Anesthesia

If you are scheduled for a surgery and having an anesthetic, the information provided here is to help you understand what is involved, and to assist you in taking an active role in your own health care. This is only an introduction to the basics of anesthesia and to the role of the anesthetist. Remember that as a patient you have a right to ask questions of the people involved in your care. This is not intended to be a substitute for an informed discussion with your anesthetist prior to your operation.

What role does the anesthetist play?
How has my anesthetist been trained?
What should I tell my anesthetist about myself?
Why can't I eat or drink anything before surgery?
How does my anesthetist select the proper anesthetic ?
What kind of anesthetic will I have?
What happens during my anesthetic?
How will I feel after my anesthetic?
What are the risks?
What's being done to ensure safety in anesthesia?
Glossary

What role does the anesthetist play?

Most operations today require some form of anesthesia. Your anesthetist is an important member of the surgical team. He or she renders you unconscious or insensitive to pain during surgery, and carefully observes your vital signs, such as blood pressure, pulse, and respiration, throughout the procedure.

In addition to working in the operating room, many anesthetists also work in pain clinics, obstetrical wards and intensive care units.

How has my anesthetist been trained?

You are in good hands! Your anesthetist is a fully qualified medical doctor (MD) who has spent years receiving specialized training in anesthesia. In this training he or she acquires extensive knowledge of drug effects, medical illnesses, the body's response to surgery, and the highly technical modern equipment used in administering and monitoring anesthesia. In addition, your anesthetist has detailed knowledge of emergency procedures.

What should I tell my anesthetist about myself?

Before your operation, your anesthetist will visit you and ask you important questions about your health and medical history. It is very important that you answer all questions truthfully and completely. The anesthetist will want to know about:

• any prescription, over-the-counter, or recreational drugs (i.e. marijuana, cocaine, etc.) you take, or have taken;
• your overall health, previous operations and hospitalizations;
• any allergies to foods, drugs, or environmental agents;
• any unusual reactions to drugs or anesthetics that you or anyone in your family has had;
• any history of asthma, diabetes, heart problems, or other health concerns;
• use of cigarettes, the birth control pill, alcohol.

You may want to make a list to help you remember what to tell or ask your doctor. Remember, your anesthetist asks these questions to plan an appropriate anesthetic for your safety and well- being.

Why can't I eat or drink anything before surgery?

Under normal conditions your body has a mechanism which automatically prevents you from vomiting anything into your lungs. However, when you are unconscious during anesthesia, this mechanism may not function. Therefore, you must have an empty stomach (no food or liquid, even water) before receiving an anesthetic in order to eliminate the possibility of vomiting any undigested food into your lungs. It is very important that you follow your doctor's instructions exactly; if not, your surgery may have to be postponed. These instructions are for your own safety. Follow them carefully. Please!

How does my anesthetist select the proper anesthetic ?

First, your anesthetist will review your health history, including results of laboratory tests, examine you, and will then choose the anesthetic best suited to your state of health and the type of surgery to be performed. A short operation, such as a tonsillectomy on a young healthy person, requires only a few drugs; a complex heart operation on an elderly person will require an array of special drugs to ensure the body's vital organs are protected.

What kind of anesthetic will I have?

The kind of anesthetic that is chosen depends on factors such as your type of operation and your health. There are three main kinds of anesthesia.

• General anesthesia
  Anesthetics used for general anesthesia enter the blood stream and travel to the brain to make you unconscious - that is, without awareness of any sensations. Usually, you first receive an intravenous injection of sodium thiopental, which sends you immediately to "sleep". The anesthetic may be administered through a face mask as a gas or vapour, or through a tube inserted through your mouth into your lungs.
  
  Other drugs are administered to prevent pain, to maintain you in an unconscious state, and to relax your muscles to help the surgeon perform your operation. All important body functions, such as blood pressure, pulse, breathing, and temperature, are closely monitored during this time. Your anesthetist remains with you during the entire procedure.
  
  
• Regional anesthesia
  This form of anesthetia is used to numb only the part of your body that requires surgery. Your anesthetist makes an injection near a cluster of nerves, to numb a specific area. You may remain awake or receive a sedative, but will not feel the surgery take place. The surgical site will be covered, so that you do not have to see or watch anything. This form of anesthesia includes epidurals which are commonly used for pain relief during childbirth.
  
  
• Local anesthesia
  This is used for minor surgery on a specific location (i.e. hand or mouth). An anesthetic drug is injected into the tissue to numb the exact area where surgery is required.

What happens during my anesthetic?

Before the surgery:
Before going into the operating room, you may be given some pre-operative medication to relax you. Just before your operation your anesthetist will usually insert an intravenous line (I.V.) to administer additional fluids such as special sugar and salt solutions. Various monitoring devices, such as an ECG and a blood pressure cuff, will then be attached to you in order to monitor your vital signs and your body's reactions to the anesthetic.

During the surgery:
Your anesthetist will be present at all times. During the anesthetic, you will not be aware of anything around you. You will receive different medications to maintain your bodily functions such as heart rate and breathing. You will be observed at all times, and should a complication occur, such as a fall in blood pressure, your anesthetist is prepared and trained to respond quickly.

After the surgery:
When your surgery is complete, your anesthetist will reverse the anesthetic effects and take you to a recovery room. The recovery room staff, under the supervision of the anesthetist, are trained to care for you while you are returning to consciousness.

They will constantly check the colour of your skin, your breathing, temperature, pulse and blood pressure. In addition, you will receive oxygen to breathe, and will be asked to cough and breathe deeply to help keep your lungs clear. Should you have any pain from your surgery, you will receive medication to control it. Once you are fully awake, you will be transferred to your room or discharged to return home.

How will I feel after my anesthetic?

You may suffer some pain or discomfort from your surgery. Some temporary effects you may experience due to the anesthetic procedure include dry throat, nausea, vomiting, sore jaw, sore muscles and perhaps some short-term memory loss. This is why we ask you not to drive or operate heavy machinery immediately after your surgery, and to go home accompanied if you are an outpatient.

What are the risks?

Adverse effects and serious complications are very rare. However, any operation or anesthetic carries some risks, which vary depending on your overall health and the seriousness of your operation. Since the specific risks vary with each patient, you should ask your anesthetist what risks, if any, you may face. Your surgical team and anesthetist take every precaution to ensure that your operation proceeds smoothly.

What's being done to ensure safety in anesthesia?

The Canadian Anesthetists' Society works with hospitals and university departments of anesthesia, professional organizations, government agencies and the pharmaceutical industry to develop standards for training, equipment, drugs, and procedures to ensure that Canadians receive the highest quality anesthesia care. The Society encourages all anesthetists to attend continuing medical education sessions and to constantly update their medical skills. The primary goal is patient safety and, thanks to the efforts of all those in the field, modern anesthesia has become very safe.

Glossary

ECG: a recording of the electrical activity of the heart

Epidural: the injection of a local anesthetic through a needle into a space just outside the spinal cord and its covering

Intravenous: insertion of a needle or small plastic tube directly into a vein

Preoperative: the time before surgery

Sedative: a drug used to relax and calm you before surgery

Sodium thiopental: a drug which is injected into a vein and rapidly produces sleep.

For more information click here to visit the Canadian Anesthesiologists' Society web site.