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Anesthesia

Anesthesia can be a scary subject for some people. Not everyone is comfortable with the concept of “going under” for surgery (even if it is for much anticipated elective cosmetic surgery). And then there’s the issue of side effects associated with anesthesia that gives some people cause to pause.

While such anxieties are understandable, even normal, the fact remains that anesthesia is necessary for a smooth operation and a proper recovery. So it’s best to know what to expect from anesthesia and not fear it.

anesthesia side effects

Millions of patients safely undergo medical procedures under sedation each year, and there’s no reason that you can’t be one of them.

Why Is Anesthesia Needed?

“To stop pain” is probably the first response that springs to mind, but anesthesia goes beyond providing pain relief. What it really comes down to is control of natural bodily reactions to pain and trauma.

When your body is breached, whether it by a cut, surgical incision or other type of trauma, its natural response is to immediately set about repairing the injury. It reacts in several ways: the heart rate increases (tachycardia), breathing becomes short and shallow, tissue swells by taking on fluid (edema), and white blood cells are dispatched to repair the affected tissues.

Anesthesia suppresses these reactions until the surgical procedure is over. For example, local anesthesia (usually an injection into tissue but sometimes a topical cream or gel) keeps the treatment area from causing you pain until it wears off. And the amnesiac properties of both conscious and unconscious sedation prevent memories of the surgery, leaving you in peace to heal. It has been proven that healing is better and faster if you don’t experience or remember the pain.

Anesthesia actually works in five ways:

as an analgesic (pain reliever)
as an amnesiac (loss of memory)
promotes unconsciousness
immobilizes the patient
eliminates or reduces autonomic responses, including rapid heartbeat, rapid breathing, and a rise in blood pressure

How long anesthetics last and how well they work depends on your body fat, weight, and the dose of the drug itself. Some patients have a higher level of tolerance for anesthesia medications than others, and the person administering anesthesia must take all these factors into account to safely administer and maintain a pain-free state of unconsciousness.

Your Choices in Anesthesia

There are several choices when it comes to anesthesia, although not all surgeons offer every one.

The four main categories of anesthesia are:

local anesthesia
regional anesthesia (nerve blocks)
conscious sedation
general anesthesia

Local Anesthesia

Local anesthetics numb the immediate treatment area. You may have had a local anesthestic at the dentist's office prior to having a cavity filled or for other dental work, but you may also receive local anesthetics in conjunction with sedation during a rhinoplasty or other type of facial surgery.

The injection is most commonly a combination of lidocaine (or Xylocaine or Marcaine) and epinephrine (a vasoconstrictor that impedes bleeding in the treatment area). There are many different local anesthetics that differ in absorption, toxicity, and duration of action. Several local injections are often used during surgery, right before the first incision.

What Does a Local Feel Like?
I have had locals many times, mostly for lip augmentation procedures or in the dentist's chair. It feels like a typical shot, burning a little as it goes in. As it starts to take effect, the treatment area begins to feel numb. Locals generally begin to wear off within an hour or so, depending on the dose. As feeling returns, the site may feel tingly, like when your arm or foot falls asleep. This may feel slightly uncomfortable but it wears off quickly.

EMLA Creams and Topical Liquids

You can also obtain the benefits of local anesthesia by using a topical agent. One is EMLA (which is an acronym for ectatic mixture of local anesthetics) cream, which contains lidocaine and prilocaine to numb the mucus membranes and skin before a procedure such as injectable fillers, micropigmentation, or other minimally invasive procedures. The cream must be applied and covered for an hour before the procedure for optimum anesthetic effects. Once the cream is applied it may feel cold for a while. The cream is removed right before the procedure and will start wearing off immediately. EMLAs do not last very long in my opinion. For some procedures it is more of a hassle to anesthetize with an EMLA than to stand the pain itself. Another topical local anesthetic is Ela-Max. It is cheaper, available over the counter, faster acting and doesn't have to be covered and packed against the skin.

Regional Anesthesia

Regional anesthesia is used to anesthetize a region of the body, la arger area than what can be treated with a local anesthetic, but without rendering the patient unconscious. Examples are the spinal and epidural anesthesia used for childbirth. Some facial surgeries are routinely performed while the patient is under this type of anesthesia. These include brow lift touch ups, lip reduction and augmentation surgeries, chemical peels, and under-the-chin liposuction.

Regionals are sometimes referred to as nerve blocks, during which an anesthetic is injected into a nerve cluster and affects sensation in all areas controlled by the cluster. There are nerve clusters all over the body, including under the jaw, in the chin, and under the eye.

What Does Regional Anesthesia Feel Like?
I have had regional anesthesia several times and it feels like a typical shot, but into a nerve cluster. Sometimes when the needle strikes a nerve you will feel a little jolt or shock. It can be uncomfortable but it works very fast and you need fewer injections than with a typical local anesthetic.

Conscious Sedation

Sedation can be gas, oral, or intravenous (IV). They make you feel relaxed and drowsy. The medications used often include muscle relaxants, pain medications, and drugs that cause temporary amnesia. Sometimes an oral sedative is given ahead of time.

To administer the IV, a catheter is inserted into the vein on the hand or arm and a mixture of saline and medications is dripped in. The mix can be customized to the patient. You are usually given sedation along with a local. The sedation helps with the anesthetic properties, while the local helps with pain relief after you awaken.

You may have had laughing gas (or nitrous oxide) before for dental work. It is an inhaled gas of low doses of the same type of gases used in general anesthesia incorporating pain relief and amnesiac properties. A sedative or local or even regional may be administered as well. The good thing about nitrous oxide is when they take the mask off, you are back to normal in a few minutes with no pain if you had the local anesthetic as well.

What Does Liquid IV Sedation Feel Like?
An IV is used to administer anesthesia and to keep you hydrated through the saline carrier. Inserting the IV may be more stressful for some patients who haven’t received a sedative beforehand.

Having an IV inserted feels sort of like having blood drawn, but it is quicker. The initial placement of the IV catheter may sting a bit. After the needle is placed in the vein (usually in the crook of arm or back of the hand), it is pulled out and a little plastic tube is left in its place. This is the catheter, which is taped to your skin to hold it in place. This is usually done before you get into the operating room. A bag of saline will be hooked up via a tube and medications will be administered through a drip system. The saline will keep you hydrated both during surgery and postoperatively.

After you are properly catheterized and your vital signs are stable, the person administering anesthesia will inject the medications into your IV tube or attach a bag of them to the saline line. The effects of the anesthesia are felt within seconds of injection or opening the stopper on the drip. It may feel like heat going into your veins and then creeping up your arm and jumping to your shoulder. You’ll probably notice a metallic taste under your tongue, and then you are blissfully anesthetized. I have had several forms of IV sedation and actually prefer it.

What Does Light Gaseous Sedation Feel Like?
If you have chosen light gaseous anesthesia, all this entails is breathing through a mask. Typical mask-delivered anesthetics are commonly used for very short procedures or very light sedation. Regardless of the type, you are told to count down from 100 – you’ll usually make it to about 96, it’s that fast-acting. After the gas hits your lungs, your blood is saturated by the anesthesia gases and they are carried to your central nervous system and you are out like a light.

You may wake up with a sore, dry throat because canned or cylinder air is very dry. There is no moisture in these tanks.

What Does Oral Sedation Feel Like?
Oral sedation is basically taking a sedative pill such as Valium (diazepam) or Xanax (alprazolam) by mouth an hour to an hour and a half before a procedure. Oral sedatives make you very calm, drowsy and you may even fall asleep, depending upon the dosage. Many times you are may be given an oral sedative before a procedure with standard anesthesia. It takes the edge off of the anxiety you may feel the night before and morning of your operation.

You take the sedative either by swallowing or dissolving it under your tongue (sublingually), and within 20 minutes to an hour you will feel its effects. You will feel very peaceful and possibly fall into a light sleep.

General Anesthesia (Gaseous)

General anesthesia affects the entire body and therefore is used for more extensive surgical procedures or when other forms of anesthesia should not be used. It can be administered by an inhaled gas or by an IV liquid, or both simultaneously.

Sometimes general anesthesia is preceded by a sedative or medications to impair your memory, making you sleepy before you even enter the operating room. These agents can be administered either orally or by IV.

The chance of side effects with general anesthesia is greater than with other forms of anesthesia. That’s why your vital signs will be constantly monitored while you are under a general. Usually only a small percentage of people have a problem, and side effects are generally temporary.

Gas anesthesia may not be used for some types of facial plastic surgery near the mouth because the tubes to administer the gas would be in the way.

What Does General Gaseous Sedation Feel Like?
If you have chosen gaseous general anesthesia, what you remember afterwards will depend on the anesthesiologist's preferences. If your anesthesiologist prefers IV sedation first, you will only remember the experience getting an IV catheter put in. If your anesthesiologist prefers gaseous sedation beforehand, all this entails is breathing through a mask. After you are lightly sedated, the intubation, where they put a tube down your throat, is done.

The newer intubation (LMA) is basically like the older intubation for general anesthesia, but there is a shorter tube and a little balloon that holds your tongue and throat tissues out of the way so it does not obstruct your breathing. I have had LMA before and I don't remember a thing. The sedated me with an IV anesthetic and then while I was knocked out, they intubated me.

With the older intubation, you have a longer tube inserted down your throat but you don't remember it going in as you are usually temporarily anesthetized with IV sedation or gaseous sedation as outlined above. After the seal is made with the tube, and only after your oxygen saturation is satisfactory and your vitals are determined to be stable, other medications may be given. The anesthetic gas saturation may be increased and other modifications may be made.

Be advised that if you have bronchospasm, asthma, or other respiratory disorders, the person administering anesthesia must take this into account. You may need premedication or to have certain anesthetics used. Please make sure you read the risks associated with anesthesia, listed below and make sure both the surgeon and anesthetist have your complete medical history.

Twilight (or laughing gas) can be given via a mask as well, with no intubation. I have had this as well and find it to be really mild and fast acting. The good thing about this is that as soon as they remove the mask you start waking up.

Why Shouldn’t I Eat Before Surgery?

Your surgeon will tell you how far in advance of your surgery you should start fasting. If you are scheduled for a morning procedure, you’ll probably be told to stop eating and drinking at late the evening before, and most definitely by midnight.

You are instructed to fast before anesthesia to ensure there is no undigested food in your stomach that you might throw up. As unpleasant as vomiting is, it’s also dangerous if it happens while you are lying on your back because you might inhale some of the material into your lungs. Additionally, anesthesia interferes with your normal reflexes, including the one in your throat and airway that keeps you from choking. So take your surgeon’s instructions about when to stop eating very seriously. If you must take medication the morning of surgery (with your surgeon’s permission), do so with only a few sips of water.

Who Will Administer Anesthesia?

A number of different medical personnel can administer anesthesia, including an anesthesiologist, a medical doctor trained in anesthesia and pain management, a certified registered nurse-anesthetist (CRNA), or the surgeon Some hospitals and freestanding surgical units use CRNAs, while others have the surgeon in charge of anesthesia. If you are going under general deep sedation, it is best to choose a surgeon who will have an anesthesiologist or anesthetist administer the anesthesia.

The amount of anesthetic is determined by your individual body weight. Personal tolerances are also taken into account. However, any reactions by the body while under anesthesia should be monitored closely by a highly qualified individual.

Recovery From Anesthesia

Many factors come into play as you are regaining consciousness after surgery, so patients must be carefully monitored to detect and treat any adverse side effects to anesthesia. Your vital signs should be checked at regular intervals, and a pulse oximeter should be used to monitor oxygen levels in the blood.

Coming out of anesthesia is a highly personal experience. When I begin to regain consciousness I feel as though my peripheral vision is gone temporarily, and everything is of a blanched (white) hue. I get emotional sometimes and this is very normal.

Some patients cry while some are immediately back to normal and some take a little longer, but most report a sluggish feeling in their limbs. This, too, shall pass. You may think that you didn't even have your surgery because it feels as if you just went to sleep 5 minutes ago.

If you feel nauseous, alert one of the nurses and he or she can give you a few sips of cool water or provide a receptacle in which to vomit. You probably won't be given fluids just yet, more than likely just ice chips until you are no longer feeling nauseated. Some surgeons give you an antinausea medication to decrease your risks of vomiting after your surgery.

Some patients begin shivering uncontrollably. If that happens to you, let the recovery room nurse know so he or she can give you one of the warm blankets they keep on hand.

If you are going home the same day, you will stay in recovery until you are fully out of anesthesia, although you may still feel somewhat groggy. The staff will review your instructions to make sure you understand what you need to do when you get home and in the days that follow.

You will not be allowed to drive yourself home, so you must have a responsible adult available to do the honors. Your surgeon may also insist that someone stay with you overnight, so be sure to make those arrangements as well. If you fail to do so, your surgery may be canceled before it begins or you will be kept in the hospital overnight.

The best laid plans may go awry, however, if there were any complications with your surgery. These include elevated blood pressure, severe nausea, or bleeding. If any of these occur, you may be required to stay overnight at the hospital or at the surgery center. Don't complain. It’s better to be safe than sorry in this type of situation.

Risks, Contraindications, and Complications of Anesthesia

Although the vast majority of patients have no problems with anesthesia, it is not a risk-free proposition. The best precaution you can take is to talk to your surgeon and the person administering anesthesia ahead of time. Inform them of your health history, any allergies you have, and any problems you or a family member have ever had with anesthesia. There are a number of health conditions and medications that can change the way your body reacts to anesthesia, so be thorough with your disclosures.

Certain respiratory conditions may be a problem you when it comes to anesthesia. These include asthma, chronic bronchitis, or allergies that cause you breathing difficulties. While these conditions do not rule out surgery, your surgeon and whoever administers anesthesia should be aware of them so they can take precautions.

If you smoke tobacco or marijuana, your odds of having breathing difficulties during surgery are higher than a nonsmoker. And smoking will impair your ability to heal. You will be told that you should refrain for a period of time before and after your surgery.

Likewise, inform your surgeon and the anesthetist/anesthesiologist if you have ever had any heart-related problems, such as a heart attack, heart failure, high or low blood pressure, a history of clotting problems or embolisms, or irregular heartbeat. Here again, you may have no problems with surgery or anesthesia, but precautions may be necessary.

Medication and Supplement Contraindications Regarding Anesthesia

There are many medications and dietary or herbal supplements that can interfere with anesthesia. This is a partial list, but you should discuss any medications or supplements that you are taking regularly with your surgeon and anesthesiologist.

Ginseng can cause rapid heartbeat/and or high blood pressure in some individuals.
St. John's Wort, yohimbe, and licorice root have a mild monoamine oxidase (MAO) inhibitory effect and can intensify the effects of anesthesia.
Some well known and popular antidepressants are MAO inhibitors (MAOI) and are known to intensify the effects of anesthesia, especially general anesthesia. This could be quite dangerous in the operating room if your doctor is unaware of your medication usage. If you advise your doctor he or she can make adjustments for your anesthesia or at least will watch for the slightest decrease in heart or breathing rate. These medications include Isocarboxazid, Marplan, phenelzine (Nardil, Nardelzine), tranylcypromine (Parnate, Sicoton), Deprenyl, and selegiline hydrochloride. They are used for the treatment of depression, obsessive-compulsive disorder, eating disorders, essential hypertension, chronic pain syndromes, and migraine headaches. It is reported that drug interactions can occur even weeks after discontinuing use of an MAOI. Therefore, patients undergoing general anesthesia are usually instructed to cease taking them several weeks prior to surgery to avoid possible cardiovascular effects.
Melatonin decreases the amount of anesthesia needed for surgery.
Echinacea may have a severe impact on the liver when general anesthesia is used.

For a complete list, check out our Medication and Supplement Alert List. Review the list to see if any of your medications or supplements are on it, and let your surgeon know.

In Conclusion

Information in this section is meant to inform, not scare, you so that you are able to make a well-educated decision regarding your anesthesia. Remember, thousands of people undergo anesthesia safely every day. Please don't let anesthesia be the factor that kept you from having your surgery – just know that complications are possible.