You will be interviewed by your Certified Registered Nurse Anesthetist,
or CRNA, just before your surgery. Your surgeon, your CRNA and you will
decide on the appropriate choice of anesthesia based on your procedure,
your medical history, and your personal preference. Many types of anesthesia
are available. They include:
General Anesthesia
This type of anesthesia is used for many types of surgery. The entire body,
including the brain, is anesthetized. The patient has no awareness, feels
nothing, and remembers nothing of the surgery. It can be given by mask
injection, or both. While under anesthesia, you are monitored very closely.
Your breathing may be controlled by an endotracheal tube or a laryngeal
mask. Once the surgery is complete, the tube will be removed, and when
you are stable, you will be transferred to the Post Anesthesia Care Unit,
(PACU) or Recovery Room. Some patients may have a sore throat. Once you
are alert and pain management is satisfactory, you will be discharged
from the PACU.
Regional Anesthesia
Regional anesthesia, or spinal/epidural is achieved by injecting a specified
specific amount of local anesthetic directly into the area where the nerves
are located that supply that region of the body where the surgery is to
be performed. This is accomplished by either sitting the patient up or
with the patient on their side. The back is cleansed and a small amount
of numbing agent is injected, then a very fine needle is used to inject
the local anesthetic. Your legs will become heavy and numb, and you will
be unable to move your legs and the anesthesia/surgery team will position
you for your surgery as needed. This type of anesthesia provides muscle
relaxation as well as pain relief that may last several hours after the
surgery, hence reducing the need for additional post-op pain medications.
This is accomplished with or without the loss of consciousness using IV
sedation. It is especially advantageous for patients undergoing childbirth
(vaginal or Cesarean section) and for the elderly. It can be used for
most surgeries below the umbilicus (belly button). During the procedure,
medications are given through the IV to provide relaxation and sedation.
Bier Block
This is another type of regional anesthetic reserved for surgery of the
arm or hand. It involves the placement of the local anesthetic utilizing
a needle in the involved arm and the placement of a tourniquet above the
elbow. The tourniquet is inflated before the injection of the local anesthetic
to keep the injected anesthetic within the arm. This technique is best
used in surgery that can be accomplished within 30-60 minutes. IV medications
may also be given for sedation.
Local Anesthesia / Monitored Anesthesia / Conscious Sedation
These types of anesthesia involve the injection of the local anesthetic
directly into the area requiring surgery and may be supplemented with
IV sedative medications.
Several combinations can be done to optimize the anesthesia:
Local only – The surgeon administers the local medication directly
into the surgical site with no IV sedation given.
Local / MAC (monitored anesthesia care) – Local anesthesia is injected,
and an anesthesia provider (CRNA) administers IV sedation
MAC only – no local is administered, such as for colonoscopies, and
other such procedures
Conscious sedation – can be either with or without local anesthetic
injections, sedation is administered by an RN as directed by the surgeon.
