General anesthesia is administered intravenously or via inhaling a special gas. Once asleep, you may have a tube inserted in your windpipe to assist breathing. Your blood pressure, breathing and pulse will be monitored closely, and you will not likely remember anything that occurs during the procedure.
There are also more moderate forms of anesthesia, including conscious sedation, in which you will be awake but comfortable during a relatively minor procedure.
Thousands of people undergo general anesthesia each week in the nation’s hospitals and outpatient clinics. Complications are rare, but they do occur – witness Joan Rivers, who underwent sedation at a doctor’s office and died from complications.
No Problem for Most
Healthy people usually have no problems, but some may be at a higher risk for problems. These are usually people who are obese; have existing heart, kidney or lung problems; are heavy smokers or drinkers, or abusing other substances; or have a family history of allergies to certain substances. While rare, deaths like Rivers' occur, and you may develop problems with vocal cords, get a lung infection, have a heart attack or stroke, have problems with your teeth or gums, and, in the most rare instances, awaken during the operating procedure. There have also been instances of post-anesthesia hallucinations.
The good news is that anesthesia-related deaths have decreased, according to the American Society of Anesthesiologists. Over the past two decades, deaths have decreased from two in every 10,000 patients to one per 200,000 to 300,000 patients. That’s in stark contrast to previous generations. In the 1940s, 640 people died for every 1 million who underwent an operation.
Today, as the ASA puts it, you’re more likely to be hit by lightning than to die from an anesthesia complication.
The Dangers of Anesthesia
That’s not to minimize the risks. The National Institute of General Medical Sciences says general anesthetics are among the most dangerous drugs doctors use. The reason deaths have declined is that the modern methods used to sedate patients are much shorter-acting than previous medications, thus decreasing the potential for side effects. And with new devices and technologies that can monitor blood pressure, oxygen levels, breathing patterns and heart rates, anesthesiologists can quickly take measures to stop any potential problems.
Despite increased safety, undergoing general anesthesia is still a traumatic experience for some people. The biggest fear is never waking up. Perhaps that’s a valid concern, because even with advances in medicine and the increasing safety of the procedure, it’s still unknown how anesthetics actually work. Most believe that the drugs target specific nerve cell molecules that send signals to the brain. Some believe different drugs target different molecules. But again, there is no certainty, and anesthetics have been around since 1846.
There is a condition called postoperative delirium. This is a condition that sometimes occurs after anesthesia allegedly wears off and can lead to confusion, hallucinations and memory loss. Some patients experience a kind of dementia in which they forget the reason they’re in the hospital, can’t respond to simple questions, and speak in fragmented and sometimes nonsensical sentences. While it’s not unusual to be a bit foggy after a major operation, the delirium can last for a day or more before most patients return to normal. In some rare cases, although confusion goes away, a patient can experience inattention and memory lapses for months and even years.
Three Types Of Anesthesia
Doctors can administer three types of anesthesia to their patients. The mildest is local anesthesia, which usually affects only a small area and is typically used by dentists during oral surgeries. Then there’s regional anesthesia, which numbs a large area of the patient’s body by inserting drugs into the spine, blocking off pain transmission to a certain area. This occurs with sedatives like propofol, which fans of singer Michael Jackson will recognize as the drug that ultimately caused his demise. Finally, general anesthesia renders a patient totally unconscious and is used in major surgeries.
While it’s not certain what causes postoperative delirium, some have argued that it may not be from anesthesia, but from a combination of other stresses, including the actual surgery, the poor sleep associated with being in an unfamiliar hospital setting, the restrictions of being hooked up to monitoring devices, and even the medications that are given before and after the operation.
But researchers aren’t satisfied that anesthesia doesn’t play a role. They suspect that the deeper one is put into hibernation, the greater the risks of post-operative delirium. In one study conducted by the Johns Hopkins University School of Medicine, a study of 114 patients undergoing hip surgery saw half receive propofol and half undergo general anesthesia. Approximately 11 of the light-sedation patients were delirious after the operation, as opposed to 23 who suffered delirium after general anesthesia.
While more studies need to be conducted, researchers are building a case. Still, trained anesthesiologists are competent professionals who will work hard to make sure you have a safe experience. Before your surgery, they will interview you for your complete medical history and use that information to determine how much anesthesia you will receive.
You also will be asked to cut back on blood thinners like aspirin, warfarin and ibuprofen, and any other drugs you ingest will be taken into consideration. The anesthesiologist will determine if you could be pregnant or are a smoker, both factors in the administration of any drugs. As with any surgery, you won’t take any food or drink after midnight before your surgery. This is done to prevent vomiting during your general anesthesia.
While you will wake up tired and groggy, your general anesthesia experience likely will be safe. Modern equipment, safety protocols and a better understanding of how much medication to administer have increased the safety margin, ensuring that you will not experience any complications out of the ordinary.