Dr. Beemeth Robles

The onset of local anesthetics depend on the location where they are placed. Local anesthetic can be given intravenously, into the skin as a "field block," around nerves, into the spinal or epidural space or into a joint. If one uses Lidocaine in the skin, the area becomes numb very readily, certainly less than a minute, and in reality, faster than that. If local anesthetic is injected around a nerve, it works within minutes. When I do a nerve block for postoperative pain control, I tell patients that the nerve block can take up to 20 minutes to set up completely. I will defer on spinal or epidural anesthetics since those are typically done for joint replacement surgery. I do not know anyone who does spinals or epidurals for knee scopes which is what I am assuming you are calling "knee surgery."

Two nerve blocks that can be performed for knee surgery, which typically is not done for knee scopes, is a Femoral nerve block or an Adductor Canal block. Keep in mind, however, the knee has two compartments, a front half and a back half. The two nerve blocks I mentioned only cover the front "compartment" of the knee so with these nerve blocks you would not be able to operate in the back part of the knee unless you did an additional nerve block called a sciatic/popliteal nerve block.

The last option for local anesthesia is what is called a Bier Block. This block has never been done by me in my career for the leg.

It always comes down to what one is going to have done. Typically for urologic procedures one would undergo a general anesthetic. If one wanted to avoid general anesthesia, one could undergo the procedure with epidural or spinal anesthesia as well.

First let me say that your fear is common, and many more wonder about this issue but fail to verbalize their concerns. Depending upon what type of procedure you are having done, you will likely stop breathing and that is why you have an anesthesia trained person to take care of you. I say anesthesia trained person because not all anesthesia providers are doctors. There are also nurses with anesthesia training providing anesthesia care to patients, however they are not anesthesiologists. Soon, there will also be nurses with PhDs providing anesthesia and calling themselves doctor even though they are not Medical Doctors (MD). Just like your Primary Care Doctor, is not the equivalent of a Nurse Practitioner or a Physician's Assistant, Nurse Anesthetists are not the equivalent of Anesthesiologists. However, any of these anesthesia trained providers should be able to provide you airway support, meaning that if you are intended to stop breathing, then we breathe for you. Anesthesia trained individuals should be airway experts and they will provide airway support with "breathing tubes" or a variety of airway devices. The majority of my patients stop breathing, but in 25 years of practice, that has been a non-issue. So, on the day of surgery, speak to your anesthesia provider and let them allay your fears and answer your questions. Regardless of what you are having done, you should be fine barring anything extraordinary occurring.

As to your heart stopping, that would be an extraordinary event. In 25 years of practice, the only patients who have had their hearts stopped were those where it was intended, such as in Open Heart Surgery or an intended Cardiac Arrest (none of which died - it is planned for the procedure). Otherwise none of my patients have had their hearts stop. Should that happen and it is unintended, your anesthesia provider should be able to help "restart" your heart, so to speak.

Best,

B. Robles, MD

Pain is a personal experience based on patient tolerance. With colonoscopy, the individuals who have had it done without sedation or anesthesia, said it was tolerable but it was certainly uncomfortable. There are clearly patients who could not tolerate the procedure without receiving medications and others could. So the answer is dependent on what you can and want to tolerate. I believe most would say that there is some amount of pain that would have to be tolerated to have a colonoscopy without any sedation. I hope this helps.

Rhinoplasty, in my experience, requires General Anesthesia. This is not to say, and it is likely, that your surgeon will also inject local anesthesia. General Anesthesia renders the patient unconscious and unresponsive to anything that is done to them. Can this procedure be done with sedation? Probably, but if I were having this procedure done, I would never go that route for a lot of reasons. This procedure in the hands of a good anesthesiologist, should be safely done.

I have not been involved in cataract surgery for many years, but during the time I was, patients did not receive general anesthesia. Typically, we would provide some form of mild sedation to allow the administration of local anesthetic to the eye that is going to be operated on. The local anesthesia was provided by injection, around or below and behind the eye. Rarely, general anesthesia has been required.

Terminal anesthesia is not a term that I am familiar with. However, if the patient is anesthetized, they would be unconscious. Pain is a conscious phenomenon and as such she would not experience pain. Once the patient is rendered unconscious, there should be no awareness. Keep in mind the patient is not having surgery and as such there should be nothing to cause pain. The typical use of "anesthesia" is to make the patient unaware of stimuli that might be painful. Many times in end of life situations, medications are used to render the patient unconscious. The amount of drug given to the patient will determine when they pass on. Anesthesia given to patients who are not having procedures performed have no stimulation to balance the effects of the drugs being given. If the patient is not monitored, you will not see the drop in blood pressure, heart rate and eventually the drop in oxygen levels and the increase in carbon dioxide levels. Together all these things will lead to the end of life.
I hope this helps.

There are many approaches one can take, and some surgeons will perform Rhinoplasty in their office with sedation, but what I am most familiar with is the patient undergoing General Anesthesia in an Ambulatory Surgery Center with the surgeon also utilizing local anesthesia (lidocaine with epinephrine to reduce bleeding). I only do these procedures with the patient intubated (a breathing tube in place) and though one might utilize an LMA (laryngeal mask airway, an airway device that does not go below the vocals cords), I do not. The general anesthetic can be provided with a total intravenous approach, which I do not typically do, or an inhaled anesthetic approach. In both cases you will receive oxygen via an airway device but in the total intravenous approach, no inhaled anesthetic is typically used. =20

Hope this helps. Your anesthesiologist should be able to answer your questions after they review your medical record and examine you.

B Robles

Surgery and anesthesia is often dealt with as if all general anesthetics and all surgeries are the same. Specifics always help answer the question more completely. With this said, general anesthesia effects multiple organ systems, it is not simply "going to sleep" and waking up. There is also no recipe to anesthesia as patients differ in the medications they take regularly and drugs they use like alcohol, THC, and nicotine. Also, surgical and patient needs vary. There are typically two drugs that are longer acting and can certainly have an effect on the patient after surgery. Having had surgery many times myself, I speak from experience as an anesthesiologist and a patient.

There is context missing in this question. I am curious as to when did your son become combative? Was this in the recovery room or was this at home after being discharged from surgery? Often, parents receive their exposure to postoperative behavior of children after surgical or diagnostic procedures. A very common procedure is the placement of myringotomy tubes, i.e., pressure equalization tubes that are placed across the ear drum. This procedure is very short and the anesthetic exposure is short. Children with limited anesthetic exposure will still emerge (wake up) fussy, irritable, and even combative at times. This is a well known and documented phenomenon such that children are given sedatives or narcotics for their sedative properties so that this "phase" of post anesthesia is minimized, limited or missed altogether. Personally, I tend to give all my kids some amount of narcotic and I tell my parents that their children will be sleepy in recovery, but will be relaxed and calmer than kids that did not receive either a narcotic or sedative. So, without more details, this is what I can surmise from your scenario.

Best,

Beemeth Robles

There is no single answer and has a lot to do with your child and their maturity level. Is it their first surgery? Have they had surgery and had a bad experience? The anesthesiologist is going to put your child under "anesthesia" though many say asleep. Why I do not like sleep is that we sleep every night and anesthesia is nothing like sleep. Some people have wondered if they are asleep, won't they wake up during surgery? Again, anesthesia is a state of unconsciousness. It is like "sleep" in that you close your eyes and the next thing you know you are waking up. As in sleep, unless you are awakened, you are unaware of what is happening around you. People can relate to falling asleep and it is likely why it is said to patients, and if I use the term sleep, I assure the patient that they will know nothing until I wake them up. The patient should be unaware of anything happening to them while under anesthesia and once you "wake up" you will start to feel what there is to feel as a result of surgery. Pain should typically be mild to moderate because the anesthesiologist provides intravenous opiates (pain medicine in the IV) during surgery. Once the patient is "awake" (could be sleepy from the opiates used during surgery or sedatives used before surgery) they typically begin to feel some degree of discomfort and it is treated with additional pain medicine. Some patients will also be nauseated and thus many if not most patients (all of mine) will receive medication for nausea prevention. Some patients will have a "sore" throat because of breathing tubes or other airway devices. This feeling in the throat is typically not very significant, at least from personal experience and the experience of my patients. In any event, the simple answer is, it is like falling asleep. You close your eyes and the next thing you know, you are waking up and everything is done. Hope this helps.

Today with more nerve blocks being performed, I believe many are using the terms interchangeably. The term regional denotes a specific area as opposed to a general anesthetic which is a state of unconsciousness that is generalized to the entire being. When I was in training the lines were not as blurred. Back then, we typically referred to spinal and epidural anesthetics as regional anesthetics. A lot of nerve blocks were not being done in my training which I finished 25 years ago. However, one thing that is for sure, all regional anesthetics as well as "locals", require the use of a local anesthetic. Today if the surgeon schedules a case as "local with sedation" for example, the surgeon plans to inject the local anesthetic in the area of surgery, while we provide sedation so that the surgeon can inject the local anesthetic with minimal discomfort to the patient. The injection of local anesthetic can be quite uncomfortable for many patients so the provision of sedation makes it less traumatizing to the patient. Thus, today regional techniques refer to the old spinal and epidural anesthetics, plus a variety of nerve blocks. Most local anesthetics are limited to small and area-specific site surgeries. Further, local anesthetic injections in a specific site are limited as to what type of surgery can be performed. No amount of local anesthetic injected by a surgeon into a shoulder could allow a surgeon to operate on a shoulder but a single interscalene nerve block can certainly allow a surgeon to perform shoulder surgery very effectively. I hope I have not muddied the waters.

Many patients have high blood pressure and are on medications for that condition. Having treated hypertension should not be a significant issue for your gall bladder surgery per se. However, keep in mind I do not have a complete history or a list of medications that you are taking so my answer is also not complete. A greater problem for you would be if you have high blood pressure and you do not take medications. So long as you are appropriately treated, you should be fine during your anesthetic. Typically, blood pressure is monitored with an automated blood pressure cuff, which I typically check every 2 1/2 minutes, though the range can be every minute to as long as every 5 minutes (vital signs during anesthesia are recorded every 5 minutes by many anesthesiologists).

There is always some level of risk but if his disease state is medically managed and is optimal, he should be able to have an anesthetic safely. Of course, given the type of surgery it can have an impact on him, if his lung function is poor. I have done plenty of anesthetics for patients with COPD and they have done well. The risk seems to be greater in the postoperative period given that they have a slightly increased risk of pulmonary complications as they have chronic secretions which are harder to clear and their physiology is not normal. One should not forget, if the lung disease is significant, the type of surgery may lend itself to other types of anesthetics besides general anesthesia. Some surgeries can be performed with sedation and local anesthesia. Other surgeries can be done with nerve blocks with sedation. Finally, there is spinal or epidural anesthesia. Keep in mind that sedation can be light or conscious sedation, it can be moderate sedation where the patient is still arousable and then there is deep sedation where the patient remains unconscious during the procedure. Sedation is not sufficient for surgery, if local anesthesia or a nerve block is not performed in conjunction with the sedation. If the surgery is performed with intravenous sedation only, then its still general anesthesia and very likely that the patient will have some type of airway device inserted in their throat, though it may not be a "breathing tube" otherwise known as an endotracheal tube.

Typically you are given a sedative prior to the surgeon administering local anesthesia to "numb" the eye. The injection is not given into the eye itself but rather an injection is done below or around the eye itself. I have not done an injection (block) for eye surgery for a very long time. Back then we did retrobulbar blocks, where a needle is inserted through the skin below the eye into the eye socket and behind the eye itself. Today there is a different approach which still requires local anesthesia. General anesthesia is rarely utilized and usually reserved for unconventional situations, for example, if a patient has tremors and cannot lie still.

It should not be an issue.

A CT Scan requires cooperation on the patient's part and a 3 year old is not going to sit still while they are in a foreign place, with strangers around and away from the comforts of parents. I have done general anesthesia for both MRIs and CT scan on children and it was appropriate.

Your question is if it is possible to be drowsy days after a procedure and the answer is anything is possible. What matters most is to understand what medications were given and appreciate the effects of these drugs on the patient. Now, if you ask if it is typical to have these effects after endoscopy anesthesia, then I would have to say no. Typically I provide anesthesia with Propofol only and no other drugs and most patients feel pretty good within a short time in recovery. I would definitely ask about what medications were used for the procedure. Also, you did not say how old your husband is. The older the patient the more of an impact medications can have on patients.

It is difficult to answer this question as the term "anesthesia" is not defined. Did the child have an anesthesiologist involved or was the child given an oral medication? If the medication was given orally, then they were given sedation. There was a time when drugs like Chloral Hydrate was commonly given to children for procedures and tests and this would lead to prolonged sedation. If an anesthesiologist was involved and the child was given inhalational or intravenous anesthesia then prolonged sedation would be much less likely. However, it is well known that prolonged inhalational anesthesia will lead children to awaken in a state which we call emergence delirium and in such cases children can be given sedatives so that they awaken in a calmer state, and sedatives and narcotics can last for hours. There is no same approach for every patient so one cannot say that "my child was given anesthesia" and then ask if it is normal for them to be drowsy hours later. Need specifics about was done and given to the child.

Yes, anesthesia can be administered to a diabetic patient. If he has pus in his ankle then he needs to have the infection treated otherwise his diabetes will be more difficult to manage and his infection will worsen due to the uncontrolled diabetes. Keep in mind, that your husband does not have to undergo a general anesthetic, which is what I believe your question is based. There are nerve blocks that can be done to provide anesthesia for the surgery and he does not necessarily need to have general anesthetic. As to safety of anesthesia, I have anesthetized hundreds, if not thousands of patients with diabetes without a bad anesthetic outcome, so yes it should be safe. The information I share here is based on the limited information you have shared with me.