About Anesthesia

  • Anesthesia is the administration of medications to a patient at the time of surgery that eliminates pain, anxiety and all discomfort while surgery is being preformed. Modern anesthesia for a healthy patient is very safe and effective. We commonly use four types of anesthesia: 1) general, 2) regional, 3) local and 4) conscious sedation. Anesthesia is administered by a specialist in anesthesia who has had specialty training after medical school and is eligible or has passed specialty board examination.
  • Our Preferred Anesthesia technique is a combination of local and general anesthesia. The general anesthesia is very safe and effective. Local anesthesia combined with the general has several advantages. First, it is 100% effective. You will not feel anything or be aware of anything. Second, we can avoid deep general anesthesia compounded by narcotics and sedatives. This means that you wake up faster and more clear headed and have less risk of anesthesia hangovers such as nausea and memory loss. Third, most patients wake up pain free. The local anesthetic lasts about a day which makes your first day and night after surgery very comfortable. Even after the local anesthetic has worn of you will have an easier time because you were spared pain during the first day. Our patients have no trouble traveling home across the country literally one day after surgery.
  • General Anesthesia induces a deep state of sleep rendering a patient completely unaware of the surgery which is being preformed. This is the type of anesthesia that is used most commonly for hernia and gallbladder surgery. It may be used for any type of surgery but may be more that what is required for more minor procedures. Ether was one of the first medications used for successful general anesthesia but it is no longer used today. Ether has been replaced by safer modern anesthetic gases and intravenous medications which are selected and combined by an anesthesiologist for the particular needs of each patient. Each patient prior to surgery is examined and interviewed by the anesthesiologist who then tailors and plans the anesthesia procedure.
  • Regional Anesthesia is the administration of a nerve block which makes an arm, a leg or the lower body from the waist down numb and insensitive to pain. This is like the local anesthesia a dentist uses for a tooth but applied to a limb or the entire lower body. Along with the numbness the patient experiences temporary paralysis of the limb or lower body. During this type of anesthesia the patient is awake or in a very light sleep. Light sleep is induced to relieve anxiety in some patients. Examples of this type of anesthesia are: spinal block, epidural block, Beer's block and ankle block. Patients that undergo regional anesthesia occasionally require conversion to general anesthesia.
  • Local Anesthesia is the application of an injectable nerve blocking medication such as Novocain into a small area of the body. This is commonly used for very minor procedures such as removal of a skin mole. It is used by some surgeons in combination with conscious sedation for hernia repair. We have used it for hernia repair in a few select patients but we feel this technique has too many disadvantages to be the first choice for most patients.
  • Conscious Sedation is the induction of a light sleep. The cerebral cortex is asleep and the patient is not conscious. The sleep is not so deep however to stop brainstem activity. This means that the respiratory centers which are in the brainstem are still functioning and the patient is breathing by themselves. The patient may still move and breath of their own accord and they may be quickly woken up. Conscious sedation is commonly used in combination with regional and local anesthesia. It is used alone for less painful procedures such as colonoscopy. The major disadvantage of this technique is that if the patient stops breathing the anesthesiologist does not have control of the airway. This is an emergency situation.
  • Choice of Anesthesia is made by our specialist in anesthesia for each individual patient prior to surgery.  Safety comes first. The safest form of anesthesia for a particular patient and procedure is always chosen. There is a very common misconception by patients that local anesthesia is the safest. This is not true for hernia surgery and is not true for most major surgery. The problem with local anesthesia is that it is not 100% effective. Failure of local anesthesia after the surgery has begun and switching to a different form of anesthesia is where the risk occurs.
  • Cognitive dysfunction after general anesthesia It has been reported that elderly patients can experience temporary cognitive function decline after major surgery. Risk factors are age, existing cognitive dysfunction, cardiovascular disease, hypotension during surgery and length of surgery. When it happens it is usually temporary lasting weeks and sometimes months. It is rare in short elective cases in patients with no risk factors. I have not seen it in 7,000 elective hernia repairs including elderly patients. I spoke to our chief of anesthesia and he says that in 10,000 cases he has not seen it. It used to be widely assumed that it was caused general anesthetic medications and gases. There is mounting evidence that it is not caused by general anesthesia but is caused by the acute inflammation that surgery triggers.

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