Before, During, and After General Anesthesia

Understanding General Anesthesia

Patient with a respiratory mask on operating table
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Anesthesia is medication given to a patient to prevent pain. There are multiple types of anesthesia and some allow the patient to be alert and oriented during a medical procedure, while other anesthesia medications can be given to prevent awareness by making the patient unconscious during a medical procedure.

The type of anesthesia used depends on the nature of the procedure being performed, the age and health of the patient, and the preferences of the surgeon and anesthesia provider.

With some procedures the patient may be able to choose between different types of anesthesia while others may require a specific type.

General Anesthesia Explained

There are multiple types of anesthesia. One type is general anesthesia, the strongest anesthesia, and the type most frequently used during surgery. This type of anesthesia makes the patient unresponsive in what is essentially a medically induced coma.

General anesthesia is a combination of medications that are intended to make the patient unaware of what is happening around them, to prevent pain, and to paralyze the body during a procedure. Typically used during surgery, general anesthesia allows a physician to provide treatments that would be extremely painful if the patient were awake and able to feel.

General anesthesia not only makes the person unaware, it also paralyzes the muscles of the body including the muscles that make it possible to breathe.

For this reason, patients who receive general anesthesia require a ventilator to do the work of the diaphragm and other muscles that help make it possible to inhale and exhale.

Why Is General Anesthesia Necessary?

General anesthesia is typically used for more serious surgeries, lengthy procedures, and procedures that would typically be very painful.

 This type of anesthesia not only allows a patient to undergo a procedure without pain, but also allows the patient to be unconscious for the procedure.

For some surgeries, it would be very traumatic to be awake for the procedure, whether or not you were able to feel pain. Imagine having a body part removed, such as during an appendectomy to remove the appendix, and being wide awake. While you might not feel any pain, it would still be extremely distressing to have be experiencing surgery while awake and alert.

Risks of General Anesthesia

The risks associated with anesthesia vary widely from from procedure to procedure, and between different patients. As you can imagine, each patient has their own individual risk level, as no two people are exactly the same. For example, a 90-year-old patient will have a completely different level of risk when having an appendix surgery than a 12-year-old patient. Here are some of the possible risks:

  • Nausea/vomiting: This is the most common issue patients face after general anesthesia, and is far easier to prevent than treat. For this reason it is important to mention a history of nausea caused by anesthesia prior to surgery.
  • Anesthesia awareness: This is a condition that occurs when the patient isn’t completely unconscious during general anesthesia.
  • Sore throat/hoarseness: Caused by the breathing tube, this irritation is typically minor.
  • Dry mouth: A minor issue that typically goes away when the patient is able to drink fluids.
  • Shivering/chills: This typically lasts for a short time after surgery and goes away when the patient is awake and moving.
  • Sleepiness: This is common after surgery and resolves when the body has eliminated most of the medication used for anesthesia.
  • Muscle aches: Caused by the medication or by lying still during a procedure, this condition is typically temporary and goes away within hours or days of having surgery.
  • Itching: Pain medication is often to blame for itching, and this issue typically goes away when pain medication is no longer necessary.
  • Confusion: The patients who are most likely to have confusion after surgery are elderly, have Alzheimer’s disease, dementia, or another condition that contributes to confusion on a regular basis.
  • Difficulty urinating/inability to urinate: This is more common in patients who have a urinary catheter during surgery and it can take hours or even days for the bladder to return to normal.
  • Ileus: This is a condition where the intestines do not wake as quickly as expected after surgery and movement is very slow or is absent.
  • Difficulty getting off the ventilator: Weaning from the ventilator is more challenging in very sick patients or patients who have a breathing problem.
  • Aspiration/pneumonia: Accidentally swallowing food or fluids during surgery is a known risk of surgery and is the reason why eating immediately prior to surgery is forbidden.
  • Blood clots: This issue is more common after surgery because the patient is still for an extended period of time, which is a known risk factor for blood clots.
  • Malignant hyperthermia: This is a potentially life-threatening condition that causes a severe reaction to anesthesia. It typically runs in families.

Other Types of Anesthesia

Before you decide that you need general anesthesia for your procedure, it is important to know the different types of anesthesia that are available. The most common types of anesthesia, outside of general anesthesia, are the following:

  • Regional anesthesia: Also known as a regional block, this type of anesthesia prevents the patient from feeling a region of the body, such as an entire arm or below the waist.

  • Local anesthesia: This type of anesthesia prevents feeling in a small area of the body, such as when a finger is numbed so that stitches can be used to sew a cut closed.
  • Monitored anesthesia care (MAC)This type of anesthesia, also known as twilight sleep, is a type of anesthesia that prevents pain while the patient is conscious or lightly sedated. The patient may remember the entire procedure or may have no recall of events.

During General Anesthesia

The process of general anesthesia often starts with sedation, to make it possible to insert a breathing tube. The type of sedation is left to the anesthesia provider to choose, and can vary widely depending upon the patient and the type of surgery.

Once the patient is in the operating room, attached to the monitoring devices, and the safety protocols have been completed, anesthesia can begin.  It is common practice that before sedating medications are given, a "time out" is done to identify the patient and the procedure they are having. This is done to prevent wrong site/wrong patient surgery.

Once the time out is completed the patient can be given medication to sedate them and the anesthesia provider starts the process of preparing the patient for the surgery.

Intubation and Ventilation During General Anesthesia

The muscles of the body are paralyzed during general anesthesia, including the muscles that help the lungs draw breaths, which means the lungs are unable to function on their own. For this reason, it is essential that a ventilator is used to provide breaths to the lungs. To be clear, the lungs still work during anesthesia, they just lack the ability to draw a breath because the muscles that do that work are temporarily unable to work.

Being placed on a ventilator requires that a tube, called an endotracheal tube, be inserted into the airway. This tube is then attached to larger tubing that goes to the ventilator, allowing the ventilator to deliver oxygen to the patient. The process of inserting the tube is called intubation.

Monitoring During General Anesthesia

During surgery the patient is monitored very closely by electronic monitoring devices that track heart rate, the amount of oxygen in the blood, the number of breaths the patient is taking, and even the patient’s EKG. In addition to electronic monitoring, the patient is also monitored by OR staff and the anesthesia provider.

General anesthesia is typically provided by either a physician anesthetist, called an anesthesiologist, or a CRNA, a certified registered nurse anesthetist. Both provide safe and effective anesthesia, and have extensive experience in providing general anesthesia.

During the procedure, the goal is for the patient to be completely unaware of what is happening around them, including being without pain.

Waking Up From General Anesthesia

How an individual wakes from anesthesia depends on the type of surgery they had and how well they are breathing. The goal after general anesthesia is to extubate the patient—remove the breathing tube—as quickly as possible after surgery ends.

Common and uncomplicated procedures typically end with medication being given that reverses anesthesia, waking the patient and ending the paralysis of the muscles. These patients typically have the breathing tube removed promptly at the end of surgery and are breathing on their own within minutes of the surgery ending. These patients typically wake in the PACU—post anesthesia care unit—and move to a hospital room or return home once they are completely awake.

For some very serious surgeries, such as open heart surgery or brain surgery, the patient is allowed to slowly wake from anesthesia and no reversal agent is given. This means the patient may remain on the ventilator for 6-8 hours after surgery and then having the breathing tube removed once they are awake.

Some patients will remain ventilator dependent for days or even longer after surgery, but this is less common. Patients who have respiratory diseases that make breathing more challenging are more likely to have difficulty with being removed from the ventilator, as do smokers and obese patients.

Eating and Drinking After Anesthesia

Once the patient is awake after surgery, they are often able to suck on ice chips or take sips of water. If this goes well, the next step is to drink regular liquids, followed by a regular diet. This process can take hours, or even days if the patient experiences nausea, vomiting, or just doesn’t feel up to taking food or fluids.

In most cases, the patient is able to eat regular foods within a day of having general anesthesia.

Safety After General Anesthesia

The American Association of Nurse Anesthetists (AANA) makes multiple recommendations for patient safety after receiving general anesthesia. This is because it can take a full day or longer to have anesthesia completely wear off, and until it does, the average patient may find themselves feeling sleepy, nauseated or even confused.

For the first day after surgery, expect to spend most of the time resting quietly, napping, or doing relaxing activities. Plan on taking the day after general anesthesia off from work and other challenging activities.

The AANA recommendations include not operating heavy machinery—including driving a car—or signing any legal paperwork for at least 24 hours after surgery. Arrange to have a driver to take you home from the surgery center, and avoid drinking alcohol or taking sedating medications not prescribed by your surgeon for the first day after surgery.

They also recommend that you find help with childcare if you have young children at home, as you will require more rest than usual for at least a day after surgery, possibly longer.

A Word From Verywell

General anesthesia does have risks, but the rewards of having a pain free surgery can be great. Your decision to have surgery should weigh the risks of the procedure and the anesthesia you will receiving against the potential rewards of the procedure. While it is true that every surgery has risks, there can also be great benefits from surgery. Only you can decide if you are willing to have surgery—and anesthesia—if the benefits are worth the time, effort, pain and risk.

Source:

All About Anesthesia.  AANA. Accessed August, 2017. http://www.aana.com/forpatients/Pages/All-About-Anesthesia.aspx​

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