Dr. Michael A. Kellams

Thats a vague question, but without knowing what type of surgery you are having a few "don'ts" regarding general anesthesia are:
-Don't eat any sooner than 4 hours before general anesthesia (sometimes longer depending on the type of surgery and other medical problems you have
-Don't drink alcohol or do recreational drugs less than 24 hours before general anesthesia. Also, very importantly, let your anesthesiologist know what type of recreational drugs and how frequently you use them.
-Don't smoke less than 24 hours before general anesthesia. And actually, the longer you can abstain before surgery the better your surgical healing.
-There are also several prescription and over-the-counter medications to avoid before general anesthesia. You should consult your surgeon or an anesthesiologist before having surgery to know what these are.

Depending on the type of hernia you have, and the size of the hernia, sometimes you can have local anesthesia for repair. Something to keep in mind, however, is that once you commit to local anesthesia you can't change your mind after the surgeon begins as an anesthesiologist will not be present. It may be more preferable to have at least Monitored Anesthesia Sedation with local anesthesia so that an anesthesiologist can be present and can adjust the sedation level to safely get you through the procedure and help the surgeon be able to accomplish a complete repair.

For planned C Sections, the safest and preferable anesthetic is a spinal anesthetic.

For breast biopsies, we typically use local anesthesia plus monitored anesthesia sedation.

I'm assuming you are referring to the local anesthetic the dentist injects to numb to area. Local anesthetics work by blocking sodium channels on the nerve to "turn off" the nerve so that pain messages don't reach the brain from that nerve. This is why the area has no feeling temporarily. Typically the numbness can last anywhere from an hour up to 4 hours.

Nausea can be common after tonsillectomy. The anesthesiologist will administer medications during surgery to help prevent nausea. In addition, the surgeon will prescribe an antiemetic to take postoperatively. It is important to prevent vomiting after a tonsillectomy to prevent bleeding.

No. Epidural Steroid injections are typically done in the office with local anesthesia. The doctor will numb up the area before placing the epidural needle.

There haven't been any case reports in the modern age where anesthesia changed someone's personality. While under the influence of various anesthetic drugs, however, you temporarily may act differently. For example, you may be either drowsy or disinhibited, much like when under the influence of alcohol.

Bupivacaine is well known for its cardiotoxicity if inadvertently injected intravascularly.

By virtue of their desired clinical effect, almost all anesthetics and sedatives cause respiratory depression. An exception is local anesthetics. This is why anesthesiologists are the ones who administer these medications. The degree of respiratory depression is dose-dependant and varies among different medications and medication types.

Nerve blocks are performed with local anesthetics. When a local anesthetic is injected near a nerve, the local anesthetic is absorbed through the nerve membrane. The resultant interruption of Sodium channel activity by the local anesthetic causes the nerve to temporarily cease to function. If the nerve is a sensory nerve, the result is numbness in the area of the body that nerve is travelling from. If the nerve is a motor nerve, the nerve cannot conduct an impulse with resultant motor activity. If the nerve has both motor and sensory functions, there will be numbness and motor inactivity in the area of the body that nerve is travelling to and from.

The duration of a nerve block is dependent on which local anesthetic is used and if any adjuncts to prolong the block were used. If a short acting local anesthetic like lidocaine is used, the nerve block may only last an hour or 2. If a long acting local anesthetic like bupivacaine is used the nerve block may last 4-6 hours. If epinephrine is added to the local anesthetic it will roughly double the duration. If a medication such as dexmedetomidine or clonidine is used, the duration could be 4-8x longer.

You do not need to lay flat after a spinal anesthetic. Spinal anesthetics differ from a "Spinal tap" for diagnostic purposes. Spinal taps for diagnosis use a fairly large needle and involve removing spinal fluid for testing. Patients are advised to lay flat after that for a few hours to give their body time to manufacture more cerebrospinal fluid (CSF) to replace what was removed. The purpose for laying flat is to avoid a severe headache from the loss of CSF. In a spinal anesthetic, a very small specially designed needle is used and no CSF is lost. Rather a small amount of local anesthetic is placed into the CSF. The risk of headache is very small, so patients do not need to lay flat.

Unfortunately, there’s no way to “get rid of numbness fast.” The local anesthetic that causes the numbness has to be metabolized by the enzymes in your body’s tissue. Different local anesthetics are metabolized at different rates and in some instances by different enzymes, depending on whether the local anesthetic is an amide or ester based chemical. Also, the rate at which a local anesthetic is metabolized is dependent on where in the body it was placed because of different blood supply. In highly vascular areas like the mouth, local anesthetics tend to be metabolized faster. In poorly vascular areas like fat tissue, Local anesthetics take much longer to be metabolized. Finally, sometimes other medications are mixed with local anesthetics to make them last longer.

Yes, anesthesiologists are taking care of COVID-19 patients, in several different ways. Some patients with active COVID-19 have a need for surgery that can’t wait until they have recovered from their disease. Also, some women in labor had active COVID and needed anesthesia for delivery of their baby. Finally, some anesthesiologists manage patients who are on the ventilator in the ICU. In my hospital, we have intensive care specialists that do that, but when we were at our peak in April here in Indiana, they became quickly overwhelmed and asked for assistance from the anesthesiologists. Some of us spent those peak weeks helping our intensive care colleagues out by staffing the ICU and performing procedures on those
patients that needed them.

Shivering after surgery is indirectly caused by anesthesia. When a patient is put under general anesthesia, especially with inhalational anesthetics, their brain and it’s functions are temporarily “turned off”. This includes the area of the brain called the hypothalamus, which is responsible for many things. One of which is thermoregulation. Essentially our hypothalamus is our thermostat and it gets “turned off” during general anesthesia. By turning the thermostat off, the brain can’t respond to temperature changes. Operating rooms are typically kept cool, usually 65 degrees. So our body under general anesthesia begins to cool due to the ambient temperature being 30 degrees less. This is one of the responsibilities of your anesthesiologist. To prevent too much body temperature loss, the anesthesiologist often places a warming blanket over the parts of the body not being operated on. Most of these blankets have a large hose with hot air blowing into it (convection heating) Some have an electric heat source and heat by conduction. The anesthesiologist also often will warm IV fluids being administered by running the IV tubing through a warmed fluid tube.

Finally, the anesthesiologist also uses a heat and moisture exchange unit (HME) added to the patients breathing circuit so that warm, humid exhaled gases heat and humidify the patients oxygen source. The reason for shivering upon awakening is that the hypothalamus retains its function, detects a cooler temperature than it last detected and sends signals to the musculoskeletal system to shiver to generate heat. (Same reason we shiver when we go out into the cold). Some general anesthetics (Total IV Anesthesia) that don’t use inhalational techniques preserve hypothalamic function and thus the brain is able to attempt to maintain heat by methods such as vasodilation and shunting of blood from warmer core areas to cooler peripheral areas of the body.

I hope this answers your question.

Many patients have hypertension that are undergoing surgery. As long as your anesthesiologist is aware and knows what medicine you take for it, there should be no problem undergoing anesthesia and no problems with your blood pressure afterwards.

That is actually the goal when delivering a spinal anesthetic. We place local anesthetic into the spinal fluid to achieve the desired numbness at the level the medication is placed and below. The local anesthetic is completely metabolized in the spinal fluid in 1-4 hours, depending on which anesthetic is used.

There is no more risk with the 3rd as there would be if it’s your first. Many patients have undergone many epidural or spinal anesthetics. There is no evidence of a cumulative effect.

Yes. CT scans require complete stillness to get an adequate study. Children often have difficulty being still for a variety of reasons: they may be frightened by all the equipment and strangers, they may be in pain, or simply because they are children and are a bundle of energy. In those situations the anesthetic is very brief and very safe.