General Anesthesia
General Anesthesia is defined as the maintenance of an unconscious state even when a painful stimulus is applied. In real world terms, this means you are deeply unconscious while an airway device is placed. Anesthetic gases are then delivered to maintain your unconscious state.
General anesthesia usually begins with an IV induction agent (IV drug) that brings you to an initial state of unconsciousness. Once completely asleep, an airway device is placed to maintain your breathing. This airway device can come in two forms: an endotracheal tube or a laryngeal mask airway (LMA). The former is a tube that is inserted through the vocal cords into your trachea. This will allow the airway to be secured while delivering oxygen and an anesthetic gas to maintain your asleep state. The LMA is a soft, pliable device that sits in the back of your mouth. This device maintains an open airway, allowing you to breathe on your own while you are kept asleep with anesthetic gas. Additional medications may also be given through your IV to help maintain your unconscious state. All of your vital signs will be monitored closely throughout the operation.
Once the surgery is done, the anesthesia gas will be turned off and you will start to come to a state of consciousness. You will then be transferred to the Recovery Room.
The most common side effect of general anesthesia is nausea/vomiting. Medications will be given to help prevent these, but in some instances, it is not 100% preventable. A sore throat is also a common side effect. If you do get a sore throat, usually it only lasts for 1-2 days before resolving on it's own. Throat lozenges and sprays usually help alleviate most of the discomfort. There is also a possibility of dental/lip injury when we place the breathing device, but it's is extremely rare.
Upon arrival to the recovery room, most patients are awake and responsive, and very few initially remember their arrival. Their first recollection usually occurs within the next 10-20 minutes. In the recovery room, you will be closely monitored until discharge.
Total Intravenous Anesthesia (TIVA)
Total IV Sedation is a type of anesthesia in which the entire anesthetic is administered through your IV (vs. anesthetic gas trough your lungs). This type of anesthesia is usually used in surgeries that are less painful, thus requiring a lighter sedation.
Although completely unconscious, patients will continue to spontaneously breath on their own usually through a nasal cannula or face mask that will provide additional oxygen. Sedation is maintained through a continuous infusion of medicine through your IV.
Recovery from TIVA is much quicker than general anesthesia and has fewer side effects. The most common is nausea/vomiting, but even that is a rare event. TIVA is tolerated very well by most patients.
Monitor Anesthesia Care (MAC)
Monitor Anesthesia Care (MAC) is a type of anesthesia in which a very light sedation is given. Although all patients remain conscious through the procedure, some might not remember their operation secondary to the amnesia effect of the sedation medicines.
This type of anesthesia is usually used in operations that require the patient to be somewhat responsive at certain points of the surgery (eg. cataracts, etc..).
The recovery from this anesthetic is quick and the side effects associated with MAC anesthesia is negligible.
Regional Nerve Blocks
Regional anesthesia is accomplished by carefully inserting, usually under ultrasound guidance, a needle near a selected nerve and injecting local anesthesia to numb that nerve. The result is numbness and loss of muscle control in the affected area, usually lasting several hours and up to 3 days if a catheter is inserted. This can often produce excellent pain relief for the patient.
Common blocks include: Axillary, Popliteal Fossa, Femoral, Sciatic, Intrascalene, and many others. These blocks are contraindicated for certain patient populations and do have risks associated with them. Each patient is very different and must be evaluated by an anesthesiologist on a case by case basis. Risks of the different blocks will be thoroughly discussed by your attending anesthesiologist.
In addition to the regional block, we usually administer some sort of sedation - either MAC or TIVA - to render the patient comfortable and calm, often unconscious. Certain patients benefit from a deeper sedation. Lighter anesthesia usually quickens wakeup and recovery from anesthesia and causes fewer side effects like nausea and vomiting.
Spinal and Epidural Anesthesia
While more commonly performed on patients in labor, spinal and epidural anesthesia can be administered by your anesthesiologist for procedures involving the lower extremities. These include total knee and hip replacements, partial knee replacements, and on occasion ACL repairs and reconstructions. These techniques allow the anesthesiologist to numb the lower portion of the body, thereby temporarily eliminating the pain sensations associated with surgery. In addition to the spinal anesthetic, we usually administer some sort of sedation - either MAC or TIVA - to render the patient comfortable and calm, often unconscious. While certain patients benefit from a deeper sedation, a lighter anesthesia usually quickens wakeup and recovery from anesthesia and causes fewer side effects like nausea and vomiting.