Layman's guide to anesthesia

Written by Caitlin Goodwin, Caitlin Goodwin, DNP, RN, CNM, is a Board Certified Nurse-Midwife, Registered Nurse, and freelance writer. She has over twelve years of experience in nursing practice.

Anesthesiology is the practice of medicine supporting the pain relief and complete care of patients before, during, and after surgery. Early anesthesia occurred in Mesopotamia around 3400 BC in the form of poppies. Arabic physicians used opium in Sumeria (modern-day Iraq) before surgery. However, nurses have a long history of delivering anesthesiology in the western hemisphere. In the United States, nurses administered anesthesia during the Civil War from 1861 to 1865.

Luckily, we’ve come a long way when it comes to surgical pain relief. Safety, efficacy, and collaboration in anesthesiology care are critical to healthcare. This article will cover pain relief, the different sedation practices, and when they are used.

Who performs anesthesia?

There are many members of the anesthesiology care team that support the anesthesia clinicians. Physicians, advanced practice nurses, and non-physician non-nurses can administer anesthesia.

• Anesthesiologists: Medical doctors who graduate from an undergraduate science program, medical school, and a residency. Some anesthesiologists participate in fellowships for even more specialized training.
• Certified registered nurse anesthetist (CRNA): Registered nurses with critical experience who complete a CRNA program and become an advanced practice registered nurses. In some states, they must work with a supervising board-certified physician while working independently in others.
• Anesthesia assistant (AA): AAs are non-physician anesthesia providers with graduate-level education and clinical training. They work in cooperation with the anesthesiologist, under their medical direction and supervision. Not all states allow AAs to practice, but they are a valuable asset to the team where available.
• Anesthesiology technician: Anesthesiology techs perform tasks like restocking, cleaning, calibrating, and testing tools. They also monitor equipment for anesthesiology patients. Techs:
  1. supports anesthesiology providers and personnel,
  2. manages and maintains equipment,
  3. and assists with the administration of drugs to patients.

What are the available anesthesia services?

Anesthesia services are diverse and can specialize in various age ranges, anesthesia types, and populations. Anesthesia services include a number of areas, such as:

• Patient consultations
• Anesthesia and analgesia before, during, and after surgery
• Managing patient during surgical and medical procedures
• Assisting with cardiopulmonary resuscitation and intubation
• Anesthesia for obstetric patients
• Critical care patient management in intensive care units (ICUs)
• Acute and chronic pain management
• General anesthesia
• Regional anesthesia
• Conscious sedation (minimal, mild, and deep)

What are the types of anesthesia drugs?

The route of medication that you receive will vary depending on the type of anesthesiology that you will receive:

• Oral
• Intramuscular (a shot)
• Intravenous (through an IV, usually in your arm)
• Inhalation (like nitrous oxide, also known as “laughing gas”)

What are the main types of anesthesia?

The anesthesia type will depend on the procedure, the patient’s health status, and the doctor’s preference. Make sure to discuss any alternative options with the anesthesiology team if you have concerns. The primary types of anesthesia available are:

1. General
   • General anesthesia renders patients wholly unconscious and they breathe through a tube that goes into the lungs (intubation). Patients under general anesthesia inhale and exhale with the help of a ventilator and must be monitored closely by an anesthesiology provider.
   • Procedures include cardiac or brain surgery.
2. Intravenous (IV) or Monitored anesthesia care (MAC):
   • With this type of anesthesia, you will receive sedation and comfort but remain conscious and breathe on their own. Many patients fall asleep with MAC, also known as conscious or twilight sedation, to encourage relaxation and even sleep during mild surgeries or less complex procedures where an injection of local anesthesia will not cover, but general anesthesia is not needed. It is performed in a hospital or outpatient setting like same-day surgery or an office.
   • Sedation includes:
     • Minimal: You are likely to be awake but relaxed. You will understand questions, be involved in the procedure, and able to follow directions.
     • Moderate: You may feel drowsy and fall asleep during the procedure but may or may not remember some of the procedure
     • Deep: You won’t be unconscious, but you will not recall the procedure.
   • Procedures include colonoscopy or dental work.
3. Regional (spinals, epidurals, nerve blocks)
   • Regional anesthesia offers comfort while remaining conscious and breathing on their own. Nerve blocks prevent the sensation in a part of your body during the procedure. These drugs numb the pain without putting you (or your infant if you are pregnant) at an increased risk from medications.
   • Examples include labor epidurals, spinal for cesarean section, and nerve blocks for reducing dislocation of fractures.
4. Local
   • Surgery can be performed while alert and awake with a local anesthetic injected to numb a small area of the body for mild procedures. You won’t feel any pain in the area but will feel pressure and pulling.
   • Examples include getting teeth pulled, a skin biopsy, receiving stitches, or repairing a deep cut.

What should I expect from anesthesiology?

• Your doctor will discuss the pre-operative and post-operative guidelines for eating and drinking.
• The anesthesiology team will look at your medical record and take a complete history. Be honest and open to their assessment.
• They will tailor an anesthesia plan to you and discuss the type of anesthesia to expect for procedures and surgeries that range from simple to complex.
• The team will discuss the risks and benefits of anesthesiology and encourage you to ask questions to feel comfortable with the procedure.
• Anesthesia monitors your health during the surgery to ensure that you are safe and comfortable.
• Just because the surgery is finished doesn’t mean they stop participating in your care. They will work with the surgeon or doctor to make sure that all of your needs are addressed, and your pain is managed.

What are the possible side effects or risks of anesthesiology?

The side effects vary depending on the type of anesthesia.

1. General anesthesia:
   • Nausea and vomiting
   • Dry mouth
   • Sore throat or hoarseness
   • Chills and shivering
   • Confusion and brain fog
   • Muscle aches
   • Itching
   • Bladder problems
   • Dizziness
2. Conscious sedation or intravenous (IV):
   • Nausea and vomiting
   • Drowsiness
   • Heaviness
   • Amnesia of procedure
   • Slow reflexes
   • Low blood pressure (hypotension)
   • Headache
3. Regional anesthesia:
   • Hypotension
   • Itching
   • Headache
   • Allergic reaction
4. Local anesthetic:
   • Infection
   • Bleeding
   • Nerve damage
   • Allergic reaction
   • Swelling

Anesthesiology is now a regular part of medical care. Historically, patients who did not have anesthesiology would often choose death rather than face the pain of uncomplicated surgical procedures. Anesthesiology saves lives and makes surgical procedures accessible for all. It is important for those undergoing anesthesia to feel comfortable with what it is and what to expect.