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Administering AnesthesiaSource: Wikipedia Commons



Anesthesia is broken down into three main categories: general, regional, and 1) ___. All of these can be given through various methods using medicines that affect the nervous system. Think of the brain as a central computer that controls all the body’s functions and the nervous 2) ___ as a network that relays messages back and forth from the brain to different parts of the body. It does this via the spinal cord, which runs from the brain down through the backbone and contains threadlike nerves that branch out to every organ and body part. With general anesthesia, the goal is to make and keep the patient completely 3) ___ (or “asleep”) during the operation, with no sensations, feeling of pain, awareness, movement, or memory of the surgery. General anesthesia can be given through an IV (which requires a needle stick into a vein, usually in the arm) or by inhaling gases or vapors. Regional anesthesia is used when an anesthetic drug is injected near a cluster of 4) ___, numbing a larger area of the body (such as below the waist). Most people who are given regional anesthesia are deeply sedated or asleep for the procedure. Rarely, older kids or those might be at risk by being asleep may be awake or lightly sedated for this type of anesthesia. Local anesthesia is an anesthetic drug that numbs only a small, specific part of the body (for example, a hand or patch of skin). Depending on the size of the area, local anesthesia can be given as a shot, spray, or ointment. With local anesthesia, a person may be awake, sedated, or asleep. Local anesthesia is often used for minor surgeries and outpatient procedures (when patients come in for an operation and can go home that same day). If you are having surgery in a clinic or doctor’s office (such as the dentist or dermatologist), this is probably the type of anesthetic that will be used.


The type and amount of anesthesia will be specifically tailored to the patient’s needs and will depend on various factors, including: age and weight, the type and area of the surgery, allergies and current medical condition.

Common side effects are: disorientation, grogginess, confusion when waking up after surgery. Some other common side effects, which should go away fairly quickly, include:


1. Nausea or vomiting, which can usually be alleviated with anti-nausea medication

2. Chills or shakiness

3. Sore throat (if a tube was used to help with breathing)


Anesthesia today is very safe. In very rare cases, anesthesia can cause complications (such as strange heart rhythms, breathing problems, allergic reactions to medications, and even death). The risks depend on the kind of procedure, the condition of the patient, and the type of anesthesia used. Most complications can be prevented by giving the 5) ___ complete information before the surgery about things like:


1. Current and past health (including diseases or conditions such as recent or current colds, or other issues such as snoring or depression)

2. Medications (prescription and over-the-counter), supplements, or herbal remedies the patient is taking

3. Any allergies (especially to foods, medications, or latex)

4. Whether the patient is a smoker, drinks alcohol, or takes any recreational drugs

5. Any previous reactions the patient or any family member has had to anesthesia


To ensure patient safety during the surgery or procedure, it’s extremely important to answer all of the anesthesiologist’s questions as honestly and thoroughly as possible. Things that may seem harmless could affect patient reaction to the anesthesia. Doctor’s recommendations must be followed about what not to do before the surgery, like eating or drinking (usually nothing after midnight the day before) and discontinue taking herbal supplements or other medications for a certain period of time before surgery. Safety of anesthetic procedures has improved a lot over the years. Very rarely – in only one or two out of every 10,000 medical procedures involving anesthesia – a patient may become aware or 6) ___. The condition – called anesthesia awareness – means the patient can recall the surroundings or an event related to the surgery while under general anesthesia. Although it can be upsetting, patients usually do not feel pain. Certain surgeries or circumstances increase the risk of awareness during surgery because the usual dose of required anesthesia cannot be used safely. These include emergency surgeries – such as C-sections, heart surgery and trauma surgery – as well as when patients have multiple medical conditions. Physician anesthesiologists closely monitor surgeries using sophisticated equipment to ensure that, even in the rare case when awareness occurs, a patient is safe and does not feel 7) ___. A patient who has experienced anesthesia awareness during a procedure, should tell the physician anesthesiologist or health care team as soon as possible. It’s not uncommon for patients to believe they were aware during surgery, when this was not the case. A patient typically remembers the time when the anesthesia has just begun to work but has not completely taken affect, or shortly after surgery, when the anesthesia has not yet worn off, but this is not considered awareness which would take place during the procedure. Patients also are more likely to have awareness with procedures that do not involve general anesthesia. For example, you may recall all or part of your procedure if you have:


1. Intravenous, or “twilight“ sedation, often given during minor procedures such as a colonoscopy, a biopsy or a dental procedure

2. Local or regional anesthesia, such as an epidural or spinal block, or a nerve block


To reduce risk of experiencing awareness during procedures with general anesthesia, it is important to tell the physician anesthesiologist important health information, including:


1. Previous problems with anesthesia, including a history of being aware during surgery

2. All medications being taken, both prescription, over-the-counter and herbal supplements

3. Concerns about surgery, including fear of being aware during surgery


Patients who have experienced anesthesia awareness during a procedure can get counseling to help ease any feelings of confusion, stress or trauma.


As scientists learn more about the molecular mechanisms by which anesthetics cause their various effects, they will be able to design agents that are more targeted, more effective and safer, with fewer side effects. Observations of the short- and long-term effects of anesthetics on subsets of the population, such as the elderly or cancer survivors, will reveal whether certain anesthetics are better than others for members of those groups. Research on how a person’s genetic makeup influences the way he or she responds to anesthetics will enable doctors to further tailor anesthesia to individual patients.


Spinal and 8) ___ anesthesia are medicines that numb parts of the body to block pain. They are given through shots in or around the spine. Doctors who administer epidural or spinal anesthesia are anesthesiologists. First, the area of the back where the needle is inserted, is cleaned with a special solution. The area may also be numbed with a local anesthetic. Fluids will be received, through an intravenous line (IV) in a vein. You may receive medicine through the IV to help you relax or sleep lightly. For an epidural:


1. The doctor injects medicine just outside of the sac of fluid around the spinal cord. This is called the epidural space.

2. The medicine numbs, or blocks feeling, in a certain part of the body so that pain cannot be felt. The medicine begins to take effect in about 10 to 20 minutes. It works well for longer procedures. Women often have an epidural during childbirth.

3. A small tube (catheter) is often left in place. You can receive more medicine through the catheter to help control your pain during or after your procedure.


For a spinal:


1. The doctor injects medicine into the fluid of the spinal cord. This is usually done only once, so that a catheter will not need to be placed.

2. The medicine begins to take effect right away. It works well for shorter and simpler procedures.


Your pulse, blood pressure and oxygen level in your blood are checked during the procedure. After the procedure, you will have a bandage where the needle was inserted. Spinal and epidural anesthesia have fewer side effects and risks than general anesthesia (asleep and pain-free). Patients usually recover their senses much faster. Sometimes, they have to wait for the anesthetic to wear off so they can walk. Spinal anesthesia is often used for genital, urinary tract, or lower body procedures. Epidural anesthesia is often used during labor and delivery, and surgery in the pelvis and legs. Epidural and spinal anesthesia are often used when:


1. The procedure or labor is too painful without any pain medicine.

2. The procedure is in the belly, legs, or feet.

3. The body can remain in a comfortable position during the procedure.

4. You want fewer systemic side effects and a shorter recovery than you would have from general anesthesia.


With aging, the more likely it is to have surgery for a health condition such as clogged heart arteries or an arthritic knee. So it’s no surprise that more than one in 10 people who have surgery are 65 or older. Advanced age can affect the potential for surgery risks (although the patient’s medical condition type of surgery, play the major role). One concern is that the aging brain is more vulnerable to anesthesia, which prevents you from feeling pain during surgery. Two anesthesia-related surgery risks particularly in older people are:


Postoperative delirium – This temporary condition may not develop until a few days after surgery, when a patient may be confused, disoriented, have problems with memory and paying attention and is not aware of the surrounding environment. It is common, may come and go, and usually disappears after about a week.


Postoperative cognitive dysfunction (POCD) – This condition can be serious and lead to long-term 9) ___ loss and lessened ability to learn, concentrate and think. Because some of these problems are common in the elderly, the only way to determine if a patient actually suffers POCD is to conduct a mental test before surgery. Thankfully, researchers have learned about these conditions and know how to prevent or reduce the effects and anesthesia is safer today than ever before. To ensure anesthesia-related safety during surgery and decrease risk of cognitive delirium or dysfunction, plan ahead.


1. Request that a physician anesthesiologist who specializes in geriatric patients lead the anesthesia care.

2. Ask the physician to conduct a pre-surgery cognitive test – an assessment of mental function. The physician can then use that as a baseline for comparison after surgery.

3. Be sure the caregiver who spends the most time with the patient, carefully observes physical and mental activity after surgery. If anything troubling occurs, it should be reported to the physician. The physician should be consulted before taking medications after surgery that can affect the nervous system, such as drugs for anxiety, seizures, muscle spasms and difficulty falling asleep.


During surgery the physician anesthesiologist closely monitors the anesthesia to prevent problems. But there are things that can help re-orient you after surgery and reduce confusion or disorientation. Doctors recommend having a family member stay with a patient as they recover from any surgery. While conscious sedation is usually safe, however, if a patient is given too much of the medicine, problems with 10) ___ may occur. Therefore, a health care provider will be watching you during the whole procedure. Providers always have special equipment to help with breathing, if needed, and only certain qualified health professionals can provide conscious sedation.


NIGMS is a part of the National Institutes of Health that supports basic research to increase our understanding of biological processes and lay the foundation for advances in disease diagnosis, treatment and prevention. For more information on the Institute’s research and training programs, see . Sources: NIH.gov; reviewed by: Judith A. Jones, MD; Mayo Clinic.org. Date reviewed: September 2015


ANSWERS: 1) local; 2) system; 3) unconscious; 4) nerves; 5) anesthesiologist; 6) conscious; 7) pain; 8) epidural; 9) memory; 10) breathing



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