Dr. J. Arthur Saus, M.D.

There are different approaches to administration of anesthesia. Spinal Anesthesia and General Anesthesia are both valid approaches to anesthesia administration. The decision of which one to use depends on the situation. In some situations, a spinal anesthetic is probably the better approach to use, while in other situations, spinal anesthesia would be exactly the wrong choice, and general anesthesia is better to use. It is not possible to simply state that either Spinal Anesthesia or General Anesthesia is "better", without first understanding everything about the context in which administration of anesthesia is being considered.

The answer, of course, depends on your definition of "safe." Every medical procedure, just about like anything else any of us do during our lives, generally carries some kind of risk. Administration of anesthesia, regardless of the route by which it is administered, is a medical procedure.

Sometimes risks with a medical procedure are relatively minor, while at other times risks are major. Whether the risk is major or minor depends not only on the procedure itself, and the reason for which it is done, but it also depends on the patient's overall medical condition at the time anesthesia is administered. When a regional anesthesia technique is selected, then administered by people with the proper training to perform the procedure correctly, it is relatively very safe. Despite this, opportunities are always present for things to go wrong unexpectedly, with anesthesia administration, just as it is for any other medical or surgical procedure.

With this in mind, it is important to be certain that administration of any kind of anesthesia (whether using a regional anesthesia technique or a technique which involves complete unconsciousness provided by general anesthesia) is managed by someone with extensive training and experience in anesthesia. This is the most compelling reason I can find for the concept that as a patient, you would want to have a physician with extensive training and experience in anesthesia involved in your care, whether you jointly decide on a regional anesthesia technique or a general anesthesia technique. This can be assured by verifying that a Board Certified Anesthesiologist is involved, whether that individual provides the anesthesia personally or supervises others who are actually performing the procedure.

General Anesthesia

The answer is both very straightforward, both on a deeper level extremely complex. On the straightforward level, general anesthesia is a controlled unconsciousness. The patient becomes unaware of anything going on during the time of general anesthesia. but when you dive deeper than this rather superficial answer, the answer becomes very complex, and in fact, all the complete answer is probably not known even today. Certain systems within the brain remain functioning, while others are temporarily "shut down". Fortunately, with general anesthesia, the "shut down" of these systems is reversible, so that the patient regains consciousness the the completion of the anesthetic. You may have read if brain waves, and frequencies of various parts of the brain communicating with other parts of the brain...all of these systems are modified by the effects of administration of general anesthesia. in general, the frequencies of these communications occur at lower frequencies than normal. Additionally, the communications of various parts of the brain with other parts of the brain. and with other body systems are modified.
Fortunately, with administration of anesthesia medications in the hands of those who are properly trained to manage the administration of anesthesia, these effects are temporary and reversible, so that the patient regains consciousness at the completion of the anesthesia administration. But this takes years of study and training to become proficient at it.

There is no easy and simple answer to this question, as there are multiple chemical agents that provide anesthesia properties. The duration of effects depends on the exact agents that are used to accomplish the state of general anesthesia, and the rates the with these agents are removed from the body, and that depends on the individual clearance mechanisms in each person's body. These mechanisms can be modified by many factors, such as the other medications (or other drugs or alcohol) someone has been using prior to coming for surgery and anesthesia administration. It also depends on individual genetics and intrinsic rates of metabolism or removal of the administered medications from the individual's body.

Neck surgery is typically done under general anesthesia, unless it is something superficial such as removing a nevus, i.e. a "mole" from the neck. If the neck surgery to which you are referring is a superficial skin modification, it may be accomplished under a local anesthetic to make the area "numb". But in general, a more extensive neck surgery would be done with the patient completely unaware of anything going on, as in general anesthesia.

The rates of drug removal from the body are typically modified in the elderly. I would not necessarily say the "anesthesia is dangerous for the elderly", but certainly the patient's age should be a consideration which is taken into account when planning and administering anesthesia.

Local anesthetics typically block the nerve input to blood vessels in the local area which are responsible for providing the message which cause constriction of blood vessels. If an anesthetic agent is administered which interferes with the messages from nerves in the area to cause blood vessels to constrict, the result is that they tend to dilate. It's not really that the anesthetic causes vessel dilation itself, but rather by blocking the nerve input to constrict, vessel diction naturally occurs.

In a practical sense, there is really nothing you can do to make the effects of a local or regional block wear off any faster. But there are multiple drugs which may be used for a local or regional anesthetic block, and some of them wear off more quickly, while others have a longer duration of action.

The duration of a local anesthetic effect following a dental implant depends on exactly which medication is administered to accomplish the local anesthetic (or "numbing") effect. Some medications provide a long lasting numbness, while other medications have a shorter duration of action.

In the ideal world, it would be better to avoid general anesthesia whenever the patient has a "cold" or any other respiratory compromise situation. However, we all live in the "real world", and not in an "ideal world". Sometimes despite a "cold" or an upper respiratory situation that may present less than ideal situations, the best situation for the patient is to avoid delaying a surgical procedure. In that case, everyone has to simply make the best of a less than ideal situation, when the surgery is deemed urgent or emergent. For a purely elective surgical procedure, in my opinion, yes, it would certainly be better to wait until the patient does not have any symptoms of any respiratory compromise.

There is really nothing you can normally do as a patient to "speed up" the return of sensation following a regional anesthesia block. However, a block may last a shorter or longer time based on many factors, most of which are exactly which medications were used in the anesthetic, and exactly where and how they were deposited into the body tissue.

I guess it would be possible for an appendectomy to be done without anesthesia, but it would be horribly unpleasant. An appendectomy is a major surgical procedure, and any patient would want to have anesthesia administered before this surgical procedure begins.

There is no easy answer for this question, as the duration of effect depends on multiple factors. There are a few different medications which can be injected to provide local anesthesia or a regional nerve block. Additionally, there are "additives" that can be mixed in with the local anesthesia prior to injection, such as epinephrine, that prolong the duration of anesthesia. Additionally it depends to some extent on exactly how the injection is made, such as whether it is just injected under the skin to provide local anesthesia or if it is injected around a nerve bundle to provide a regional block. Finally, it depends on the patient's blood flow and clearance mechanisms that are somewhat unique to each individual. These mechanisms determine the speed at which the deposited bolus on anesthetic is either metabolized (broken down), removed from the site in which it was deposited, and ultimately removed from the body.

I'm sorry, but I do not understand your question, or the basis for your question of a "detox" following general anesthesia. Medications used to accomplish general anesthesia have "built-in" clearance mechanisms. While those medications provide very powerful effects on the body (specifically the nervous system) to provide loss of sensation of pain or the provision of complete unconsciousness, they function in only a temporary manner. In general, there is no other substance that can be added to the body to "detox" anesthetic agents (which I'm interpreting to mean you are asking about a way to make anesthetic agents leave the body more rapidly). If you mean something different by your question, please re-ask in a different manner. I may be misunderstanding your question. But all anesthetic agents have only temporary effects in the body. They are specifically intended to have only short-term actions, and have actions that generally can be well controlled by the physician anesthesiologist or nurse anesthetist who is administering those substances.

This brings up a good discussion of anesthesia, and probably a broader discussion than what your question intended. The answer may be confusing on the surface, because the answer is No, Yes, and Maybe. Here's the deeper explanation: "anesthesia" is made up of many different pharmacologic agents that can be administered to the body in different ways. for a few broad, general categories, those ways may be local anesthesia, regional anesthesia (i.e. "nerve blocks"), or general anesthesia. Within each of those broad categories of anesthesia, there can be many different medications used to accomplish each of those categories of anesthesia. For instance, there are many different drugs that can be selected to provide local anesthesia or nerve blocks. Often, the specific medication or group of medications selected depends on the duration of loss of sensation that is desired for the procedure, or a specific medication may be selected to avoid specific medication effects or side-effects. Likewise, when selecting medications for general anesthesia, resulting in complete unconsciousness, there are many different medications that may be selected, or even a "blend" of those medications may be selected. Within that "blend" it is certainly clearly recognized that some medications which either cause general anesthesia by themselves at the right dose, or contribute to general anesthesia when mixed with other medications with anesthesia properties, have a side-effect of promoting the effects of constipation. The most obvious of these medications where constipation tends to be a "side-effect" is whenever any opioid medication is used. These opioid medications are often referred to as "narcotics". But there are many other medications that are not anesthesia agents that also tend to cause constipation. Essentially any medication that encourages more water absorption into the body from the contents inside the intestine tends to promote constipation. Since all "narcotics" tend to slow the transit time through the intestine, it gives more time for water to be absorbed from whatever is inside the intestine. A greater amount of water absorption results in a material moving through with less remaining fluid. Less remain fluid in that mass, makes it more difficult to pass that mass through the intestine and completely out of the body. This is what is recognized as "constipation".

Anesthesia agents do not "cause" panic attacks. However, there is a range in depth of anesthesia that is carefully controlled by the anesthesiologist or nurse anesthetist administering the anesthesia medications. Not all of the central nervous system (including the various parts of the brain) respond in exactly the same manner at exactly the same time to exactly the same concentration of anesthesia. This tends to be more noticeable when the level of anesthetizing is not "deep". Anesthesia can be controlled to provide lighter amounts of anesthesia administration or deeper amounts. If the patient is anxious, and deep anesthesia is not rapidly established, there may be a point in which the inhibitions to fright or "panic" become anesthetized, but consciousness is not yet anesthetized. This could happen during the beginning of anesthesia administration or at the end of anesthesia administration, at times when lower levels of anesthesia are present in the body for some (generally short and transient) amount of time. So the answer is that while anesthesia does not CAUSE panic attacks (per your question), anesthesia administration may facilitate at least temporary levels of the sensation of loss of control, in which some people may develop a sensation of panic. That's one reason why the beginning of anesthesia, generally referred to as the period of "induction" of anesthesia, is often done in such as manner as to rapidly progress from fully conscious to deeply unconscious. This helps minimize the duration of any type of discomfort associated with this transition of states of consciousness.

There is no specific age that can be considered "unsafe" or "safe" for anesthesia. Anesthesia is administered to persons of all ages from newborn babies, who may be not even a few hours old all the way up to very elderly patients, even those who are over 100 years old. The relative risks of anesthesia administration have much more to do with the patients co-existing medical conditions which they bring to that point of anesthesia administration, instead of the patient's age.

It is not advisable. There are many reasons for this. Wearing contacts during even a short procedure increases the potential risk of eye injury. During administration of anesthesia, all reflexes are blunted, and this includes the reflex of blinking, which helps keep contact lenses moistened and essentially "floating" on the eye.

The first thoughts I have in answering this question is to say first, take all of your routine medications as they were prescribed, unless your anesthesiologist tells you otherwise in a pre-operative evaluation (which should be done days before the procedure, not at the last minute). Be sure your anesthesiologist knows everything about your health, and any medical problems you might have. DO NOT EAT any solid food for at least 8 hours prior to the procedure. The optimal preparation also include staying away from any smoking materials for at least 2 weeks.
Many anesthesiologists feel it is OK to drink any clear liquid (one that you can read a newspaper through a glass of it) up until 2 hours prior to the administration of anesthesia, but while this could be discussed and requested, it should be up to the anesthesiologist who is responsible for your anesthesia to decide in your particular case if this is appropriate or not.
It is not possible to make statements which cover everything that an individual should or should not do prior to any administration of anesthesia for any type of surgery. That's why the best advice is for you to discuss what you should or should not do with your anesthesiologist for your surgical procedure. in answer to this question, I can provide only generalizations that must be "fine-tuned" for the surgical procedure.