovascular problems; however, these are rare and many precautions are in place to minimize these complications. A rare condition called neuropraxia, essentially a transient bruising of the nerve that may cause persistent numbness and weakness can last from days to months. Again, serious complications are extremely rare. For Lower Extremity Nerve Blocks, there are no specific risks other than reactions a patient may have the medication or procedure discussed above. For Upper Extremity Nerve Blocks, there may be Benign temporary side effects may occur such as hoarseness, eyelid droop, pink sclera (Horner’s Syndrome), and shortness of breath from a “sleepy” phrenic nerve that innervates the diaphragm. All symptoms subside as the block wears off.

General Guidelines & Expectations

  1. Depending on the type of block, pain is reduced upwards of 75-100%, but they don’t always eliminate it.
  2. A combination of nerve block, pain pills, and cold therapy greatly increase overall comfort.
  3. Anticipate block to last 12-24hrs, wears off gradually, and feels like tingling “pins & needles”.
  4. Protect limb from extreme hot, cold, and pressure while it is numb.
  5. Take pain medication with food when the block starts wearing off. Do NOT wait until the block has completely worn off as pills won’t be as effective. Once your pain is manageable minimize pain pill use as it can cause nausea, respiratory depression, sedation, and dependency.
  6. Do not drive with a block or while on pain medications.
  7. Report significant swelling or bruising at the site of your block that is painful or worrisome.
  8. You may participate in physical therapy when the block has worn off as prescribed by your surgeon.

Consent

During Pre-Op you will meet with your anesthesiologist. They will review your medical history, complete physical examination and discuss any concerns or questions you may have regarding anesthesia. At this time you will be asked to sign and date the Patient Consent for Anesthesia. Below is an overview of the consent for you to read and review prior to your surgery.

I understand that:

  • I need anesthesia services for the procedure(s), and the type of anesthesia will depend upon the procedure and my physical condition.
  • Conditions may arise that require additional or different anesthetic monitoring or techniques the anesthesiologist may provide and/or obtain any other necessary service for my benefit and well-being.
  • My anesthetic may be provided by an anesthesiologist, other than those named here.
  • No guarantees of outcomes have been made by anyone regarding anesthesia services.
  • I understand that residents, nurses or students may participate in my care under the direction of my Anesthesiologist.

I have been given the opportunity to ask questions about my anesthesia. I feel that I have been given sufficient information regarding the anesthesia choices indicated about, to give the information consent. I agree to the administration of the anesthesia prescribed for me. I recognize the alternative to acceptance of anesthesia might be no anesthesia for the procedure or cancellation of the procedure.