Anesthesia During Surgery

An anesthesiologist will always be in your operating room with you throughout your surgery.

Our job is not only to anesthetize you (provide you with medications so that you are not conscious during surgery), but just as importantly, to make sure all of your vital bodily functions, including your heart/lungs/brain/kidneys, are supported and working properly.  A successful anesthetic is not merely putting a patient “to sleep,” but rather, making sure they wake up without any complications or problems!

For your intraoperative anesthetic care, depending on several variables including your surgery and medical comorbidities, you may receive (1) monitored anesthesia care (MAC); (2) general anesthesia; (3) regional anesthesia; or a combination of the different types of anesthesia.  “Local anesthesia only” is where your surgeon or proceduralist administers medication (a local anesthetic like lidocaine) to make numb the specific area where they will be working, and usually does not involve an anesthesiologist.

Monitored anesthesia care (MAC) is the administration of sedatives and/or pain medicines by an anesthesia provider to allow for a diagnostic or therapeutic procedure to be safely completed.  It often involves a deeper level of sedation than just conscious sedation and is sometimes referred to as “twilight sleep.”  Your ability to independently breathe is maintained, although it will likely be supported with supplemental oxygen via a facemask or nasal cannula. It is not uncommon for patients to occasionally have awareness or recall during a MAC. A MAC is ideal for a less invasive procedure or is used in combination with a regional anesthetic where your sensation of painful stimuli are significantly blunted.  Recovery from a MAC is usually much quicker with less side effects, like nausea and/or prolonged sedation.

General anesthesia is when you’re rendered completely unconscious and insensate for your procedure. This is achieved with a combination of both intravenous and inhalational medications.  Your respiratory mechanics will be supported via a breathing apparatus and for the duration of the surgery, you will be connected to a ventilator.  There are many perturbations to your body’s normal physiology during a general anesthetic, so your anesthesiologist may need additional monitors to keep you safe and may have to intervene with different medications, IV fluids, and/or blood products.  A major benefit of general anesthesia is that it allows for you to undergo extremely invasive interventions without your being aware of the procedure.  Many surgeries would not be able to be done without general anesthesia.  Some shortcomings of general anesthesia is that it is commonly associated with nausea after the procedure and, due to the breathing apparatus, a sore throat.  With modern advancements in medicine and the high degree of specialty training of our anesthesiologists, the risk of major catastrophic complications, such as a heart attack, stroke, or intraoperative awareness, are rare.

Regional anesthesia involves injecting a local anesthetic around a cluster of nerves to make a particular area of your body completely numb.  Common regional techniques include a spinal (intrathecal block), epidurals, and peripheral nerve blocks.  They are often done so that you do not feel any of the painful stimuli associated with the surgery both during the operation and for pain control after surgery.  Depending on the surgery, there may be significant benefits to receiving a regional anesthetic, including decreased blood loss associated with certain procedures, decreased incidence of blood clots, and better pain control postoperatively.  A regional technique is often administered in combination with a MAC or general anesthesia.  It is imperative you inform your anesthesiologist if you take any blood thinners or anticoagulants and if you have any bleeding disorders.  The anesthesiologist should also be made aware of any nerve problems/injuries in the area of the surgery.  Finally, you should let the medical team know if you have any allergies to a local anesthetic.