Dr. Thomas J. Rick

Interesting question. Answer is...well, it depends on one's sensitivity to narcotics on the vesciculo-urethral sphincter, the junction of the bladder with the urethra. Narcotics increase the tone of the sphincter there and cause urinary retention. If it persists past 10-12 hours, the patient will need catheterization in the bladder to relieve the urinary pressure.

Dosing and technique are based on weight, metabolism and tolerance to drugs

Malignant hyperthermia is a rare occurrence among genetically susceptible patients. It involves an irregularly in muscle contraction with extreme calcium release and increased metabolism with an increase in body temperature.

Airway problems. Anesthetics create an unconscious state in which a patient is unable to protect one's airway. They generally knock out the drive to breathe and the ability to reflexively protect the aspiration of stomach contents. This is why a preoperative fast for > 8 hours is recommended. Aspiration pneumonia is always a risk. Additionally, chipped or broken teeth or dental work can occur from intubation with use of a laryngoscope.

Allergic reaction. Patients can mount a histamine-related response to any anesthetic or other drugs such as perioperative antibiotics.

Nerve/soft tissue compression. A patient under deep sedation or general anesthesia is not aware of sensation at critical pressure points, such as ulnar, tibial or femoral nerves and face and eyes. Nerve palsies or compression injuries can result.

Regional anesthesia complications, although rare, include, but are not limited to bleeding, infection, allergy, nerve damage, seizures, swings in blood pressure, and cardiac arrest. In the qualified hands of an anesthesiologist, overall risks are minimal.

Standard ASA monitors include non-invasive BP, pulse oximetry, and ECG. C02 monitoring (capnography) is also recommended.

No

Over the past 5-10 years, the standard of care for colonoscopy has been the administration of propofol to achieve a state of deep sedation for the patient. However, the possibility of awareness still exists, especially in patients with high tolerance for sedatives, such as those who liberalize alcohol, narcotics and benzodiazepines.

The true essence of conscious sedation is that the patient is truly able to be verbal, yet mildly sedated. Unconscious sedation involves a deeper plane of consciousness when the patient is not verbal.

Ideally, local injection to block the dental nerve is ideal. Definitely avoid benzodiazepine meds in first trimester.

When you are literally referring to "conscious" sedation, the answer would be YES. If you are rousable and conscious, then you potentially could talk. Usually, during deeper sedation states, you would not be very talkative.

Less than one hour...

Significantly delayed emergence. Sustained drop in blood pressure, ventilation or oxygen saturation. Possibly prolonged state of confusion.

Cetacaine spray is often used to numb the back of the throat; for example, to facilitate an awake intubation. Another spray is ethyl chloride, which provides a topical "freeze" of the skin during, for example, an IV catheter placement.

A normal vaginal delivery is commonly facilitated by epidural anesthesia. A Caesarian section delivery is usually carried out under an epidural or spinal block, or sometimes under general endotracheal anesthesia if emergent.

General anesthesia does not usually affect the memory of a healthy 29-year-old.

ummm...no

Not exactly. Local anesthetics (numbing medicine) is either injected around nerve bundles for a nerve block, injected into the subarachnoid space for a spinal block, or epidural space for an epidural block. These are considered regional anesthesia. Local anesthetics can also be infiltrated directly into the tissues. This is considered "local anesthesia".

In general, regional anesthesia is very safe. If you are referring to obstetrical regional anesthesia, usually either an epidural or a spinal block is implemented. Aside from theoretical risks, if bleeding or infection, they are safe.

I don't know of any maximum time limit to general anesthesia.

General anesthesia */- interscalene nerve block

There is no age limit for local, general, or regional anesthesia. The most appropriate anesthetic should be administered based on the patient's comorbidities/health issues and the type of surgery.