The Doctor Is In: Anesthesia, fact or fiction?

The Doctor Is In is an occasional series where JHU Press authors discuss the latest developments and news in health and medicine. Guest post by Steven L. Orebaugh, M.D. 1. Anesthesia is a very risky aspect of the surgical process. Fiction: The risk of dying or  having a severe adverse outcome from the effects of  anesthesia has decreased 100-fold over the past four decades, according to some studies. With the impressive array of physiologic monitoring devices, the extensive training required for certification, and the variety of modern pharmaceuticals available to them, anesthesiologists today are able to deliver a very safe anesthesia experience to the vast majority of patients. 2. Regional anesthesia represents a reasonable alternative to general anesthesia for many procedures. Fact: While surgeries that involve body cavities (pelvis, abdomen, chest), the back, or the head/neck often require deep general anesthesia with airway control as a matter of course, many types of surgeries can be conducted with regional anesthesia techniques, which involve rendering the operative area numb through the injection of local anesthetic drugs. This is especially true for procedures that are superficial (such as hernia repair or breast surgery), and those that involve the extremities. Such techniques do require the extra step of injecting the nerve block before the surgery. 3. Regional anesthesia techniques and general anesthesia are mutually exclusive ways to prepare a patient for surgery. Fiction: Regional techniques can be used with awake patients or with mild “twilight” type sedation in the operating room. However, when a regional nerve block is performed, a patient may still be safely rendered insensible to events in the operating room with sedative/anesthetic drugs, and this is much more common than patients remaining awake. The sedation may be utilized to produce a light state of unconsciousness or a deeper state of general anesthesia. 4. When a patient has a spinal or nerve block, he is usually awake during the surgery itself. Fiction: The degree of sedation that is administered can be discussed with the anesthesiologist—light levels may permit some perception of events in the operating room while allowing quicker return to consciousness after the procedure (which is preferred by some patients). Providing deeper levels of sedation, or general anesthesia, prevents such perception with greater certainty. 5. Nerve blocks involve a great deal of pain. Fiction: In studies of pain levels experienced during block placement, the level of pain is similar to that of placement of an IV catheter in the hand or arm. What makes nerve blocks far more tolerable than IV sticks or other needle injections is that patients are typically placed under mild sedation. 6. Nerve blocks pose a high risk of nerve injury to patients. Fiction (with some fact): There is some risk in placing a nerve block, but the actual cause of nerve injury after a block is poorly understood. The injected chemicals—the local anesthetics—may be the primary agents of injury, as opposed to the needle. The risk of serious nerve injury is quite low with any of the popular means of guiding a nerve block—on the order of one in two to five thousand. Minor disturbances of nerve function (numbness or tingling after surgery) are more common, but usually involve no functional compromise and almost always disappear within a few weeks, if not days. When nerve injuries that occur in the wake of surgery and regional anesthesia are thoroughly investigated, only a small minority (perhaps 10 percent) are actually attributable to the block. 7. Nerve blocks can reduce the side effects of general anesthesia. Fact: When nerve blocks are used, the amount of anesthesia required to maintain unconsciousness during the surgery is substantially reduced, which in turn reduces anesthetic side effects such as nausea, vomiting, drowsiness, dizziness, and poor concentration. Peripheral nerve blocks used for extremity surgery, in combination with sedation, have shown particular benefits, including less postoperative pain and anesthesia side effects on the day of surgery, earlier ambulation, earlier capability to eat and drink, and earlier discharge from the hospital. Steven L. Orebaugh, M.D., is an associate professor of anesthesiology at the University of Pittsburgh School of Medicine, where he is also an associate professor of critical care. His book, Understanding Anesthesia: What You Need to Know about Sedation and Pain Control, is now available from the JHU Press. The information provided in this blog post is not meant to substitute for medical advice or care provided by a physician, and testing and treatment should not be based solely on its contents. Instead, treatment must be developed in a dialogue between the individual and his or her physician. This post has been written to help with that dialogue. The services of a competent medical professional should be obtained whenever medical advice is needed.
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