Dr. Beemeth Robles

If you mean an upper endoscopy otherwise known as an EGD (Esophagogastroduodenoscopy, you certainly can have it done awake. However, the anesthesia will be in a thick liquid form, viscous lidocaine jelly which you will have to gargle with and then swallow to numb the rest of your esophagus. It is doable, but you have to be able to swallow a "hose" and breathe around it comfortably. I am not even sure if your GI doctor would entertain you having this done awake with a numb throat. But is it possible, yes. It is done this way in other countries where anesthesia care is more limited. Keep in mind that once the scope is down, it sometimes has to be removed and reinserted. If you are curious if you could have some pain during the procedure, yes it is possible. Good luck if you go this route, I have not seen this done without other drugs on board.

Every thing in life has risk. Anesthesia for a liver biopsy has risk but so does the biopsy itself. I can tell you that anesthesia is very safe and when I meet my patients that are having their first surgery or are afraid due to what they have heard or read on the internet, I remind them that by the time they get to the surgical site, they have already done the most dangerous thing they had to do that day. What they have done surprises them is so dangerous.... maybe 500 times more dangerous than anesthesia, they drove to their appointment! If I were getting a liver biopsy, I would be more concerned with the risks of the biopsy.... anesthesia should be safe. Remember that overall risks in medicine are low and these procedures have been done many times because they are relatively safe. In medicine we do not do procedures if your chances of a bad outcome are great unless there is no other option and only if it would be life preserving. Good luck!

Typically the patient receives intravenous general anesthesia. Some will call it sedation or Monitored anesthesia care but the reality is that the patient feels no pain, does not move, is unconscious and therefore unaware and they cannot protect their airway so it is a general anesthetic. Typically Propofol is administered via an IV while you wear a mask or nasal cannula that provides oxygen. The anesthesia time is 10 to 15 minutes longer than the procedure itself, typically.

You can actually have a colonoscopy done without any additional medications and I have several GI doctor colleagues that do just that. However, I would not recommend it because it is likely to be uncomfortable and unless you are will to tolerate some discomfort, you will need some type of medication. Most colonoscopies are truly done under Intravenous general anesthesia. The patient is unconscious, but breathes under their own power. The patient typically does not move and they have no knowledge of the procedure being performed. The hallmarks of general anesthesia is amnesia (no recall), analgesia (no pain), and akinesia (no movement). The patient also is unable to protect their own airway, though they are able to maintain it patent so they can breathe under their own power. Local anesthesia is not really an option for colonoscopy.

You can have hand surgery and be awake but it depends on what the surgery is. An open Carpal tunnel surgery or a trigger finger release can be done with local anesthesia alone. If the surgery is more involved, you can have a regional technique, supraclavicular nerve block being my favorite block for surgery of the upper extremity but you can also do an axillary block, an infraclavicular block or a Bier block (intravascular). Most of the blocks I refer to above are isolated brachial plexus blocks with the exception being the Bier block which involves intravenous Lidocaine. Good luck! Best, Beemeth Robles

I really do not have enough information but given that I spend a lot of time working with Endocrine Surgeons and ENT surgeons who remove portions and entire thyroid glands, I would have to say that the biopsy you are referring to is a needle biopsy. I have never seen a thyroid "biopsy" in the operating room. So lets assume we are talking about a needle biopsy. Needle biopsies normally are done in the surgeon's office and requires the insertion of a fine needle into the thyroid gland, typically a nodule or mass. It should not require anesthesia.

Upper endoscopy and colonoscopy are usually both performed under intravenous general anesthesia. You are made unconscious for the procedure so that you remain unaware. Should anyone tell you that you will have "twilight anesthesia", that is a meaningless, undefined, garbage term not found in any anesthesia text I have ever read and should not be used. Sedation comes in three forms, conscious, moderate and deep. Conscious sedation means you are awake and can hold a conversation. Moderate sedation will be a bit "deeper" than conscious sedation where you might doze off for periods, though you remain easily arousable. Deep sedation basically borders General Anesthesia and an otherwise painful procedure like colonoscopy (if you were awake) can be done and the patient remains unaware of what is happening to them. Keep in mind that general anesthesia is a titratable level of unconsciousness. Intravenous deep sedation/general anesthesia is sufficient to perform a colonoscopy but if the patient required a surgical incision, the level of sedation/anesthesia for colonoscopy would be inadequate for surgery and requires yet a "deeper" level of anesthesia.

Yes they do.

This is a better question for a surgeon, however, I have given anesthesia for many of them. With this said, it would depend on the complexity of the surgery. Some can be done in an hour and others can take three hours. It would be bet to ask your surgeon what they are planning and what you need done. All rhinoplasties are not the same.

Yes, it is if it is done at an ambulatory surgery center. Some surgeons will do “sinus surgery” in their office with the use of balloons with sedation. Cannot state definitively that this would be considered endoscopic sinus surgery.

Usually general anesthesia with an associated adductor canal nerve block for postoperative pain control.

Usually as there are limited options.

It can be, but most surgeons I have worked with prefer general anesthesia.

The answer depends on the type of surgery and the length of time of the surgery. If its something as “simple” as a carpal tunnel release or a trigger finger release, those surgeries can be done under straight local anesthesia, local anesthesia with sedation or general anesthesia. There are some surgeries that are typically done with general anesthesia and the use of a nerve block for postoperative pain control. Keep in mind that surgeries done at Ambulatory surgery centers are done with efficiency in mind.

A lot of it depends on what your surgeon may want and what kind of surgery you are having done. For example, a carpal tunnel release can be done with straight local, local with sedation, an IV regional block, or. General anesthetic. However, regardless of what surgery you are having done, many hand surgeons prefer general anesthesia. If you are having a surgery where postoperative pain is expected to be considerable, some surgeons will request a nerve block for postoperative pain control which last 16 to 24 hours typically. It is best to discuss this with your surgeon.

When undergoing spine surgery, general anesthesia is the only anesthetic approach that I have utilized and have known others to utilize. There really are no other options if the bony structures are going to be operated on.

B. Robles, MD

Typically the Ophthalmologist will inject local anesthetic behind or around the eye after that anesthesiologist has administered intravenous medication for sedation prior to the local anesthetic injection. After the initial dose of sedative, the medication will have a lessened effect such that the patient is typically aware of what is happening during surgery. The eye is anesthetized by the local anesthetic and thus there should be no pain. In very rare instances, general anesthesia is employed but that is the exception, not the rule.

Typically you do not need to meet with your anesthesiologist preoperatively. If you have a rare medical problem, a history of difficult experiences with anesthesia, familial difficulties with anesthesia that could be inherited, then you can ask your surgeon to have the anesthesiologist call you the night before surgery. For the most part, meeting your anesthesiologist the day of surgery is sufficient. Your anesthesiologist should review your chart for health issues, medications, allergies to medicines, preoperative vital signs, laboratory results if available, perform an examination of your airway, heart and lungs and answer your questions. Anesthesiologists (or any other anesthesia provider) are expected to perform this preoperative assessment.

Questions are easier answered with details that are provided. Surgeries differ from each other, and the length of anesthetic matters. Given the lack of information, one has to assume and speculate. Nonetheless, one might be able to surmise that the patient would be hyper from medications they were given. These medications in question can come from the surgeon though more likely from the anesthesiologist. Surgeons often inject local anesthetic, but many times the local anesthetic has epinephrine. Epinephrine can certainly make someone hyper. Depending on the type of surgery, some surgeons also use cocaine during the surgery because it is a great local anesthetic and the only one that reduces blood loss. As far as drugs given by the anesthesiologist, patients often receive steroids because they help reduce swelling and they are excellent medications to treat nausea. In addition, anesthesiologist may give drugs like ephedrine during surgery to elevate the blood pressure and this might make patients "hyper." There are medications like atropine which is used to elevate heart rate as well as epinephrine, but one would expect these drugs to be short acting and not have effects hours later. A lot of these drugs are fairly typical to be used during an anesthetic or a surgery, so it is possible that your child may simply be sensitive to some of the medications utilized. More information might provide insight, but this is the best I can do with the information provided.

Local anesthesia, or better said, local anesthetics can be used to provide many types of anesthetics. Local anesthetics can be used to perform nerve blocks that normally will affect a part of the body, it can be used in the spinal or epidural space to numb the lower half of the body, or it can be injected into an area of skin to allow the removal of a lesion in or below the skin. Now, given the information provided, I anticipate that local anesthesia is being used to remove some kind of skin lesion. Local anesthesia is very safe, if used safely. Local anesthetics used incorrectly, for instance, injected into the blood stream, can be lethal. Of course local anesthetics for the most part, are not typically used in the blood stream and as such are very safe and effective. In addition, the patient has to understand that local anesthesia does not mean that a patient will not feel nothing. Local anesthesia is great at blocking pain, but if a patient is an anxious one, then given the fact that they may be aware that they "feel something," may be enough that they may become uncomfortable with what they "feel." In that case, the patient may not be a good candidate for procedures performed with just local anesthesia.
Good luck!

Best,

B. Robles