Anesthesia will vary
Dear Doctor K: I have a minor surgical procedure coming up. Will I have any say in the type of anesthesia the doctor uses?
Dear Reader: For some surgical procedures, more than one type of anesthesia may be appropriate. The doctor who will administer the anesthesia (the anesthesiologist) will talk to you about the options.
I spoke to Dr. Kristin Schreiber, an anesthesiologist at Harvard-affiliated Brigham and Women’s Hospital. She explained that anesthesia has four goals. The first is to make sure you have no pain; the second is to make you drowsy or unconscious. The third is to keep your body still during the procedure — you don’t want your surgeon to have to deal with a moving target. And finally, the fourth is to prevent bad memories of the procedure.
There are four basic kinds of anesthesia. The type used depends upon the procedure you’re having and your state of health. Sometimes, but not always, the doctor will be able to take your preferences into account.
n LOCAL ANESTHETICS are injected near the area to be treated, to numb it. Their effects are limited to a fairly small area. They are used when you’re having dental work done, or if you require stitches. When a local anesthetic is first injected, you feel a very brief sting. Then the area becomes numb, and more local anesthetic can be injected. Although you won’t feel pain from dental work or stitches with a local anesthetic, you may feel pressure.
n In REGIONAL ANESTHESIA, local anesthetics are injected near clusters of nerves. By numbing the nerves, the doctor is numbing all parts of the body to which those nerves travel. That is a larger area than local anesthetics injected under the skin can affect. Regional anesthesia can numb all of your arm or foot, for example.
n NEURAXIAL ANESTHESIA includes epidurals and spinals. First, the doctor numbs the skin above your spine with a local anesthetic. Then a needle is passed through the numbed area, and anesthetics are injected near the spine. The anesthetics are injected in a slightly different place for epidural anesthesia than for spinal anesthesia. Both types block sensation from the waist down. Epidurals are commonly given to ease the pain of labor and childbirth or the pain of a large abdominal incision. Spinals are often used for cesarean section and knee surgery.
With both regional and neuraxial anesthesia, you may be able to choose how conscious you’ll be during the procedure. With minimal sedation, you’ll be relaxed but aware of what’s going on. Moderate sedation will allow you to drift in and out of consciousness, but still let you be easily aroused. With deep sedation, you are essentially fast asleep and unlikely to remember anything.
n GENERAL ANESTHESIA works in the brain to render you completely unconscious and unable to sense pain. This effect is achieved through a combination of intravenous drugs. You are also often given a drug to relax your muscles. For certain types of major surgery — heart surgery, for example — general anesthesia is the only choice.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.