If you’ve ever had a biopsy, colonoscopy, joint replacement or heart procedure, you’ve experienced the miracle of anesthesia firsthand. Medication that prevents patients from feeling pain (or remembering it afterward) has come a long way since the days of taking a shot of whiskey or breathing in a chloroform-soaked cotton pad. Thanks to advancements in the medications and delivery methods, patient deaths attributable to anesthesia have plummeted from one in 10,000 cases in 1980 to less than one in 250,000 today.
Still, when it comes to helping a patient navigate a procedure without pain, there is the possibility of unpleasant—even dangerous—side effects. It’s important to arm yourself with information before you hit the operating table.
Just because anesthesia is safer today than ever before doesn’t mean that side effects or mistakes don’t happen. Here are some ways to protect yourself…
Be honest in your pre-anesthesia interview. Just prior to receiving general or regional anesthesia, you’ll meet with your anesthesiologist and/or be asked to fill out a pre-anesthesia questionnaire. This information can help your health-care team predict how you will respond to certain drugs. Some questions will duplicate those you’ve already answered for your doctor, but this time your answers are being reviewed by different providers for a specific purpose. And answering these questions even may help you remember a detail that you forgot to share with your doctor, such as an over-the-counter product you have been using or a bad reaction to anesthesia during your wisdom tooth extraction or C-section decades ago.
Be honest when answering questions about your drinking and smoking habits (both increase risk for complications and delay recovery)…whether you take medicine for erectile dysfunction (which can cause blood pressure to drop dangerously low when combined with anesthesia)…if you’ve recently had a cold or the flu…and anything else he/she might ask.
Some patients are more likely to develop complications due to pre-existing conditions, so make sure your anesthesiology team knows if you’ve been diagnosed with diabetes…heart disease, high blood pressure or stroke…allergies…kidney disease…a lung condition, such as asthma, COPD or have a history of smoking…obesity…or seizures or other nervous system complication.
Tell the anesthesia team if you have loose or chipped teeth or recently underwent cosmetic dental work. Dental injuries are one of the more common complications of general anesthesia. Loose teeth can be dislodged during intubation. If you recently had a crown or implants placed, let the anesthesiologist know, so extra care can be taken to avoid damaging your new work…or you may be asked to wear a plastic mouth guard during the procedure.
Tell the anesthesia team if you use more than one pillow at night or a CPAP machine. People who need to prop themselves up to sleep well (perhaps due to reflux, obesity or sleep apnea) generally don’t tolerate lying down for prolonged periods, as is required during surgery. It changes the way weight is distributed on your diaphragm and/or can cause your tongue or neck tissue to obstruct the airway. Letting your team know you need extra pillows at home puts them on high alert for challenges. If you use a CPAP machine: Let your doctor know before the day of your procedure. You may be asked to bring it to aid your breathing in the recovery room.
Tell the anesthesia team if you easily become nauseated, carsick or seasick. Anesthesia stimulates an area of the brain called the chemoreceptor trigger zone, which is linked with nausea. People who tend to experience nausea in day-to-day life may be more likely to experience it after surgery. You can request that anti-nausea medications, such as ondansetron (Zofran), granisetron (Kytril) and dolasetron (Anzemet), be administered during surgery to prevent post-op nausea. Or order the FDA-approved ReliefBand wristband device, and ask for it to be put on your wrist after surgery.
Ask family members if they’ve ever had a negative experience with anesthesia. Several anesthesia-related problems tend to run in families. If you’ve never gone under anesthesia before, it’s crucial for you to warn your anesthesiologist if any family members, especially your parents, have experienced problems.
General anesthesia is for surgeries of the head, chest, spine and abdomen. It involves a combination of preoperative sedatives, narcotic painkillers, muscle relaxants and sleep agents to render you unaware and immobile. Most of these are given via IV right before the operation. Possible side effects: Sore throat…nausea and vomiting…and lingering grogginess. Rare serious risks: Brain damage due to lack of oxygen, nerve or dental injury, aspiration pneumonia or death.
Regional anesthesia is used to numb the entire lower part of the body or numb a specific region (such as a shoulder, foot or toe.) It’s often used alongside sedating drugs, which make you so relaxed that you barely realize you’re in surgery. Spinal anesthesia, one type of regional anesthesia, is injected through the back into the spinal fluid. Spinal anesthesia with sedation often is used for hip and knee surgeries, hernia repairs and transurethral resection of the prostate (TURP). Possible side effects: Headache, feeling short of breath and a rapid, but temporary, drop in blood pressure. Serious but rare risks include pain, bleeding or infection at the injection site, nerve injury or a debilitating headache. One benefit: A small catheter can be placed to allow the medicine to be delivered continuously over hours or even days. Note: If the doctor wants the patient awake during surgery, he/she may use spinal anesthesia (also known as a spinal block) with some sedation to ease the patient’s anxiety. Called awake spinal surgery, it results in shorter operating time, quicker recovery and fewer side effects.
Epidural anesthesia is similar to spinal anesthesia. Anesthetic is injected through the back into an area near the spinal cord. Epidurals take effect more slowly than spinals and are less likely to produce a sudden, rapid drop in blood pressure. A catheter also can be placed to administer the medicine continuously.
Nerve blocks—a third type of regional anesthesia—are good for hand, arm, leg and foot procedures, as well as cosmetic procedures such as face-lifts. Local anesthesia is injected into a specific nerve to numb the region or limb. Patients can remain awake and speak with their surgeon. Rare risks include nerve injury or seizures if the medicine is accidentally injected into the bloodstream.
Local anesthesia is typically used in procedures involving isolated areas, such as during LASIK or cataract surgery, breast biopsies or mole removal. The risk of side effects is extremely low.
Monitored anesthesia care (MAC) is a combination of local anesthesia plus sedation. MAC often is used during outpatient diagnostic procedures or therapeutic procedures such as colonoscopies, breast biopsies and minor orthopedic procedures including carpal tunnel surgery. Various levels of anesthesia, ranging from light to heavy, may be used to control pain, along with sedating and antianxiety drugs. Advantage: You remain semiconscious (“twilight sleep”) and can respond to verbal commands. Potential side effects: Post-procedure nausea and drowsiness. While MAC has been proven to be overwhelmingly safe, there are rare and isolated instances in which dosing errors have harmed patients.
One-quarter of patients over age 65 may experience problems with thinking, learning, judgment and perception in the weeks and months following surgery. Called post-operative cognitive decline (POCD), it’s thought to be caused by the release of inflammatory toxins that can occur when anesthesia is administered.
New finding: A 2020 study by University of South Australia found that nearly 40% of patients continue to experience POCD one to five years after coronary bypass, one of the most common heart procedures. POCD impacts older adults more often because an aging brain doesn’t bounce back from anesthesia easily.
Reduce your risk of POCD by regularly practicing brain-healthy habits such as following the Mediterranean diet…getting regular exercise…maintaining a healthy weight…managing stress…and getting sufficient sleep.
Also ask your doctor about possible risks of your specific surgery…how deep your level of anesthesia will be (POCD is more likely to occur following longer, more complicated procedures using general anesthesia than quick outpatient ones)…and what medications will be used during and after the surgery. Opioids, for instance, may increase risk for POCD.
