top of page
nursejillllc
Mar 235 min read

I'll Be Asleep, Right?!


The second installment in our Navigating Surgery series.

Check out the first installment: They're going to cut me?!


Now that you have had your conversation with the surgeon about your procedure and you have a rudimentary grasp on what will be done, possible complications, and expected recovery requirements, the next question that usually arises is: I’ll be asleep, right?!


A reasonable question!


Anesthesia to the Rescue


The next conversation you will have prior to your procedure is with your anesthesia provider. Usually this is either a Medical Doctor of Anesthesia (MDA) or a Certified Registered Nurse Anesthesiologist (CRNA). Both go through rigorous training to become skilled in the art of making sure you are comfortable during your procedure.


Anesthesia is an Art as Much as it is a Science


There is a wide spectrum of consciousness that can be achieved with a titration approach of select drugs. One one side of the spectrum you have just sleepy enough to be unaware during a colonoscopy but you're still breathing on your own. On the other side of the spectrum you have sleeping so deeply that the anesthesia provider has to take over breathing for you.


Your anesthesia provider watches over you every minute and adjusts medications, adds medications, or titrates medications to make sure you are stable during invasive procedures. This is an art just as much as it is a science.


The most common types of anesthesia are: general anesthesia, spinal anesthesia, regional anesthesia, and conscious sedation though many times an anesthesia provider may use more than one type to offer the most comfort to a patient both during the procedure and immediately after.


General Anesthesia


General anesthesia is a term used for induced unconsciousness. As stated above this unconsciousness can vary from a really good nap to sleeping so deep that you require a breathing tube. The breathing tube protects your airway and allows the anesthesiologist to breathe for you while you are asleep.This is extremely common in the operating room. The vast majority of patients who require a breathing tube during a procedure have it removed before they are awake enough to remember it. Even though you are in a deep sleep you will still receive pain medication to treat incisional pain.


Spinal Anesthesia


Spinal anesthesia is when an anesthesia provider carefully injects medication into a special fluid-filled space around your spinal cord. This medication then numbs your body from that point of injection down. When they do this your legs will begin to feel warm and heavy and within minutes you won’t be able to lift your foot. This procedure is very effective for pain control but can only be used for procedures on the lower parts of the body such as total knee replacements, total hip replacements, and c-sections.


A lot of times the anesthesiologist will also give you a little medication through an IV to help you sleep lightly through the procedure so that you don’t have to be aware of the details during surgery. The exception to this is C-sections as the mom usually wants to stay alert in order to interact with her baby right away.


Regional Anesthesia


Regional anesthesia is targeted pain management. An anesthesia provider injects a medication around a main nerve that then blocks pain from that nerve which includes all nerves "downstream" from the main nerve.


For example: if you are having arm surgery, the anesthesiologist could inject around a main nerve in your shoulder that would then block pain from the shoulder down. These injections are referred to as "nerve blocks" and they are very effective for pain control. Nerve blocks are most frequently used in surgeries involving limbs but there are a few other regions that can also be nerve blocked that may be offered. A lot of times you will still be given some medication to sleep through the procedure but this technique can significantly reduce the amount of pain medication you need both during and after surgery. However, the block itself is usually, but not always, done prior to actually going back to the surgery suite.


Conscious Sedation


Conscious sedation sounds somewhat contradictory but it is actually a very accurate description. Conscious sedation is when you are conscious enough to follow simple commands and breathe on your own but sedated enough that you have little to no anxiety. You may or may not dose off a bit. Some procedures, such as cataraact removal, require that you stay mostly awake so that you can follow directions and stay still but the concious sedation will chase away the butterfiles that you may have.


Constant Care


Regardless of how light or deep your anesthesia needs to be for your procedure the anesthesia provider uses different monitoring tools to be able to watch your heart rhythm and rate, oxygen saturation, breathing rate and depth, and blood pressure for every minute that you are under sedation. They continue to monitor you immediately after your procedure as well until you are fully conscious again. The anesthesiologist literally sits right by you the entire duration of the surgery taking care of you. They do not leave unless another anesthesiologist comes and sits right by you to continue your care.


Collaborative Care


Your surgeon and anesthesiologist will let you know what type of anesthesia is necessary for your procedure. They work together closely to make sure you get the right type of sedation and pain relief. The procedure itself usually dictates the type of anesthesia that you need so while you should let your preferences be known to your care team, their recommendations are frequently spot on for making sure you have the most comfortable experience possible.


Honesty Effects Safety


Be honest with your anesthesiologist. A lot of patients get self-conscious about some of the questions that their care team asks. There is a fear of judgement from the providers or a fear that the team with withdraw good care if certain details are revealed. Your anesthesiologist is extremely skilled in balancing and titrating all the medications it takes to keep you asleep, comfortable, and stable during your procedure but if they don’t know about all the variables at work in your body it can pose a higher risk for unwanted events.


This is especially true of alcohol consumption, tobacco product use, marijuana use, non-medical use of perscription drugs, and use of illicit drugs.


If, however, you are honest with them they can take steps to mitigate the risks associated with these variables. They will not judge you nor withdraw good care! They just want to keep you safe during your anesthesia.


Also be open about any chronic conditions. Your anesthesiologist needs to know about your current and past health to be able to support you well during your surgery.


One last thing to not fudge about when chatting with your anesthesia provider: the last time you had anything to eat or drink. Eating or drinking too close in time to your anesthesia (regardless of how deep it will be) poses a high risk of aspiration. Aspiration is when stomach contents enter your lungs. This can cause pneumonia which sometimes results in complications severe enough to hospitalize you. Having an empty stomach is the best way to decrease your risk of aspiration.


Be honest with your team and they can take steps to keep you as safe as possible.


So I’ll be Asleep, Right?


The answer to the question that we posed at the beginning is: "Yes...probably." Your surgeon and anesthesia provider will give you what you need to get through your surgery. This usually is offering some kind of sleep but not every time. Just know that they both are extremely experienced and have done this so many times that they know what is most helpful for patients. Ask questions and get clarification but know that you’re in good hands.


Next step in surgery: recovery and managing pain. How to make a plan with you care team to keep your pain at a manageable level as well as how to heal quickly.


Sources:

bottom of page