March 12, 2015
What to know about general anesthesia
BY Laura Nathan-Garner
Undergoing surgery soon, or know someone who is? You may have questions about general anesthesia, which is typically used when patients undergo surgery.
We recently spoke with Katherine Hagan, M.D., assistant professor in Anesthesiology and Perioperative Medicine, to learn more. Here's what she had to say.
What do patients need to do to prepare for general anesthesia?
At MD Anderson, all inpatients see a physician assistant or anesthesia provider before surgery. Outpatients see an anesthesiologist, physician assistant, or registered nurse in the Anesthesia Assessment Center. For a small number of outpatient procedures, such as routine colonoscopies or endoscopies in patients without recent medical problems, we may just do a phone interview.
During this appointment, your anesthesia provider will:
- Talk about not eating or drinking prior to surgery. Having an empty stomach is very important. It decreases the risk of food, fluid or gastric juices in the stomach getting into the lungs. The amount of time you can't eat depends on your age and the type of food or fluid. Your anesthesia provider will tell you when you can and can't eat.
- Tell you what medications you can take the night before and morning of surgery. Patients who take medicine for hypertension, diabetes and blood clots often can't take these medicines before surgery. Be sure to bring a list of your medications to share with your anesthesiologist.
- Assess your overall health, identify potential problems, and decide if you need to see a specialist. For example, if you've recently started having chest pains, you may need to see a cardiologist prior to surgery.
- Answer all of your questions.
How do you typically deliver general anesthesia for cancer patients? What should patients expect?
For many patients, we use intravenous (IV) medication to help with anxiety, pain and/or amnesia before going to the operating room. Once in the operating or procedure room, we monitor patients. This may include EKG, blood pressure and oxygen and carbon dioxide levels. Patients receive extra oxygen through a nose tube or facemask before going to sleep.
Some patients continue with only IV medications. Others may begin receiving anesthetics through both an IV and inhalation. Sometimes, young children receive anesthesia by breathing oxygen mixed with anesthetic gases. We then place an IV for the procedure.
In some cases, we offer the patient localized anesthesia. This will limit the feeling in a certain part of the body. We still monitor these patients and give them extra oxygen. We usually give medication to limit anxiety, and administer local anesthetic near the nerves around the surgical site. This may be called a nerve block, epidural or spinal. Afterwards, we may give the patient additional medication for surgery via an IV and/or a breathing tube.
How long does it typically take patients to fall asleep once the anesthesia has been delivered?
Typically, the anti-anxiety medicines we give take effect in less than two minutes. We give more medicine to induce sleep after we set up the patient in the operating room. This medication also takes about two minutes to work.
What does the anesthesiologist do during the surgery?
At MD Anderson, your anesthesia will be given by either a physician anesthesiologist or a team that consists of an anesthesiologist and a certified registered nurse anesthetist. One or both of them will be with you for your surgery and anesthesia. They will induce anesthesia, monitor your vital signs, adjust your anesthetic, ensure that you are comfortable after the anesthesia wears off, be there when you wake up and take you to the post-anesthesia care unit.
What happens if there are complications?
Anesthesia complications are extremely rare. But if there are complications related to the surgery or anesthetic technique, your anesthesia team and surgeon will work together to resolve the problem or concern. They also will thoroughly discuss the concern with the patient and family.
What should patients expect after surgery?
Typically, you can follow simple commands prior to leaving the operating room or procedure area. However, you are unlikely to remember this. Usually, 10 to 15 minutes after arriving in the recovery room, you are more aware of your surroundings and can talk to your nurses.
No matter what kind of surgery you're having, you shouldn't drive, drink alcohol, or make important decisions the day of surgery. You also may need to restrict what you eat or drink the rest of the day, depending on the surgery.
You may still have some pain or nausea when you're in the recovery room. Tell your nurses right away if you experience discomfort. This way, we can help make you more comfortable.
What are common anesthesia side effects?
Common side effects include drowsiness, nausea, itching and shivering. Your anesthesia provider will help minimize this by administering the right amount of anesthetic, providing other medications and keeping you warm.
What advice do you have for patients who are about to undergo general anesthesia?
Make sure you attend your anesthesia assessment center appointment. And, be honest so we can address all of your needs and concerns.
If possible, bring a family member or friend who will be with you on the day of surgery. This way, your caregiver will know what to expect.
Also, if you expect to be discharged the day of your surgery, you may want to have someone stay with you that night to help out if you need anything.
Be honest so we can address all of your needs and concerns.
Katherine Hagan, M.D.