- What are the types of anesthesia?
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A general anesthetic is one in which the patient is rendered unconscious for the period of surgery.
A regional anesthetic blocks the electrical nerve impulses in a nerve or group of nerves to the site of the surgical procedure.
A local anesthetic prevents pain by inducing the loss of sensation in a certain area of the body while the patient remains awake.
Sedation is a type of anesthesia where a drug is given to calm a patient during an otherwise excited, uncomfortable, or anxious period of time. Often administered to patients immediately prior to surgery or during uncomfortable medical procedures.
- Who administers anesthesia?
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GHA has adopted the Care Team approach to administering anesthesia. For each patient, an anesthesiologist performs a preoperative examination and evaluation, prescribes the type of anesthesia the patient will receive, and is present while the anesthetic is administered.
Depending on the circumstances of the case, a CRNA or AA may work with the anesthesiologist to administer the anesthetic and often takes over monitoring the patient's condition under the supervision of the anesthesiologist. However, an anesthesiologist is present during the most demanding procedures of the anesthesia plan and is available for immediate diagnosis and treatment of emergencies.
Following the surgery or procedure, a CRNA, AA or anesthesiologist will take the patient to the post anesthesia care unit ("PACU") and will stay with the patient until it is safe to turn the patient's care over to a recovery room nurse.
- Definitions
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Analgesia - absence of normal sense of pain without loss of consciousness.
Analgesic - a drug that relieves pain without causing loss of consciousness, such as an aspirin.
Anesthesia - partial or complete loss of feeling or sensation, with or without loss of consciousness, primarily for the purpose of surgery or other medical procedure. There are three main categories of anesthesia: general, regional, and local. Anesthetic - a drug that produces anesthesia administered by inhalation (breathing) or intravenously (injection or through an IV).
Anesthesia Care Team - anesthesiologists, CRNAs and AAs working together to administer anesthesia and monitor patient condition during surgery, other medical procedures, or delivery of a baby.
Anesthesiologist - physician specializing in administering analgesia and anesthesia
Anesthesiology - the branch of medicine concerned with reducing or eliminating pain or feeling in patients undergoing surgery, the delivery of a baby, or other medical procedures.
Anesthesiologist's Assistant
Anesthetist - one who administers an anesthetic. In many parts of the world, and particularly in Britain, this term applies to both nurses and doctors. However, in the USA and Canada, physicians who administer anesthetics are referred to as anesthesiologists.
Certified Registered Nurse Anesthetist (CRNA) - a highly-trained nurse specializing in the administration of anesthetics.
Edotracheal Tube (Breathing Tube) - a tube placed in a patient's windpipe to help the patient breath; commonly used during general anesthesia.
Epidural Anesthesia - anesthesia produced by injection of a local anesthetic into the peridural space of the spinal cord, frequently used during delivery, for surgeries below the waste, and for post-operative pain management. You can view an interactive tutorial about epidural anesthesia by the Patient Education Institute by clicking here.
General Anesthesia - anesthesia where the patient is rendered unconscious by administration of intravenous and/or inhalation anesthetics for the period of surgery. The patient's major bodily functions are closely monitored by a member of the Anesthesia Care Team. A breathing tube is usually required during general anesthesia. You can view an interactive tutorial about general anesthesia by the Patient Education Institute by clicking here.
Local Anesthesia - anesthesia where a small area is deadened by injection of a local anesthetic.
Narcotic - A drug that produces insensibility or stupor. The term is now generally used to describe a class of drugs, such as morphine, which are addictive analgesics, generally producing hypnosis (sleep), but sometimes excitement.
Regional Anesthesia - anesthesia where an anesthetic is administered by injection to deaden a part of the body such as an arm or leg. The patient remains conscious, though often sedated, throughout the procedure.
Sedation - anesthesia where a drug is given to calm a patient during an otherwise excited, uncomfortable, or anxious period of time. Often administered to patients immediately prior to surgery or during uncomfortable medical procedures.
Sedative - a substance that tends to calm, moderate, or tranquilize nervousness or excitement.
- Anesthesia for children
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Are the risks different between children and adults?
Respiratory complications are more frequent in the pediatric population, while injury to the nervous system is more common in adults. In experienced hands, the risk of anesthesia in children is very low.
How will my child go to sleep?
The age and maturity of your child will aid in the decision about how he/she will go to sleep. With younger children, the most frequent type of induction (putting one to sleep) is inhalation. Inhalation induction allows the child to breathe themselves off to sleep with oxygen, nitrous oxide (laughing gas), and anesthesia gas. The older child will often choose an IV because it is a faster way to go to sleep. If the older child is afraid of the IV sleep, or needles, an inhalation induction is an option.
What will you do if my child is anxious before surgery?
Medications are available that will sedate your child prior to the start of the anesthetic. These medications are similar to Valium® but are shorter acting. These medications can be given either by mouth or through an IV. In some institutions, induction rooms are available for the child to be with their parents while going off to sleep. Your anesthesiologist will decide what is the best for your child after discussion with you. A vast majority of children do not require anything other than a wagon to ride in and a hand to hold.
- Anesthesia for Labor & Delivery
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What methods of pain relief are available when I am in labor?
There are several options available to the pregnant mother. Psychological techniques like Lamaze are an option for pain relief. Intravenous medications are available but may be limited by the stage and time of labor. Pain medications like Demerol®, Nubain®, Stadol®, Fentanyl, and Morphine are examples of intravenous medications. Upon the decision of your Obstetrician, Regional anesthetics may also be a viable options for pain relief. Epidural and spinal anesthetics are administered by the anesthesiologist. Paracervical, pudendal, and perineal blocks are usually done by the obstetrician.
What are the side effects of epidurals and spinals?
Complications of spinal and epidural anesthesia include neurologic changes, headache, backache, and unexplained cardiac arrest. Backache associated with these techniques is usually transient in nature, but may occur in up to 20 % of cases. Epidurals also carry risk associated with the fact that more medication has to be given for the epidural. If this medication is given into a blood vessel or into the spinal fluid, seizures or temporary paralysis may occur. In an effort to prevent these complications, the anesthesiologist may administer a small "test dose" of medication and then gives epidural medications in small, repeated increments rather than in one large dose.
- Post-operative pain management
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What is a Pain Management Service? Can’t my surgeon give me pain medicine?
A Pain Management Service is a group of specialized doctors and nurses knowledgeable in the treatment of pain. Anesthesiologists often specialize in pain management because they spend a large amount of time involved in the treatment of pain in the operating room and recovery room. While surgeons routinely order medications for the treatment of postoperative pain in their patients, some patients require additional or different methods other than those used routinely by the surgeon. Patients with multiple allergies, a history of chronic pain, or other major medical conditions are examples of patients that may benefit from the services of a Pain Management Specialist. A Pain Management Service can offer additional options to treat pain, such as epidural analgesia, that may not otherwise be available.
What information is important for the doctor and nurses to know in order to assist me in formulating my pain management plan?
It is very important to tell your doctor and nurses the following information:
1.Type of pain you’ve been experiencing and what medications you are taking.
2. Amount of alcohol intake.
3. Medications taken for sleep or anxiety
4. Any use of recreational or street drugs
Can I take the pain medicine I’ve been taking at home in the hospital?
Do not take ANY medications on your own in the hospital.
Will I get "hooked" on my pain medicine?
While it is not unusual to develop a tolerance to pain medications over a period of time, studies show that development of addiction to pain medication is very rare - unless you already have a problem with drug or alcohol abuse.
I don’t like that "spaced out" feeling. Do all pain medicines have this side effect?
All patients are different when it comes to tolerance of pain and the medications given to treat it. While many pain medications have the side effects of drowsiness and dizziness, often, the dose can be adjusted to decrease these effects.
Can’t you just knock me out for about three days?
The goal of any pain therapy should be for the patient to be comfortable, but not necessarily pain - free. While it is normal for a postoperative patient to need more sleep, it is not normal or desired for the patient to sleep all the time. It is important to move about in order to prevent possible blood clots or pneumonia.
I don’t think my family member will understand how to use that little button for pain medicine. Can I just push it for him?
The Patient Controlled Analgesia (PCA) button on an IV or epidural pain medicine infusion should only be activated by the patient. It is potentially unsafe for another person to give the patient additional doses, especially if the patient is sleeping. If you are concerned that the patient is unable to use the dose button, please speak to the doctor and nurses.
How long will I have my IV PCA or Epidural?
IV PCA and epidural analgesia are usually used for 2 - 3 days or until the patient is able to take analgesics by mouth.
How do I tell the doctors and nurses about my pain?
Pain is a totally subjective experience that can only adequately be described by the patient. To make this description more meaningful to doctors and nurses, you may be asked to use a "pain scale". These are usually numerical or descriptive scales:
The goal is to stay on the low end of the scale, not to be pain-free.
Is there anything else I can do for my pain in addition to taking medications?
There are many non-drug therapies available. Simply changing position can often bring considerable relief. Applying heat or cold to the incision, if ordered by your physician can be of comfort. One of the easiest, but often overlooked pain management techniques is the use of distraction. Distraction is a kind of sensory shielding, i.e., the patient shields himself from the sensation of pain by increasing other sensory input. Turning the TV on, reading a book, listening to the radio, or visiting with a friend can actually provide a great deal of pain relief to patients. This is not to imply that the pain is in the mind, but rather that the mind is a powerful tool - use it!
Remember....
While you are expected to have pain following a surgical procedure, the pain should not be such that you cannot sleep, eat or move about. If it is, tell your nurse!
Contibuting Author: Peggy Phillips, R.N.
- History of anesthesia
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1842 - On March 30, Dr. Crawford W. Long administered the first anesthetic using ether in Jefferson, Georgia, a small community 60 miles northeast of Atlanta. However, this event was not publicized.
Hardie Gramatky, artist
1844 - On December 11, Dr. Horace Wells, a dentist, inhaled nitrous oxide while a fellow dentist painlessly extracted one of Dr. Well's teeth. However, Dr. Wells' attempt to produce anesthesia using nitrous oxide at Massachusetts General Hospital in 1845 failed and the use of nitrous oxide for medical purposes fell into disrepute.
Hardie Gramatky, artist
1846 - On Friday, October 16, Dr. William Thomas Green Morton, a dentist from Harford, Connecticut, and Dr. Well's partner, administered ether to Mr. Gilbert Abbott for the removal of a tumor by the well-known surgeon Dr. John C. Warren at Massachusetts General Hospital . An account of this event appeared in the Boston Daily Journal the next day.
1847 - Dr. James Y. Simpson, a highly respected obstetrician in England, administered ether to a mother during labor. However, it wasn't until Dr. John Snow, another English physician, administered chloroform to Queen Victoria during the birth of Prince Leopold in 1853 that obstetrical analgesia gained public acceptance. Dr. Snow was the first physician to devote his medical practice to the administration of anesthetics, making him the first anesthesiologist.Anesthesia as a medical specialty evolved differently in England and the USA. Chloroform, initially the standard anesthetic in England, required great skills in its administration. As a result, only physicians were considered competent to administer chloroform. In contrast, ether remained the dominant anesthetic in the USA for many years. Because ether was safer to administer than chloroform, its administration was often relegated to an inexperienced physician or nurse. Because of the development of better anesthetics, neither ether or chloroform are commonly used anywhere in the world today. However, the administration of anesthesia by either an anesthesiologist or nurse anesthetist is a practice unique to the USA.1887 - Sister Mary Bernard, a Catholic nurse at St. Vincent's Hospital in Erie, Pennsylvania, was the first nurse known to have specialized in anesthesia.1904 - First department of anesthesia in the United States established at the New York Medical College under Dr. Thomas D. Buchanan1905 - The Long Island Society of Anesthetists, later renamed the American Society of Anesthesiologists, was founded.1923 - Mary A. Ross, M.D. became the first postgraduate trainee in anesthesiology in the United States, received her certificate from the University of Iowa following a year of training after graduation from medical school.1931 - The National Association of Nurse Anesthetists, later renamed the American Association of Nurse Anesthetists, was founded.1938 - The American Board of Anesthesiology was founded. - Brochures and Videos
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This information is provided by the American Society of Anesthesiologists
Anesthesia & You...Anesthesia for Ambulatory Surgery (pdf)
Anesthesia & You...Sedation Analgesia (pdf)
Anesthesia & You...Planning Your Childbirth (pdf)
My Trip to the Hospital Coloring Book (pdf)
Herbal & Dietary Supplement Use and Anesthesia (pdf)
When Your Child Needs Anesthesia Video (Real Media File)
Sleep Apnea Video (Real Media File)
Pain Medicine Video (Real Media File)
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