It is said that “anaesthesia induction is like a flight taking off”. Your anaesthetist ensures that you have a smooth take-off, peaceful journey and a safe landing by adjusting the right medicines according to your individual needs. When you’re preparing for your surgery, it is important for you to understand the knowledge, training and role of your anaesthesiologist just like your surgeon.
Anaesthesia means the absence of pain or sensation. Anaesthesiologists also specialise in critical care medicine (caring for the seriously ill) and pain management.
They ensure your optimal safety before, during and after your procedure working with your surgeon.
Definition of anaesthesia
The word anaesthesia is from Greek origin and it means an absence of sensation, in today’s practice it can also include a loss of pain (analgesia), muscle relaxation (paralysis), and loss of memory (amnesia).
Importance of anaesthesia in medical procedures
Surgical procedures are painful and involve considerable anxiety and distress to the individual . Good anaesthetic care ensures that the transition to and from surgery is smooth and pain-free.
Types of anaesthesia
All types of anaesthesia keep you comfortable and pain-free during your surgery, medical procedure, or test. But the type you receive will depend on factors like the procedure, your health, and your preference.
When you are getting a wound stitched or undergoing a skin biopsy , a simpler, one-time small dose called local anaesthesia will be used. Possible side effects include allergies, but these are rare. This is often combined with a regional block.
This is usually done in procedures where it is better for you to be awake and only a part of the body is operated upon. In childbirth, epidurals and spinal anaesthesias are a form of regional blocks, where the mother can actively push the baby out without too much pain.
This is the most common form of anaesthesia given to keep you pain-free and unconscious. The medications are given through an IV line, after which you will drift into sleep. Many regular bodily functions will slow down, so a tube may be put in your throat (intubation) to help you breathe easily.
When your body does not need full general anaesthesia but also requires you to be relaxed and pain-free during the procedure, sedation can be offered. This is usually done with colonoscopies or biopsy procedures. It is given through a vein and recovery is faster than general anaesthesia.
How does anaesthesia work?
Mechanism of action
Pain and other sensory signals are sent from the nerves in the body and perceived by the brain. Anaesthesia temporarily blocks these signals, thereby reducing or eliminating the sensation of pain. The drugs used target specific receptors in the brain and spinal cord which are responsible for sendinging and receiving nerve signals related to pain perception and consciousness.1
Before the procedure you will be evaluated by your anaesthesiologist to ensure you are fit for it. Since it will directly impact your care, be fully honest about your medical history during the evaluation. Let them know if any of the following applies:
- You take any regular medications (supplements or otherwise)
- You smoke or use marijuana
- You drink alcohol
- If you snore
- If you have suffered from heat stroke
- Have any medication allergies
- Have any chronic illness
Depending on the type of block, the anaesthetic is usually given through a vein (at a specific nerve bundle), through inhalation of a gas or through a tube placed in your spine.2
Your anaesthesiologist will monitor your vital parameters (heart rate, blood pressure, oxygen levels, etc.) as there can be fluctuations due to the surgery or the medication.
Risks and complications
Some common risk factors that will increase your chance of experiencing complications while taking anaesthesia include:
- Heart disease
- Allergies to medication
- High blood pressure
- Kidney problems
- Lung problems
- Obstructive sleep apnoea (OSA)
- Substance abuse (smoking, alcohol, marijuana, etc.)
Some adverse effects of anaesthesia are:
- Problems with difficult airway and breathing- if you have OSA or snore during sleep, chances are your airway is narrow and you might face additional problems with anaesthesia- like difficulty breathing with a mask or tube, low oxygen levels and delay in discharge and recovery3
- Some individuals are prone to malignant hyperthermia- a condition where there are strong muscle contractions and fever on administration of anaesthesia.4 Do let your doctor know if you have a family history of this or if you have ever suffered from heat stroke
- Elderly people or those with a history of brain-related illnesses are prone to postoperative delirium (memory and cognitive decline), which can be avoided with prompt recognition and management5
Precautions to avoid risks
Take your pre-operative appointment with your anaesthesiologist seriously. Discuss all your past medical problems honestly and follow the pre-operative advice.
Recovery and postoperative care
In the recovery room the anaesthesiologist ensures pain relief, monitors your vitals and decides when it is safe for you to go home.
Various strengths of medications are given according to your weight and other criteria during recovery time and after going home to make a smooth transition to recovery.6
Different complications can occur depending on the type of anaesthesia administered.6
- Nausea and vomiting
- Back pain
- Hematoma formation (bleeding beneath the skin)
Local/ regional blocks
- Local itching/pain
- Allergic reaction
It is important to understand the role your anesthesiologist will have on your surgical procedure. So work with them by providing your full medical history to the doctor, to ensure a safe procedure and a quick recovery.
There are four types of anaesthesia (local, regional and general anaesthesia and sedation) which are given based on the procedure and each have their own side effects and benefits. Some common side effects are difficulty breathing, malignant hyperthermia and postoperative delirium. However, your anesthesiologist will carefully monitor you during and after the procedure to ensure that these effects don’t occur.
- Son Y. Molecular mechanisms of general anesthesia. Korean J Anesthesiol [Internet]. 2010 Jul [cited 2023 Jul 13];59(1):3–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908224/
- Eroglu A, Apan A, Erturk E, Ben-Shlomo I. Comparison of the anesthetic techniques. ScientificWorldJournal [Internet]. 2015 [cited 2023 Mar 27];2015:650684. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4461791/
- Rudra A, Chatterjee S, Das T, Sengupta S, Maitra G, Kumar P. Obstructive sleep apnoea and anaesthesia. Indian J Crit Care Med [Internet]. 2008 [cited 2023 Mar 27];12(3):116–23. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738308/
- Rosenberg H, Davis M, James D, Pollock N, Stowell K. Malignant hyperthermia. Orphanet J Rare Dis [Internet]. 2007 Apr 24 [cited 2023 Mar 27];2:21. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1867813/
- Whitlock EL, Vannucci A, Avidan MS. Postoperative delirium. Minerva Anestesiol [Internet]. 2011 Apr [cited 2023 Mar 27];77(4):448–56. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3615670/
- Horn R, Kramer J. Postoperative pain control. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Mar 27]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK544298/