Frequently Asked Questions About Anesthesia and Surgery
If you are having a surgical procedure done, you probably have some questions about the kind of anesthesia and pain relief medication you can expect. The American Society of Anesthesiologists wants to help you answer them. This page contains a list of some of the most common questions, and we encourage you to browse the rest of this site for more information. Even though we have answers to many questions, remember it’s best to consult with your anesthesiologist or physician about your personal situation.
Learn more about key anesthesia topics by clicking on the appropriate category below to find your question and answer.
Are there different kinds of anesthesia?
There are three main types of anesthesia: local, regional and general.
- Local anesthesia: The anesthetic drug is usually injected into the tissue to numb just the specific location of your body requiring minor surgery, for example, on the hand or foot.
- Regional anesthesia: Your anesthesiologist makes an injection near a cluster of nerves to numb the area of your body that requires surgery. You might be awake, or you may be given something to help you relax, sometimes called a sedative. There are several kinds of regional anesthesia. Two of the most frequently used are spinal and epidural anesthesia, which are produced by injections made with great exactness in the appropriate areas of the back. They are frequently preferred for childbirth and prostate surgery.
- General anesthesia: You are unconscious and have no awareness or other sensations. There are a number of general anesthetic drugs. Some are gases or vapors inhaled through a breathing mask or tube and others are medications introduced through a vein. During anesthesia, you are carefully monitored, controlled and treated by your anesthesiologist. A breathing tube may be inserted through your mouth and frequently into the windpipe to maintain proper breathing during this period. The length and level of anesthesia is calculated and constantly adjusted with great precision. At the conclusion of surgery, your anesthesiologist will reverse the process and you will regain awareness in the recovery room.
Is anesthesia safe?
Due to advances in patient safety, the risks of anesthesia are very low. Over the past 25 years, anesthesia-related deaths have decreased from two deaths per 10,000 anesthetics administered to one death per 200,000 to 300,000 anesthetics administered.
Certain types of illnesses, such as heart disease, high blood pressure and obesity, can increase your anesthesia risks. Even so, anesthesiologists routinely bring even very sick patients through major operations safely.
What are the risks of anesthesia?
All operations and all anesthesia have some risks, and they are dependent upon many factors including the type of surgery and the medical condition of the patient. Fortunately, adverse events are very rare. Your anesthesiologist takes precautions to prevent an accident from occurring.
The specific risks of anesthesia vary with the particular procedure and the condition of the patient. You should ask your anesthesiologist about any risks that may be associated with your anesthesia.
What type of education and training does an anesthesiologist have?
Anesthesiologists have four years of medical school and an additional four of advanced training as in anesthesiology. In addition, some anesthesiologists elect to complete a fellowship and spend an additional year of specialty training in a specific area like pain management, cardiac anesthesia, pediatric anesthesia, neuroanesthesia, obstetric anesthesia or critical care medicine.
What is the difference between an anesthesiologist and nurse anesthetist?
An anesthesiologist is a physician who specializes in anesthesia care and a nurse anesthetist is a nurse with extra training in administering anesthetics. Both work together on anesthesia care teams, led by anesthesiologists who make critical, medical decisions for patient care.
As physicians, anesthesiologists go through years and years of rigorous training. Anesthesiologists have at least eight years of post-graduate education and training, while nurse anesthetists have two-three years.
Nurse anesthetists are able to perform the technical aspects of the administration of anesthesia, but anesthesiologists have the education, skills and training to fully manage patients and respond to medical complications.
Preparing For Surgery
Should I continue to take my medications prior to surgery?
It is important to tell the doctors providing your care what medications you are taking prior to surgery so that they can be involved in making the decision about stopping or continuing these medications.
- Some examples of common medications are:
Aspirin and Plavix are drugs that are used to prevent blood from clotting. They are used to treat patients with certain disorders of the heart and blood vessels. Because of the way aspirin and Plavix work, they can cause increased bleeding when you get a cut or undergo surgery. If you are taking either of these drugs, you should talk to your primary care physician about stopping them before surgery. The decision to stop aspirin or Plavix is based on the reason why you need to be on the drugs (your medical condition) and on the risk of bleeding from the surgery.
- Diuretics (“water pills”) are commonly prescribed for treating high blood pressure. This class of drugs can cause changes to electrolyte levels, such as potassium. If you take diuretics, your anesthesiologist may perform certain laboratory testing before surgery.
- Diabetic patients are commonly treated with insulin or oral agents. Your anesthesiologist may decrease your usual morning insulin dose or discontinue your oral agents before surgery. Always speak with an anesthesiologist or your regular doctor to discuss your particular medications, before any surgical procedure.
Could herbal medicines, vitamins and other dietary supplements affect my anesthesia if I need surgery?
Anesthesiologists are conducting research to determine exactly how certain herbs and dietary supplements interact with certain anesthetics. They are finding that certain herbal medicines may prolong the effects of anesthesia. Others may increase the risks of bleeding or raise blood pressure. Some effects may be subtle and less critical, but for anesthesiologists anticipating a possible reaction is better than reacting to an unexpected condition. So it is very important to tell your doctor about everything you take before surgery.
What happens during a preanesthesia visit with my anesthesiologist?
The preanesthesia visit is an important visit when you will have a chance to learn about your options for anesthesia and to ask questions. It is also a time when the anesthesia care team can review your medical records, do a focused physical exam and make decisions about ordering additional tests and consultations.
The interview with the anesthesiologist is a key part of this review. During this interview, the anesthesiologist may ask questions that cover the following:
- Your general health, including any recent changes
- Allergies to medications or other items
- Chronic (long-term) medical problems, such as high blood pressure, heart disease, diabetes, asthma, acid reflux and sleep apnea
- Recent hospital admissions, including surgery or procedures
- Previous experiences with anesthesia, especially any problems
Some people keep their own health records on paper or in an electronic format. To help you answer these questions it is a good idea to bring any documents that describe your health history, as well as a list of all your medications. When there are different anesthesia alternatives, such as general or regional (nerve block) anesthesia, your anesthesiologist may give you information about these options and then ask about your preferences.
At the conclusion of your visit, you should
- Have clear instructions on when to stop eating and drinking before surgery
- Know what medications you should or should not take on the day of surgery (and sometimes even a few days leading up to surgery)
- Know what type of anesthesia will be given to you (keep in mind that things may change between the day of your pre-operative visit and your procedure that result in modifying the anesthesia plan)
How will my anesthesiologist know how much anesthesia to give me?
There is no single or right amount of anesthesia for all patients. Every anesthetic must be tailored to the individual, and to the operation or procedure that the person is having. Individuals have different responses to anesthesia. Some of these differences are genetic, or inborn, and some differences are due to changes in health or illness. The amount of anesthesia needed can differ according to such things as: age, weight, gender, medications being taken or specific illnesses (such as heart or brain conditions).
Among the things the anesthesiologist measures or observes, and uses to guide the type and amount of anesthetic given are: heart rate and rhythm, blood pressure, breathing rate or pattern, oxygen and carbon dioxide levels and exhaled anesthetic concentration. Because every patient is unique, the anesthesiologist must carefully adjust anesthetic levels for each individual patient.
Why do I need to have an empty stomach prior to surgery?
It is very important that patients have an empty stomach before any surgery or procedure that needs anesthesia. When anesthesia is given, it is common for all the normal reflexes to relax. This condition makes it easy for stomach contents to go backwards into the esophagus (food tube) and mouth or even the windpipe and lungs. Because the stomach contains acid, if any stomach contents do get into the lungs, they can cause a serious pneumonia, called aspiration pneumonitis.
Can I smoke cigarettes before I have surgery?
You should stay off cigarettes for as long as you can before and after surgery. This will help you have the best possible results from your surgery. For example, quitting will reduce the chances you will have problems like a wound infection after the operation. It is especially important that you not smoke the morning of surgery – just like you don’t eat the morning of surgery, don’t smoke.
Many people find that surgery is also an excellent opportunity to quit smoking for good because most people do not have cravings for cigarettes while in the hospital, and your chances of successfully quitting are almost doubled if you try it around the time of surgery.
What are the different types of sedation?
Sedation allows patients to be comfortable during certain surgical or medical procedures. Sedation can provide pain relief as well as relief of anxiety that may accompany some treatments or diagnostic tests.
During light or moderate sedation, patients are awake and able to respond appropriately to instructions. However, during deep sedation, patients are likely to sleep through a procedure with little or no memory. Breathing can slow and supplemental oxygen is often given during deep sedation.
What is a blood transfusion?
Blood transfusion is an important medical treatment that can save lives. When blood is lost during surgery or from other kinds of trauma, fluids are given to replace the blood. These fluids are essential for the heart and circulation. However, they do not contain essential platelets and proteins that are needed to carry oxygen to tissues, clot when tissues are injured and fight infection. Only a blood transfusion provides these things.
Who might need a blood transfusion?
Individuals who lose blood during surgery or from other kinds of trauma may need a blood transfusion. In particular, individuals who start off with lower blood counts and those with heart disease, circulation problems or other major illnesses are more likely to receive a blood transfusion.
Do anesthesiologists administer blood transfusions?
Anesthesiologists administer approximately half the blood transfusions in the United States and are experts in making the risk and benefit assessments needed during a transfusion. Anesthesiologists are committed to the responsible use of the blood supply and to make the best decisions for patients.
How can I help prevent wrong site surgery?
While wrong site surgery is very uncommon, anesthesiologists feel that even one case is too many. The most important things you can do as a patient to prevent wrong site surgery is to make sure your consent form is accurate and to be involved in the process of clearly marking the intended site.
Also, before surgery, there will be a “time out” precaution. While you may be sedated or under anesthesia at this time, all health care providers in the room will stop, pause and listen while the entire team confirms the correct site.
Should my IV site continue to be sore and swollen weeks after surgery?
Phlebitis is a term that means inflammation of a blood vessel. Phlebitis occurs quite commonly after the insertion of an IV. There is a wide variation because it depends on how phlebitis is defined, such as the place the IV is inserted, the duration that the IV has been in place, the type of material that the IV is made of, the length of the IV catheter, and on the existence of other disorders such as diabetes. If you continue to feel pain and have swelling for more than three weeks you should connect with your physician.
When is a breathing tube necessary for surgery?
Your anesthesia professional will speak to you before surgery and decide if you need a breathing tube. The decision is based on your type of surgery and anesthesia, as well as your medical history and physical exam.
Typically, a breathing tube is not needed during local anesthesia, regional anesthesia and sedation. However, if you have general anesthesia, then a breathing tube may be needed. Patients who are more likely to need a breathing tube include those who:
- ate or drank prior to surgery
- have medical problems that cause acid reflux
- are vomiting or are extremely overweight
How can I lower my risk of nausea and vomiting after surgery?
Through the development of better anesthetics and nausea prevention medications, the number of patients who experience postoperative nausea and vomiting (PONV) has decreased. However, patients who are sensitive to narcotics or are prone to motion-sickness tend to be at an increased risk for PONV.
Different kinds of nausea prevention medications can be given in combination before and during surgery to reduce PONV. Be sure to let your anesthesiologist know in advance if you are at risk for PONV.
What is a spinal block?
A spinal block is commonly used to help patients undergoing painful procedures. A spinal involves placing a small needle in the back and into the fluid surrounding the spinal cord. A local anesthetic is then injected, temporarily numbing the lower half of the body.
What is an epidural?
An epidural is commonly used for pain control after surgery and during childbirth. An epidural involves placing a small needle in the back and then positioning a small tube (catheter) near the nerves exiting the spinal cord. Medications are delivered through the catheter, temporarily numbing regions of the body.
Epidurals and spinals are often confused. When a spinal is performed, the anesthesiologist places a small needle in the back and the tip is in the fluid surrounding the spinal cord. For an epidural, the tip of the needle is outside of the sack holding the spinal fluid in the space where the nerves exit the spinal.
What are the side effects of a spinal block or epidural?
Side effects of a spinal block or epidural may include minor back pain, headache or difficulty urinating. Other less common side effects may include bleeding or infection at the needle site, or very rarely, nerve damage.
When can I receive an epidural during labor?
The decision of when you will receive your epidural will be a joint decision between you, your anesthesiologist and obstetrician. This decision may be influenced by such factors as your pain level, level of dilation, position of the baby, and whether this is your first baby. Women do not have to wait until they are dilated to a certain level before they can ask for, or receive, an epidural. If a woman is in active, established labor, and is uncomfortable, epidural analgesia is the most effective method of pain relief
Can an epidural during childbirth harm my baby?
Epidural analgesia allows for excellent pain management, has been used for over 50 years in obstetrical care, and has a strong record of safety for both mother and baby. You should speak with your anesthesiologist and feel comfortable that YOU understand the procedure, risks, benefits and alternatives to your situation, and that your questions have been answered. Your care team will monitor your blood pressure and your baby’s heart tones before, during and after your epidural just as they would in the normal course of your labor.
What is the difference between regional and general anesthesia for a C-section?
During a C-section, regional anesthesia involves the administration of a spinal or epidural anesthetic into the mother’s lower back. When this happens, the mother is awake for the delivery but does not feel any pain. Advantages to regional anesthesia include being awake for the birthing experience, the potential for improved neonatal outcomes (such as higher Apgar scores) and a reduction in the amount of blood loss during surgery. During general anesthesia, the mother will be unconscious.
Maternal request is always taken into account when deciding on regional or general anesthesia for a C-section, but there are times when one technique is far superior to the other. Both anesthetic techniques can be safely administered.
Could anesthesia harm my baby if I need surgery while pregnant?
Both regional and general anesthesia can be given safely during pregnancy. It is important to have a multidisciplinary team of an obstetrician, surgeon, anesthesiologist and perinatologist working together to optimize your care.
Certain conditions may mean that your clinical team will select certain strategies (e.g., regional or general anesthesia, appropriate drugs, position you in a tilt, place compression stockings on your legs) to keep you safe, which will in turn keep your baby safe.
The team will likely monitor the baby with fetal heart tones before surgery and after surgery. Monitoring during surgery will depend on various factors, including the risks and benefits in your situation. This will be a decision of your clinical team and you should certainly feel comfortable asking the team so you understand the decision
What is obstructive sleep apnea?
Obstructive sleep apnea (OSA) is an increasingly common condition where people quit breathing during sleep. A blockage of the airway causes OSA, causing the body to sense a lack of air and wake up to resume breathing.
OSA causes poor sleep quality and is often associated with daytime sleepiness, obesity and hypertension. It is formally diagnosed by a sleep study.
How is obstructive sleep apnea treated?
A continuous positive airway pressure (CPAP) machine is one form of treatment for obstructive sleep apnea (OSA). Patients who use CPAP wear a plastic mask over their nose and/or mouth during sleep. The machine then gently blows pressurized room air through the airway at a pressure high enough to keep the throat open.
Can I have anesthesia if I have obstructive sleep apnea?
It is important to let your anesthesiologist know if you have, or suspect you have obstructive sleep apnea (OSA). Patients with OSA may be more sensitive to some of the medications used during anesthesia.
People with severe OSA may not be suitable for outpatient surgery, and may require observation of their breathing in a hospital setting after surgery. Also, OSA may be worsened after surgery. When possible, your own CPAP machine may be used in the recovery room to help you wake up safely.