General Anesthesia

General Anesthesia is a technique during which the patient is rendered unconscious. General Anesthesia provides analgesia (you have no pain), amnesia (you are unaware and have no memory), and relaxation (your muscles are relaxed to give the surgeon better operating conditions).

General Anesthesia is usually started and maintained by giving the patient an intravenous drug (into a vein), an inhalation drug (a gas which you breathe), or a combination of both. The anesthesia provider will monitor the progress of the surgery and the depth of your anesthesia. The depth of anesthesia can be changed by increasing or decreasing the amount of drug given. As the surgeon finishes the procedure, the anesthesia provider reduces the depth of anesthesia so the patient will awaken at the end of the procedure or shortly thereafter.

What can I expect?

For a typical general anesthetic, you may experience the following. When you arrive, you will be changed into a gown and prepared for surgery. An intravenous line will be started. You will have the opportunity to speak with your anesthesiologist and have your questions answered. You may or may not be given a small amount of sedation in the pre-operative area.

When the operating room and your surgeon are ready, you will be taken to surgery. In the operating room, monitors for your breathing, heart, and blood pressure will be placed on you. You will be asked to breathe through an oxygen mask for a few breaths as the anesthetic is given through your intravenous line (IV). The next thing you should remember is awakening in the recovery room. You may be a little confused when you wake up in the recovery room, but that should improve as the anesthetic clears. If you have any pain, you will be given pain medications through your IV. When you have recovered sufficiently from your anesthetic, your pain is under control, and your vital signs are stable, you will be prepared to go home.

M.A.C. (Monitored Anesthesia Care)

M.A.C. or Monitored Anesthesia Care, refers to sedation while under the care of the Anesthesia provider. This sedation may range from mild sedation to a state of unconsciousness. Throughout this sedation, the patient's heart, blood pressure, and breathing are monitored closely by the Anesthesia provider. Additional oxygen or breathing assistance may be given if necessary. M.A.C. is usually given in addition to Local or Regional Anesthesia.

Regional Anesthesia

Regional Anesthesia involves blocking sensations to one part of the body. By injecting local anesthetic (or numbing medicine) around a group of nerves, the anesthesia provider can block the sensation from one part of the body, such as the arm, the hand, or the foot. Most of the time the patient is given sedation before and during the procedure. A regional block can often give the patient several hours of pain relief after surgery. Regional anesthesia can be given alone, with sedation, or in combination with General Anesthesia. Your anesthesia provider may use this technique to provide anesthesia for your surgery or simply to provide pain relief after your surgery. Use of this technique will depend on the type and length of your surgery, your medical history, and your anesthesiologist and surgeon's preference.

What can I expect?

When you arrive, you will be changed into a gown and prepared for surgery. An intravenous line will be started. You will have the opportunity to speak with your anesthesiologist and have your questions answered. You may or may not be given a small amount of sedation in the preoperative area. Regional Anesthesia can be performed either in the preoperative area or in the operating room.

Common Types of Blocks:

• Axillary Block: This block is used for procedures of the hand, forearm, and elbow. An injection is given in the patient's axilla (armpit) into a space that surrounds a bundle of nerves that supply feeling to the lower arm. This is usually done with the patient awake with sedation.
• Interscalene Block: This block is used for procedures on the arm and shoulder. An injection is given into a space around a group of nerves on the side of the patient's neck. These nerves supply feeling to the shoulder and arm. This block can be done with the patient sedated prior to surgery or after General Anesthesia.
• Bier Block: This block is reserved for short procedures (60 minutes or less) on the forearm, wrist, and hand. Occasionally, a Bier Block is used for the ankle or foot. The block is performed in the Operating Room. After monitors have been applied, a tourniquet (usually like a blood pressure cuff) is placed on the upper arm. The hand, wrist and forearm will be wrapped with a tight elastic bandage and the tourniquet will be inflated. The elastic bandage will be removed. Then medication will be injected into an IV in the hand below the tourniquet. The hand and arm will feel warm to hot with a "pins and needles" feeling as the arm becomes numb. After the surgery, the tourniquet will be deflated and the feeling will return to the arm.
• Ankle Block: This block is done for procedures on the foot. The block is usually done prior to surgery. Three or four injections of local anesthetic are given around the ankle to block the nerves that supply feeling to the foot.

Local Anesthesia

A local anesthetic (medication which blocks nerves) is injected around the area of the surgical site. The area blocked is a smaller area than with a regional block. This block is usually saved for small, superficial surgeries, such as breast biopsy, removal of skin lesions, and placement of long term implantable intravenous lines. Occasionally, the surgeon will give local anesthesia even after general anesthesia to reduce the discomfort at the surgical site after surgery.