Ask an Expert – Anesthesia

Question: Is anesthesia safe? What are the different types?

Dr. Wan Lijun, Chair of Anesthesiology, gives his answer…

Anesthesia is one tool used in medicine to help assure an optimal outcome for patients. Local, Regional, Sedation, and General are various levels of anesthesia and these modalities control or modify consciousness, movement, pain, and awareness. If suboptimal, patients can experience pain, anxiety, psychological trauma, and/or a poor surgical outcome due to unintended movements. If too much anesthesia is given, both short and long-term morbidity and mortality are increased. So what are your options?

Levels of Anesthesia

Local anesthesia is simple and can be performed anywhere including at home with an over-the-counter pain relief gel applied to a wound. In the hospital pain sensory nerves can be easily numbed through topical or intra-dermal injection of local anesthetics. This is commonly used for small and superficial procedures and the patient is understanding and cooperative. Local anesthesia is often not used on small children even for minor procedures since they cannot hold parts of their body still like an adult.

Regional anesthesia is separated into spinal/epidural nerve block and peripheral nerve block. These options are used for women during childbirth or procedures on the limbs. They can be used without sedation so that the patient is fully awake, with some sedation, or as an addition to general anesthesia. Epidurals are used more often for abdominal surgeries in some cultures because patients are apprehensive about general anesthesia or for financial reasons.

Sedation can be mild, moderate, or deep. Mild sedation is similar to taking a sleeping pill. Moderate sedation has a calming effect and allows patients to tolerate normally unpleasant procedures without much pain, such as colonoscopy. Patients are reasonably easy to arouse by voice or gentle tapping, and maintains the ability to breathe on his/her own. During deep sedation patients are only responsive to very painful stimuli and ideally should breathe on their own but this is not always guaranteed. Mild to moderate sedation can be administered by sedation-certified physicians but deep sedation should be administered by an anesthesiologist and requires continuous monitoring of the patient since it is so close to general anesthesia. Some patients are comforted by the idea of “sedation”, believing that since less medication is being administered it will be less “harmful” to their health, but theoretically, deep sedation is riskier than general anesthesia which provides a definitive solution for protecting their airway.

General anesthesia means the patient is unconscious, has no voluntary movements or sensation of pain, and no awareness or memory of the procedure. In some cultures general anesthesia is often feared and avoided because 20-30 years ago death during surgery from anesthesia was still a frequent occurrence. With significant advances in healthcare, anesthesiology as a specialty has advanced leaps and bounds through more rigorous training regimes, while also benefiting from inventions and applications of modern monitoring technologies such as pulse oximeters, end tidal carbon dioxide monitors, redundant hypoxemic and hypoventilation monitors, in addition to the routine vital sign monitors.

With this vital background information, if you are scheduled to have a surgical procedure, request a consultation with the anesthesiologist to discuss and better understand your anesthesia options.