Anesthesiologists use a wide variety of drugs, in multiple combinations, in order to ensure that patients remain comfortable, relaxed and free of pain during surgery or other procedures. Drugs administered by anesthesiologists are categorized as follows:
- Local anesthetics: Block transmission of nerve impulses without causing unconsciousness.
- General anesthetics: Bring about a state of unconsciousness.
- Analgesics: Relieve pain of patients before, during or after surgery.
- Sedatives: Bring about relaxation/calmness in a patient and reduce anxiety; higher doses can also be used to induce sleep.
- Muscle Relaxants: Work to paralyze skeletal muscles in order to facilitate intubation or surgery.
While only certified anesthesiologists can administer certain types of anesthesia, such as general, epidurals and spinals, some physicians/surgeons can apply local anesthetics without the presence of an anesthesiologist.
Types of Anesthesia
The type of anesthesia administered to a patient depends on a number of factors, including the type of procedure, the patient’s age (children may have a harder time keeping still then adults), and the medical history of each patient. When more than one type of anesthesia is considered to be appropriate for a certain procedure, your anesthesiologist will thoroughly explain the options and allow you to choose the one that will make you feel the most comfortable.
General anesthesia places the entire body, including the brain, into a state of unconsciousness (sleep) during which the patient has no awareness and feels nothing, and will remember nothing of the surgical experience.
General anesthesia is administered by injection or through a breathing mask, or sometimes both. In order to control your breathing, patients are intubated, which is the insertion of a flexible tube down the windpipe. The tube is inserted after the anesthesia is given and removed as you are waking up and breathing adequately. Upon awakening from anesthesia, patients may experience disorientation and/or a mild sore throat from the intubation.
- Laryngeal Mask Airway (LMA) – When possible, the anesthesiologist will use a Laryngeal Mask Airway device instead of intubation because it is quicker and causes less discomfort for the patient. An LMA is a tube with an inflatable cuff that is inserted into the pharynx (the upper part of the windpipe).
Regional (or Local) Anesthesia
Regional anesthesia is the injection of a local anesthetic around major nerves or the spinal cord to block pain from a large region of the body, such as a limb. Regional anesthesia provides muscle relaxation as well as postoperative pain relief since its numbing effects can last 8 to 12 hours, depending upon the dose. This reduces the need for pain medicine after surgery, as well as other side effects of surgery, such as nausea. If necessary, you may also be given a mild sedative to help you relax or sleep during surgery.
Types of regional anesthesia are:
- Axillary Nerve Block – Local anesthetic is injected around the nerve that passes through the axilla (armpit) from the shoulder to the arm to numb the feeling in your arm and hand. Typically used for surgery of the elbow, forearm, wrist, or hand.
- Interscalene Nerve Block – Local anesthetic is injected around the nerve block in the neck used to numb the shoulder and arm. Typically used for surgery of the shoulder and upper arm.
- Femoral Nerve Block – Local anesthetic is injected around the nerve block in the upper thigh/groin area to numb the leg from the knee to the hip. Typically used from surgery of the upper leg, hip or knee.
- Ankle Block – Local anesthesia is injected around the ankle to block the five nerve branches that supply sensation to the foot. As the name indicates, used for surgery of the ankle, foot or toes.
- Bier Block – Local anesthetics are injected intravenously to numb a limb, typically the arm, and then a tourniquet is applied to prevent the anesthetic from leaving the area. Typically used on surgeries of hand or arm that last less than an hour.
Epidural and Spinal Anesthesia can be used for most surgeries below the belly button. In order to get an epidural or spinal anesthesia, an IV must first be inserted since these procedures require the patient to be properly hydrated. Both epidural and spinal anesthesia use a local anesthetic to numb the area where the needle is inserted. Depending on the type of surgery, patients may also be placed under general anesthesia or a mild sedative that allows them to relax and/or sleep.
- Epidural anesthesia is administered in the lower back/lumbar region using a special needle that is inserted between the vertebrae of the spinal column into the epidural space around the spine. Once in place, a small catheter (tube) is placed into the epidural space via the needle, and then the needle is removed, leaving the catheter in place. Local anesthetics and narcotics are then given through the catheter. The procedure usually takes 10 to 25 minutes. Because an epidural uses a catheter, pain medicine can continue to be administered to provide post-operative pain relief if needed.
Types of Procedures: Typically used for labor, cesareans (c-sections) and surgeries of the colon and gastrointestinal tract.
- Spinal Anesthesia is administered in the lower back/lumbar region using a spinal needle that is inserted between the vertebrae of the spinal column into the dural membrane, which covers the spine and nerve roots. Once in place, medicines including a local anesthetic and sometimes a narcotic are given through the needle, and then the needle is removed. The entire process usually takes anywhere from 5 to 20 minutes.
Types of Procedures: Typically used for gynecologic (e.g. hysterectomies) and urologic (e.g. prostate) surgeries, as well as surgeries of the lower extremities (e.g. knee surgery).
MAC (Monitored Anesthesia Care)
Monitored Anesthesia Care (MAC) is the intravenous administration of mild sedatives to help a patient relax and relieve anxiety during minor procedures that do not require general anesthesia. These procedures, such as biopsies and colonoscopies, typically require the injection of a local anesthetic to numb the surgical site.
Anesthesia for Pediatric Patients
Our anesthesiologists are trained in the administration of anesthesia to pediatric patients. Physiological differences, such as a higher heart rates and lower blood pressures than adults, as well as emotional differences, such as a higher anxiety levels, are taken into consideration when preparing pediatric patients for surgery. Anxiety levels in children can be addressed through sedative premedication, as well taking them on tours of the surgical area ahead of time.
At CVMC, the most common procedures that pediatric patients undergo involve ear, neck and throat (ENT) issues, such as tonsillitis and chronic ear problems. Other pediatric procedures performed at CVMC that require anesthesia include circumcisions, small hernias and sports injuries.