Dr. Owen Ellis on Anesthesia: What to Expect

Are you undergoing surgery soon, or do you know someone who is? Then you might have plenty of questions or concerns about anesthesia.

To help ease your mind and become more informed, read what anesthesiologist Owen Ellis, MD, of Boulder Valley Anesthesiology recently said during a free health lecture on the different options for anesthesia and what to expect before, during and after surgery.

What is Anesthesia?
Anesthesia is a loss of sensation — and often a loss of consciousness — without the loss of vital bodily functions. It’s artificially produced with medicines in order to prevent or reduce pain.

“Delivered as an injection or through inhaled gases or vapors, anesthesia affects the nervous system by blocking the passage of pain impulses along nerve pathways to the brain and, therefore, pain and sensation during surgery,” Dr. Ellis explained.

What are the Types of Anesthesia?
Your anesthesiologist, along with your doctor, will recommend the best anesthesia for you based on the type of surgery you’re having, your medical condition and your preferences.

According to Dr. Ellis, there are three main forms of anesthesia: general, sedation and regional.

General anesthesia keeps you unarousable, or "completely out," during the surgery, which is necessary for certain procedures. The medicine blocks sensations, pain, awareness and movement during the surgery, and even memory of the surgery.

General anesthesia can be given through an intravenous (IV) line or by inhaling gases or vapors. It often requires a breathing tube that’s inserted into the windpipe to maintain proper breathing during surgery.

Sedation depresses awareness in order to help a patient relax and feel as comfortable as possible during a procedure. It’s administered through IV and generally used for shorter treatments. Sedation may be mild, moderate or deep. Dr. Ellis said, “With mild sedation you are able to talk. With moderate, you’re sleepy but can be aroused if needed. And with deep sedation, you’re not easily or maybe even impossible to arouse.”

Regional anesthesia is injected near a cluster of nerves, numbing an area of the body such as below the waist. There are several types of regional anesthetics: spinal, epidural, blocks and local.

• Spinal anesthesia is a single injection of anesthetic given in the lower back and into the spinal fluid that surrounds the spinal cord. It causes numbness in the lower body and is often used for lower abdominal, pelvic or lower extremity surgery such as orthopedic surgery.
• Epidural anesthesia involves continually infusing anesthetic medicine just outside the spinal column in the lower back, through a thin catheter (hollow tube). It’s commonly used for surgery of the lower limbs and for reducing pain following surgery.
• Blocks and local anesthesia numb one small part of the body. “Blocks involve the administration of local anesthesia around nerves leading to the areas of the body where you will be having surgery. Local anesthesia involves directly placing the anesthetic into the area of surgery,” said. Dr. Ellis.

What Happens Before Surgery?
At BCH, surgery patients receive a call from a nurse for pre-anesthesia testing. The nurse will review your health history, allergies and all medications and supplements you are taking. In addition, the nurse will go over instructions for the day of surgery, including when to stop eating and drinking fluids.

During this phone call, the nurse will also determine whether you need any testing, which can include such things as bloodwork or an electrocardiogram (EKG).

“Prior to the day of surgery, an anesthesiologist will review your chart and any questions from pre-anesthesia testing to make sure all needed testing is finished and okay,” Dr. Ellis stated.

What Does the Anesthesiologist do During Surgery?
Your anesthesiologist will administer and manage anesthesia during the surgery, as well as adjust the anesthesia to ensure you’re comfortable after it wears off. The anesthesiologist will also monitor and treat any changes in your critical life functions — breathing, heart rate, and blood pressure.

What are the Common Side Effects?
According to Dr. Ellis, side effects often depend on the type of surgery.

“With general anesthesia and deep sedation, about 10 to 15 percent of patients feel nausea, which usually can be alleviated with anti-nausea medication,” he said. “You will most likely feel groggy and a little disoriented when waking up after surgery, which should go away fairly quickly.”

Some other common side effects of general anesthesia and deep sedation include:

• chills or shakiness
• sore throat (if a breathing tube was used)
• possible pain at the surgical site

With regional anesthesia, you will most likely feel a little groggy.

What are the Risks?
You can rest assured that the safety of anesthesia has improved a lot over the years, thanks to advances in technology and the extensive training anesthesiologists receive.

“In very rare cases, anesthesia can cause complications. Generally, it was more dangerous for you to drive here to this lecture,” said Dr. Ellis.

Major risks depend on the type of procedure, the patient’s condition and the type of anesthesia used. Although extremely rare (less than 1 per 100,000 patients), general anesthesia can cause brain injury and even death. With regional anesthesia, there’s a very low risk of nerve injury (less than 1 per 100,000 patients).

Minor risks are also very low. They include such things as tooth injury from a breathing tube used during general anesthesia and numbness for 1 to 2 weeks following regional anesthesia.

To ensure your safety during surgery, it's important to answer all of the anesthesiologist's and pre-anesthesia testing nurse’s questions as honestly and thoroughly as possible. It's also important to follow the pre-anesthesia testing nurse’s recommendations about what not to do before the surgery.

Click here to view PowerPoint slides from the health lecture on the “Anesthesia: What to Expect Before, During and After Surgery.”

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