Anesthesia literally means "to feel nothing". When most people think of anesthesia, they imagine going to sleep and waking when the surgery is over. This type of anesthesia is known as general anesthesia, however there are many different types of anesthesia. Below are some of the most important types of anesthesia techniques used today.

1. GENERAL ANESTHESIA

When most people think of “going under anesthesia” they likely are imagining what takes place in general anesthesia. This form of anesthesia is the most widely used technique in the U.S. and the world. It is popular because the patient is completely unaware of their surroundings thanks to the effects of both intravenous (IV) medications and inhaled anesthetic gasses. The combination of these medications and gasses place the patient in a comfortable and unconscious state, preventing them from feeling or remembering the procedure. During general anesthesia, the anesthesiologist pays very close attention to important vital signs such as blood pressure, heart rate, EKG, temperature and respiratory function. These vital signs are critical for monitoring the overall stability of the patient as well as provide important clues to the level of unconsciousness. An important feature of general anesthesia is use of an endotracheal tube. This is a plastic tube that is placed directly into the patient’s trachea (the portion of airway that connects opening of the mouth to the lungs). An endotracheal tube allows the anesthesiologist to control the patient’s breathing and closely monitors the mixture of air that is delivered to the lungs. The endotracheal tube is connected to an anesthesia machine where the air is analyzed and anesthetic gasses are added to the mixture. As the surgery comes to an end, the anesthesiologist will coordinate your awakening with the removal of the endotracheal tube. The patient is monitored closely during this time to make sure that they are able to cough and breathe on their own. Once the endotracheal tube is removed, the patient is transported into the recovery room where vital signs continue to be checked. It is common for patients to be confused when awakening from anesthesia. Shivering is also a normal response during this time. Some patients may have a sore or scratchy feeling in their throat from the endotracheal tube. This usually does not last long. Pain control is also an important concern following surgery. Pain medications help to relax the patient and improve the recovery experience as they become more alert.

2. REGIONAL ANESTHESIA – SPINAL/EPIDURAL

This type of anesthesia is used to desensitize the nerves in a specific part of the body. By blocking specific nerves, the patient feels no painful sensations in the area. This type of anesthesia is advantageous in situations where the procedure is minor or the patient cannot undergo general anesthesia for health reasons. It is also commonly used when a procedure requires the patient to remain conscious, such as childbirth. Most people refer to this type of regional anesthesia as a spinal or epidural. In a spinal, the anesthesiologist will have the patient bend forward to expose the lower back. The area above the spine will be cleaned and a local anesthetic injected just beneath the skin to numb up the area. Once the skin is numbed, a longer needle will then be inserted between the vertebra (individual bones of the spine). The skilled hand of an anesthesiologist carefully guides the needle into the desired anatomical space of the spinal cord. Once correctly placed, anesthetic is injected. Many times, a very small plastic tube is inserted thought the needle and connected on the outside to a pump. This allows continuous, small amounts of anesthetic to be injected to achieve the best level of pain control. An epidural results in numbness or decreased sensation in the lower body, from the level of the injection downward. Pain below this point is greatly decreased and the patient should only feel sense of dull pressure. It also normal for the patient to feel heaviness in their lower body and it may be difficult to move. Normal sensation and movement should return as the epidural wears off.

Regional anesthesia is used in many procedures besides child birth. Below is a partial list of such procedures:

1) Biopsies or skin or bone below the belly button
2) Knee surgery such as arthroscope or ACL repairs
3) Hernia surgery
4) Cesarean sections
5) Surgery on the foot or the leg
6) Repair of fractures in the hip, leg, foot
7) Anal and rectal surgery
8) Total replacement surgeries such as hip and knee replacements
9) Urological procedures of most kinds
10) Gynecological procedures of most kinds

 

3. REGIONAL ANESTHESIA- THE BIER BLOCK

A Bier block is a specific type of regional anesthesia that is utilized in the operating room to block painful sensations within the arm or hand. In this technique, the anesthesiologist will place a tourniquet above the elbow and inject anesthetic medication directly into the tissue of the surgical site. The pressure created by the tourniquet keeps the anesthetic in the arm and prevents it from washing away. The Bier block can keep the arm numb for surgical procedures up to 60 minutes long. Other medications can also be given by IV to make the patient more relaxed during the procedure. Following the procedure, the arm may remain numb for several hours until the anesthetic completely wears off.

 

4. CONSCIOUS SEDATION

Conscious sedation is a form of anesthesia where the patient is medicated to induce a sleepy/hazy state of consciousness. This technique is advantageous for short, mildly uncomfortable procedures that do not require the patient to be fully asleep. The anesthesiologist will administer specific medications through an intravenous (IV) line which relax and sedate the patient. Patients are monitored closely during the procedure and kept in a state of semi-awareness. Pain medication may also be used to keep the patient comfortable. When the procedure is finished, the patient quickly regains full awareness.

Below is a partial list of procedures which commonly use conscious sedation:

1) Hernia Repair
2) Foot Surgery
3) Biopsies, Breast, or Lymph Node
4) Endoscopy Procedure