Age Weight Medical history Current medications including prescriptions, over-the-counter drugs, and herbal supplements Prior anesthetic records, if available Recent medical studies or specialist visits relevant to the type of anesthetic planned (for example, recent cardiology notes, echo reports) Other relevant medical history and details relevant to the type of anesthesia planned Allergies to medications and to food products
It is important for the anesthesiologist to know about any past reactions to anesthetics. If a patient has had a bad reaction to any anesthetic agents in the past or if the patient has a significant family history of problems with anesthesia, the anesthesiologist may choose to use different medications.
Cigarettes affect the heart and lungs, which can affect the type of anesthesia chosen and recovery process. Chronic obstructive lung disease can significantly impact a patient’s ability to recover from intubation. It is recommended to quit smoking at least eight weeks prior to any anesthetic to improve outcomes from anesthesia and to decrease the risk of surgical infection. Alcohol affects the liver, heart, lungs, and blood, which are important in the administration of anesthesia. Chronic liver disease can significantly impact the choice and outcomes of anesthesia. Current or past use of recreational drugs, such as cocaine, marijuana, or amphetamines, is important information for an anesthesiologist to learn. If cocaine or amphetamines are present in the bloodstream, they can lead to dangerous changes in blood pressure and even death under general anesthesia. Remember that all conversations between patient and doctor or anesthesiologist are confidential. Not sharing this information it could increase the possibility of negative side effects from the surgery, including death — make sure the patient knows how essential it is that he be honest with you.
Any food in the stomach during surgery increases the risk of aspiration during surgery. This is the medical term for when food and gastric contents rise up into the esophagus and enters the lungs during surgery. Even candy or chewing gum without swallowing can increase a patient’s risk of aspiration Because general anesthesia also puts to sleep the musculature in your body you won’t have a gag reflex and will not be able to cough to protect your lungs. Do NOT eat or drink anything during the time period your surgeon gives you prior to surgery. Aspiration can lead to prolonged intubation and ICU stays, and sometimes even death.
The patient may receive a sedative in the preoperative area before moving to surgery. The sedative will help the patient to relax. [5] X Research source An anesthetist may have to use more medication to achieve general anesthesia if a patient is highly anxious. Prior to surgery, the patient will go to sleep by receiving general anesthetics through the IV and sometimes through a face mask as well. Delivering the anesthesia through the mask alone is also an option that may be used in some cases. For example, if the patient is a child who is afraid of needles, then a mask may be used to administer medications. [6] X Research source This option, called “mask induction,” is not often used in adults or larger children, because it can be less effective and risky to induce general anesthesia without first securing an IV.
The endotracheal tube used in intubation is a flexible plastic tube that goes through the patient’s mouth with the help of an instrument called a laryngoscope. This instrument helps the anesthesiologist lift up the tongue and pharynx, or tissues of the mouth, in order to see well enough to pass the tube into the patient’s lungs. Because intubation usually happens when the patient is asleep, patients may occasionally have a cut lip or chipped tooth if placement of the endotracheal tube was difficult. It is important for patients to notify their anesthesiologist if they have loose teeth, which can increase this risk. After surgery, some patients will have a sore throat from the endotracheal tube. This can last one to two days and is a normal side effect of intubation
Knocking out a tooth during insertion of the tube, or intubation Damage to the lips, teeth or tongue Low blood pressure from the anesthetic medications Lung infection, such as pneumonia, more so with prolonged intubation
Neck or cervical spine injury that limits flexion or extension of the neck Thick neck circumference Small mouth opening Small chin or inability to move the jaw forward Previous head or neck radiation or surgery Recent meal
Oxygen saturation levels Heart rate and rhythm Blood pressure Respiratory rate Body temperature Blood loss Urine output, depending on the type of surgery Central venous pressure, depending on the type of surgery Cardiac output and other invasive cardiac monitoring, depending on the patient or type of surgery
Is breathing adequately without assistance Has stable vital signs Has had appropriate medications and reversal agents, if necessary Can follow basic commands and demonstrate good muscle strength, usually by lifting his or her head or squeezing somebody’s hands
Nausea Vomiting Sore throat Confusion Muscle aches Chills/shivering Itching
Difficulty breathing Signs of infection, such as fever or chills Chest pain or pressure Heart palpitations New weakness Arm or leg swelling and/or fatigue, which can be signs of heart failure
Postoperative delirium. This complication causes confusion and memory loss which can last longer than a few hours. Some patients are at a higher risk, such as people who are transferred to intensive care after surgery, as well as those with heart disease, lung disease, Alzheimer’s disease, Parkinson’s disease, or who have had a stroke.
Peripheral nerve block. In this procedure, anesthetic is injected adjacent to a specific group of nerves. Epidural or spinal anesthesia. In this procedure, local anesthesia is injected near the spinal cord, which blocks pain from the nerves in the spine. This will block pain in a region of the body such as the chest wall, hips, legs or belly. [14] X Trustworthy Source PubMed Central Journal archive from the U. S. National Institutes of Health Go to source
Most of the time a nurse, doctor or dentist will administer the sedation using a medication that wears off quickly. The medication is given through an IV and requires monitoring every three to five minutes. The patient will likely get oxygen through a mask during the procedure. Patients often fall asleep but will wake easily and respond to people in the room upon waking. Some medications used also induce amnesia so the patient may not remember much about the procedure. The patient may hear voices and drift in and out of sleep, all of which would be normal for conscious sedation. Awareness during conscious sedation does not mean the patient “woke up” during surgery and it is an expected part of this mild type of sedation.
