WHY ARE SOME PEOPLE AFRAID OF GENERAL ANESTHESIA?
Over the years we have had many patients who have expressed concern regarding general anesthesia. Some have had previous bad experiences such as nausea and vomiting, others have never had anesthesia but have heard of people with such side effects, yet others have had anesthesia and felt that they were lethargic or had memory lapses for a while, and finally some have heard some horror stories about “people not waking up from general anesthesia”.
So, lets look at this with some detail:
General Anesthesia Gases
Yes, the most common side effect of general anesthesia is nausea and vomiting. Many years ago, this was the accepted norm. Meaning that every patient who underwent general anesthesia was expected to have some degree of nausea and vomiting during the first 24 hours after surgery. This side effect is mainly related to the anesthetic gas that is used. General anesthesia is usually started with injection of a deep narcotic such as Propofol and maintained with inhalation of an anesthetic gas.
Since around 20 years ago the anesthesia community started looking into this. More modern anesthetic gases with less chance of nausea and vomiting were developed and this research into development of newer anesthetic gases continues. As it stands the currently available and popular gases have much less risk of nausea and vomiting. The most commonly used of these gases is Ceboflorane.
General Anesthesia Techniques
Another major change that occurred was modification of technique. The anesthesiologists realized that certain techniques had higher risk of nausea and vomiting than others. The more modern techniques that were developed have been adopted by most currently practicing anesthesiologists.
Most important among these techniques was the use of certain anti-emetic (prevention of nausea and vomiting) medications before induction of anesthesia, during surgery if surgery was prolonged, and just before the patient waking up. A whole range of medications have been developed for this purpose. But the one that is most commonly used today is “Zofran”. In addition most anesthesiologists inject a small dose of a steroid such as Decadron before induction of anesthesia and this is also known to reduce the chance of nausea and vomiting.
Complications Of Anesthesia
Lethargy for a few days after anesthesia is sometimes seen. This has to do mostly with the patient’s genetics, physical condition, and personal history. However it is not something that can be predicted or prevented and it never lasts more than a few days.
Memory Lapse is probably less common than lethargy. Again, it is unpredictable, and unpreventable. Fortunately, just like lethargy, it does not last for more than a few days.
Prolonged Recovery From Anesthesia is occasionally seen. We see some patients who take longer to totally wake up from anesthesia. In most cases this is related to certain anesthetic substances and if the patient has a history of this problem his / her previous anesthesia records would need to be reviewed to make certain that those substances responsible for this problem are not used. However, in very rare instances patients genetically lack a certain enzyme (acetyl choline esterase) necessary to metabolize a substance that is used to paralyze the muscles during anesthesia. As a result even with being awake the patient will not be able to breathe on their own. This is usually a genetic condition that patients are aware of and need to notify the anesthesiologist beforehand.
Malignant Hyperthermia and Anesthetic Death are the two most dreadful, extremely rare complications of anesthesia which will be discussed separately in future blogs.