Anesthesia

You will be interviewed by your Certified Registered Nurse Anesthetist, or CRNA, just prior to 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

• Regional Blocks

• Local Anesthesia

• Local Anesthesia with IV Sedation

Types of Anesthesia

1.       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 or 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 discharge from the PACU. 

2.       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 patient 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. 

3.       Bier Block

This is another type of regional anesthetic reserved for surgery of the arm or hand. It involves 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 prior to 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. 

4.       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. There are several combinations that 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 and RN as directed by the surgeon