Anesthesia

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Before Surgery

It is necessary to have an empty stomach before receiving general anesthesia. In most cases, patients are required to abstain from eating and drinking after midnight on the night before their scheduled surgery to reduce the chances of vomiting while under anesthesia. When a person is under general anesthesia, the body does not work normally. Certain reflexes are relaxed, and if vomiting occurs, it may enter the lungs, leading to serious complications. Every precaution is taken to avoid this occurrence. Adhering to the "no food after midnight" rule is essential for patient safety.

The requirement may differ for those receiving regional or local anesthesia. Some physicians

request that patients receiving regional anesthesia abstain from ingesting any food or liquid, just in case general anesthesia has to be used. Some sedatives also can induce nausea in sensitive individuals. A patient receiving local anesthesia without sedation for a minor procedure generally does not have any dietary restrictions, but this should always be discussed with the surgeon prior to surgery.

Before surgery, the anesthesiologist visits the patient to do a brief physical examination and to obtain a medical history. He or she will want to know about any other medical conditions; if the patient is taking any medication (prescription or over-the-counter); if any dietary supplements or herbal products are being used; if there has been recent illicit drug use; if the patient smokes cigarettes or drinks alcohol; if the patient has a history of allergies, especially to medications, has had a previous reaction to anesthesia, or has a family history of problems with anesthesia.

The answers to these questions allow the anesthesiologist to choose the most appropriate anesthetic agents and dosages and to determine what, if any, precautions should be taken. For example, anesthesia can interact with other types of medications, including illegal substances, so it is important to know if these are being used. Nicotine and alcohol can affect the way medications work in the body and affect heart and lung function. Exposure to second-hand smoke also has been shown to increase the risk for anesthesia complications.

Anesthesia is generally safe, but complications can occur. Local anesthesia carries the lowest risk, and general anesthesia the highest. An allergic reaction to an anesthetic agent can be life threatening and can occur with any type of anesthesia. Drug allergies remain unknown until the substance is ingested, so many people are unaware of them.

There are generally few adverse reactions to local anesthesia. Some patients experience nausea and vomiting, but that is usually caused by the sedative. There may also be soreness at the injection site.

Regional anesthesia has a higher risk of side effects and complications, including the following:

• Temporary weakness or paralysis of the affected area
• Headache following spinal and epidural anesthesia. This usually begins within 12 to 24 hours after surgery and can last a week or longer. It may be caused by a loss of spinal fluid that occurs when the anesthetic is injected. Headache is often accompanied by nausea, vomiting, dizziness, light sensitivity, and a stiff neck.
• Hypotension (low blood pressure)
• Inability to urinate (usually temporary and relieved by catherization)
• Backache

Much less frequently, infection, nerve damage, or permanent paralysis can occur.

Because it affects the entire body, general anesthesia has the potential to cause the greatest number of side effects and complications. Most side effects clear up within 24 hours or so. The most common ones are:

• Sore throat (caused by the devices used to keep the airway open)
• Drowsiness or feeling tired hours after surgery
  
  
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• Nausea and vomiting
• Headache, dizziness, and vision problems
• Damage to teeth (caused by airway devices)

General anesthesia also carries the risk for serious complications. The patient's risk depends on several factors including age, sex, allergies, overall health, underlying medical conditions, and current use of tobacco, alcohol, and drugs. Serious complications include the following:

• Stroke
• Heart attack
• Brain damage
• Death

Certain inhaled anesthetics can trigger a disorder called malignant hyperthermia in people who carry the gene for it. When exposed to these anesthetic agents, the metabolism speeds up, the muscles become rigid, and body temperature rises (may even exceed 110º F). If this disorder is known to run in the family, the patient must inform the anesthesiologist before surgery.

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