Anesthesia - What to Expect

Different Kinds of Anesthesia

If you're having any kind of procedure or surgery, it's understandable to be a little uneasy. You probably have plenty of questions about everything, including anesthesia — like how the anesthesia is given and what you will experience.

What happens depends on the type of procedure you're getting and the kind of anesthesia that will be used, either:

• general — in which a person is "asleep"
• regional — when one large area of the body is numbed
• local — when one small part of the body is numbed

To ease your mind and to help you feel better informed, here's a quick look at what may happen before, during, and after on the day of the procedure at a hospital or surgical center.

Before Surgery

Although you may be able to talk to the anesthesiologist a day or two prior to the operation, you might not meet until that day. Either way, the anesthesiologist will go over your medical history and information thoroughly, so that he or she can make the right choice regarding anesthetic medications tailored to your individual needs.

The anesthesiologist might order additional tests (such as X-rays or blood or laboratory tests) to help figure out the best possible personalized anesthetic plan for you.

In addition to doing a physical examination of your airways, heart, and lungs, the anesthesiologist will also want to get your medical history, which will include asking about:

• your current and past health
• your family's health
• any medications, supplements, or herbal remedies you are taking (consider bringing a list of exactly what you take, detailing how much and how often)
• any previous reactions you or any blood relative has had to anesthesia
• any allergies (especially to foods, medications, or latex) you may have
• whether you smoke, drink alcohol, or take recreational drugs

Eating and Drinking Before Anesthesia

The anesthesiologist, surgeon, or someone on the nursing staff will give you instructions about not eating or drinking before surgery. It's important to make sure you don't eat anything prior to surgery (usually nothing after midnight the day before the operation). You'll get specific instructions based on your age, medical condition, and the time of day of the procedure.

Why is eating before surgery an issue? Because the body normally has reflexes that prevent food from being aspirated (or inhaled) into the lungs when it's swallowed or regurgitated (thrown up). But anesthetic medications can suspend these reflexes, which could cause food to become inhaled into the lungs if there is vomiting or regurgitation under anesthesia.

Sometimes, though, the anesthesiologist will say it's OK to drink clear liquids or take specific medications a few hours before surgery.

Questions and Answers

To ensure your safety during the surgery, you'll need to answer all of the anesthesiologist's questions as honestly and thoroughly as possible. Things that may seem harmless could interact with or affect the anesthesia and how you react to it.

You also can ask plenty of your own questions. If you don't meet the anesthesiologist before the day of the operation, you may want to ask your doctor or surgeon the following questions beforehand so you can have all the answers you need:

• Is a parent allowed to be with me before surgery? If so, for how long?
• Is a parent allowed to be with me while the anesthesia is being given?
• What kind of anesthesia will I be given?
• How will the anesthesia be administered — with an injection, through an IV, or with a breathing mask or tube in the throat?
• Will I be sedated before the anesthesia is given?
• Approximately how long will the surgery take?
• Will I still have an IV in or be hooked up to any monitors or equipment after the surgery is over?
• How long will it take me to fully wake up from general anesthesia or feel the area if local or regional anesthesia was used?
• Will I feel pain and/or discomfort (such as nausea or vomiting) after surgery? If so, how long will it last and what can be done about it?
• How soon after the surgery can I see my family?
• How soon after the surgery can I go home?
• How soon after the surgery can I eat, drink, go to school, or drive?

You might be given a sedative before going into the operating room, but for minor procedures, this might not be needed. In fact, some people may prefer not to be sedated. The decision of whether or not to sedate you beforehand is made by the anesthesiologist, using your input.

In the Operating Room

If general anesthesia is used, the anesthesiologist will start transitioning you from the normal awake state to the sleepy state of anesthesia. This is called induction, which is usually done by either injecting medicine through an IV or by inhaling gases through a mask.

If, like lots of people, you're afraid of needles, the good news is that you may not have to get one while awake. Anesthesiologists often will begin the induction process by using a breathing mask to help you relax. The mask delivers medication to make you sleepy before and during the surgery. That way, you won't be awake when the IV is inserted for general anesthesia or when a shot is given to numb a certain part or area of the body for local or regional anesthesia.

When using general anesthesia, the anesthesiologist will monitor your vital signs, continue to deliver anesthesia, and keep you as comfortable as possible throughout the operation.

To help you breathe and/or to help deliver general anesthesia during the operation, the anesthesiologist might use an endotracheal tube (a plastic tube that's placed into the windpipe through the mouth or nose) or laryngeal mask airway (or LMA — a mask with a tube that fits into the back of the mouth).

After Surgery

Once the operation or procedure is over, you'll be taken to the recovery room or PACU (post-anesthesia care unit). In the PACU, nurses and the anesthesiologist will monitor your condition very closely to make sure you are making a smooth and comfortable transition from an anesthetized state to an awakened state.

If you had general anesthesia or were sedated, don't expect to be fully awake right away — it may take a while and you may doze off for a bit. It usually takes about 45 minutes to an hour to recover completely from general anesthesia. In some cases, this period may be a bit longer depending on medications given during or after surgery.

Although every person has a different experience, you may feel groggy, confused, chilly, nauseated, scared, alarmed, or even sad as you wake up. Depending on the procedure or surgery, you may also have some pain and discomfort afterward, which the anesthesiologist can relieve with medications. When you have recovered from the anesthesia, you'll be evaluated to make sure you're ready to leave the recovery room.

In many outpatient procedures, people are allowed to come home soon after the surgery is done. Before you leave the hospital, you'll receive instructions for further recuperation at home and for a follow-up visit with the surgeon. Talk to the surgeon and/or the anesthesiologist about what to expect after the surgery and how you can stay as comfortable as possible.

Anesthesia is very safe. In today's hospitals and surgery centers, highly trained professionals use a wide variety of modern medications and extremely capable monitoring technology to ensure that people are stable and as comfortable as possible before, during, and after their procedure.