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Thursday, May 23, 2013
During surgery you will be monitored very intensively. Advanced medical instruments are used to keep an eye on the function of the heart, lungs, brain and other vital organs, as well as to make sure you are receiving just the right amount of anesthesia. Of course, the presence of a skilled and vigilant anesthesia provider is the best monitor of all!
Aneshesiologists often take care of patients with heart disease, lung disease, kidney failure, and all sorts of other serious medical conditions. Your anesthesiologist will ask you a number of questions about your illness and will have a plan to minimize the risk associated with your condition. Tests or consultations may be arranged to learn more or even to improve your condition before surgery.
If you are a smoker, our advice is to quit smoking as soon as you can! Smokers are more likely to experience breathing complications during and after anesthesia. Fortunately, these problems are usually managed without great difficulty. Smokers must also be especially careful to carry out deep breathing exercises after their surgery to prevent chest infection, pneumonia or other lung problems. The use of a so-called incentive spirometer can be very helpful during recovery from surgery.
Allergic reactions can occur with any medicine. Allergies to anesthetic agents can occur, but fortunately are very rare. From time to time, people get skin rashes such as hives. Shock-type reactions are, luckily, rather rare. Should such a reaction occur, your anesthesiologist is trained to recognize this kind of problems and knows how to deal with it.
In almost all cases of surgery, one or more intravenous lines are necessary. Frequently, the intravenous is started in the back of the hand, using a small amount of local anesthesia to minimize the discomfort. Other sites can be used as well. The IV is used not only to provide analgesics (pain killers), and anesthetic agents, but also as a route for fluids. The IV also serves as a "lifeline" for the administration of emergency drugs if needed. The IV is usually removed when you are able to drink well and when there is no further need for intravenous medications.
Your anesthesiologist will want to know about any dental prostheses (false teeth, bridges, implants), tooth or gum disease, or cosmetic dentistry. This information is needed because of the risk of trauma or damage to teeth during the insertion of breathing tubes or other instruments. Obviously the danger is increased if a tooth is actually loose.
If you inform your anesthesiologist about dental prostheses, tooth or gum disease, or cosmetic dentistry, it will help avoid tooth damage. Special anesthesia techniques may be necessary. Sometimes, if a tooth is very loose or fragile, it is wise just to have it removed by a dentist before your surgery.
The process begins once an intravenous line is started (usually with the use of some local anesthetic). In many cases, a mild sedative agent is then administered intravenously to reduce the nervousness that is common before surgery.
When you are on the operating room table monitoring equipment is attached. For major surgery, special monitors, such as tubes going into the heart or into an artery for blood pressure measurement, are sometimes used. If a lot of blood loss is expected, more than one intravenous line may be started.
In most cases you are given oxygen to breathe through a mask for a couple of minutes. After this, drugs are injected into the intravenous line to cause unconsciousness, often followed by a muscle relaxant drug. Muscle relaxant drugs make it easier to insert a breathing tube and also assist the surgeon's work. The breathing tube may then be connected to a ventilator (breathing machine) which breathes for you during the surgery. Additional medications to keep you asleep are introduced through the anesthetic breathing tube or the intravenous line. Not infrequently, morphine-like pain relievers will be given to eliminate the pain while you are asleep.
The depth of anesthesia is continually monitored during the procedure and more drugs are added as necessary to keep the appropriate level of anesthesia and muscle relaxation, and to control the body's responses to the surgery.
Fortunately, we monitor a variety of signs that help assess how deeply under anesthesia you are. So, in ordinary elective surgery, waking up, or what we call "awareness" under anesthesia, is very rare. Although still unusual, awareness can sometimes occur during emergency surgery, such as Cesarean sections done under general anesthesia, or during operations for major trauma. If you believe that you were awake during your procedure under general anesthesia, please let your doctors know, so that your anesthesiologist can meet to discuss this with you and provide appropriate assistance.
There are great variations in the amount of pain a patient will experience after surgery. Some surgical procedures, such as lung surgery and bone surgery, can be very painful. Other procedures like cataract surgery can be almost painless during recovery.
A popular method, known as "patient controlled analgesia" (PCA), works very well. With PCA, you are able to control the amount of pain medication merely by pushing a button whenever pain is experienced. When the button is pushed, you get a small dose of narcotic analgesic. Following the administration of this dose, you are "locked out" from getting any more medication for a particular period, for example, 5-10 minutes. After that, you can get more medication. PCA is very safe when administered, as intended, by the patient. Family members or others should never be permitted to press the button for you.
Another method of pain relief that is very effective for some big surgical procedures, such as lung surgery, is epidural analgesia. Similar to epidual analgesia, various types of nerve blocks are becoming more popular as a highly effective form of pain relief, particularly for orthopedic procedures. In some centers, a catheter (thin tube) is left in place to bathe the nerve(s) continually with local anesthetic and provide around the clock comfort for surgical patients, in the hospital or at home.
Once you are eating and drinking well, the need for intravenous or intramuscular medications is reduced, and medications taken by mouth can be helpful. Not infrequently acetaminophen (e.g. Tylenol) with codeine, or similar analgesics, are used at this stage to provide pain relief. Occasionally, Tylenol, or similar medications, are not adequate for some kinds of pain, in which case "breakthrough" medication, for example intramuscular morphine, given by injection, may be ordered.
The simple answer is, no. There is no need to be concerned about the appropriate use of post-operative narcotic analgesics provided appropriate clinical precautions are used. Effective pain relief is important for many reasons. If you don't have adequate pain relief after surgery this interferes with recovery from surgery, and the risk of complications such as blood clots in the lung or pneumonia may increase.
The insertion of the endotracheal tube or other type of "breathing tube" can result in a sore throat after the surgery. Sometimes a sore throat will occur even without intubation. This is usually not a major problem, but some people find it annoying. Throat lozenges can alleviate the symptoms. A persistent or severe sore throat should be reported to your anesthesiologist or your surgeon.
Certain surgical procedures are more likely to induce nausea and vomiting than others. For example, operations on the eyes, ear, breasts, and bowel are more likely to cause nausea. Some individuals appear to be more susceptible to this problem, including those who have had motion sickness or previously had nausea or vomiting after anesthesia.
When nausea and vomiting occurs, a variety of medications are available that can alleviate the symptoms. If you had major problems with nausea or vomiting after previous surgery, please make a point of letting your anesthesiologist know, so that he or she can decide what anesthetic technique to use to minimize this possibility.
You will be given a blood transfusion only if your anesthesiologist considers it absolutely necessary to protect your life and health. All blood given is tested for presence of the AIDS virus, Hepatitis B and C viruses and other infections, so the chances of getting these serious infections is extremely low. If your religion forbids receiving blood transfusions (Jehovah's Witness), please let us know so that the risks can be explained, the issues discussed in depth, and your wishes respected.
"Malignant hyperthermia" is a very rare hereditary (inherited) problem that is triggered by anesthetic agents such as halothane or succinylcholine. If this was the case, your relative might have experienced severe fever and other problems during surgery or during recovery from anesthesia.
Some individuals are unable to metabolize (break down) the drug succinylcholine which is often used to relax the muscles during the surgery. As a result of their inability to metabolize this drug, the drug may last much longer than it would ordinarily. This is also a rare problem, which occurs in about 1 in 3,000 people.
Last Reviewed: Oct 05, 2010
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University