Dr. Jerry L. Epps, M.D.

An allergic reaction to the most commonly used local anesthetics is extremely rare. Skin testing via an injection of a small amount of the local anesthetic is how a true allergy is made.

Both general anesthesia and regional anesthesia can be used for shoulder surgery. A combination of an interscalene or suprascalene block (injection of local anesthesia near the nerves that provide sensation and movement to the shoulder) is made under sedation to provide regional anesthesia. Once the shoulder is 'numbed', the patient is positioned and more sedation administered. Conventional general anesthesia where a patient is rendered unconscious is also commonly used.

Due to the postoperative pain control benefits of regional anesthesia, this has become the preferred technique.

General anesthesia is usually used.

The stress of surgery causes some people to feel tired for days after the procedure. For example, patients undergoing colonoscopy with propofol often feel energized after emergence from anesthesia. Colonoscopy does not cause great body stress like an open abdominal procedure.

The onset of general anesthesia after the injection of a medication used to start your anesthetic such as propofol take about 30 seconds to a minute. Inhaled anesthetic agents through a mask used to start anesthesia in children usually takes 3 to 4 minutes.

During the beginning of the pandemic, elective surgical cases were eliminated. Elective surgical cases have resumed across the country. No rationing of anesthesia care exists currently.

Yes; Anesthesiologists play an integral role in the ICU management of COVID-19 patients as well as those who need surgical intervention while hospitalized.

Elective surgical procedures were postponed in the early stages of the COVID-19 pandemic but are now being performed across the country.

Most general anesthetics are a combination of intravenous and inhaled anesthetic agents. For adults, almost all general anesthetics are started with an intravenous agent.

No, a nerve block does not cause a blood clot to form. Rarely, bleeding can occur if a blood vessel is unintentionally injured.

Most anticoagulants (blood thinners) must be stopped before an epidural is administered. The time which the anticoagulant is stopped is dependent upon which 'blood thinner' is taken. This may range from 6 hours to several days. Laboratory data can help with this decision but many of the newer medications must be stopped several days prior to epidural placement. Coordination between your primary physician and your anesthesiologist can usually allow for epidural placement for planned procedures such as childbirth.

Low platelet counts predispose patients to bleeding near the spinal cord after epidural placement. When bleeding occurs near the spinal cord, the patient complains of a loss of sensation or movement. This loss of sensation or movement could become permanent if it is not rapidly treated. Since local anesthetic medication is administered through the epidural catheter, the medication would mask the signs of bleeding leading to permanent injury.

Yes, general anesthesia for tonsillectomy and adenoidectomy is very safe for children at age 5. T&A is one of the most common procedures performed under general anesthesia in the pediatric population.

General inhaled anesthetics have varying effects on heart rate. Two of the most commonly used agents, sevoflurane and isoflurane increase the heart rate slightly. Desflurane actually may increase the heart rate significantly when its concentration is rapidly increased. If a rapid increase in concentration is avoided, then desflurane will usually only slightly increase the heart rate. An older but uncommonly used inhaled agent, halothane, actually lowers the heart rate. Inhaled anesthetic and certain intravenous agents will lower blood pressure by causing the muscle in blood vessels to relax. The body will often respond with an increase in heart rate to compensate for the lowering in blood pressure.

Epidural and spinal anesthetics will also cause blood vessels to relax thus lowering blood pressure. When this occurs, the heart rate will reflexively increase to compensate. If the epidural or spinal anesthesia level is high, the nerves which control heart rate become anesthetized. In this case, the heart rate will slow even in the presence of a low blood pressure.

Most intravenous drugs used to initiate general anesthesia such as propofol have minimum effect on heart rate and may cause slight increase or decrease. One intravenous drug used to initiate general anesthesia, ketamine, increase heart rate.

Local anesthesia by itself does not cause nausea or vomiting. However, a prescription for pain would likely contain an opioid which is the most common cause of nausea after surgery.

Surgery requiring general anesthesia is best to be avoided if possible. When necessary, the commonly used anesthetic agents have no known effects that are detrimental to the fetus. However, there are obviously no scientific studies in humans and all studies are animal based. As a result, the anesthesiologist administers the fewest drugs needed to limit exposure to the fetus. 2nd trimester surgery is much preferable to 1st trimester. Premature labor after surgery is dependent on the site of surgery. Abdominal surgery is much more likely to be associated with premature labor than surgery on the extremities.

Any drug which affects the brain and central nervous system has the potential for addiction. The most common drug which leads to addiction is the pain pill prescription given upon discharge following a surgical procedure. 5% to 15% of opioid naive patients who receive a prescription for opioid pain pills are still taking opioids one year later.

Propfol is used to initiate and in some cases maintain general anesthesia. Propofol abusers are not seeking a drug high, but instead they want to “block out the entire world” by falling asleep. Most begin their addiction because of insomnia, which is often related to a history of trauma or post-traumatic stress syndrome or prescription drug abuse. Due to limited access, propofol addiction is still rare but increasing in frequency.

"Twilight anesthesia" actually refers to an older technique for moderate sedation using relatively long acting sedatives and opioids such as scopolamine and morphine. In today, modern practice, thesis drugs have been replaced with short acting drugs such as midazolam, propofol and fentanyl.

However, many surgeons still erroneously describe moderate to deep sedation for procedures where the anesthesiologist believes can be accomplished with a combination of local anesthesia and the drugs mentioned above without placement of a breathing tube as 'twilight anesthesia'.

Examples where this may occur are the sedation that takes place in the cardiac catheterization labs or interventional radiology or for colonoscopy.

Yes, a 13-year-old girl will be at risk for side effects just like an adult. Modern day anesthetics are designed for rapid recovery. The most common side effects are nausea and vomiting which have been greatly reduced by the most common anesthetic used to start the anesthetic, propofol. People who complain of excessive sleepiness after surgery are usually sensitive the sedative properties of the narcotic medications used to control pain as opposed the the actual general anesthetic agents.

Most people in the USA undergoing colonoscopy receive moderate to deep sedation with propofol. This enables great procedural conditions along with rapid awakening and little risk of nausea. Placement of a breathing tube or other airway device is rarely ever needed.