American Society of Anesthesiologists® urges critical conversations about anesthesia between patients and doctors
While anesthesia is safer than ever before, every person scheduled for a procedure or surgery must have a serious conversation with their physician anesthesiologist about their anesthesia care delivery plan ahead of time, according to the American Society of Anesthesiologists (ASA®).
“Thanks to advances in the science and research of anesthesiology, the dangers of surgery and anesthesia have decreased substantially,” said ASA President Jane C. K. Fitch, M.D. ”But that doesn’t mean these procedures are without risks. Any number of things can go wrong in the operating room, which is why it is important for patients to talk with their doctor in advance and have a highly trained physician anesthesiologist supervising their anesthesia care plan.”
Each of the more than 100 million operations and procedures performed on Americans every year involves the administration of anesthesia – but many people overlook its seriousness. Even “minor procedures” are not risk-free. Here’s what patients need to know to ensure their safety and comfort.
Sedation or Anesthesia?
Physicians have developed many methods to make patients more comfortable and pain free during procedures and operations. Sedation is a state of drowsiness or sleepiness accomplished through the administration of medications. There are various levels of sedation from having the patient relaxed, but able to answer questions, to lightly sleeping where the patient has no memory of the procedure.
There are three main categories of anesthesia, each having many forms and uses: general; regional and local. In general anesthesia, the patient is unconscious with no awareness or sensations. General anesthesia is either administered as gases or vapors inhaled through a breathing mask or tube or through intravenous medications. In regional anesthesia, the physician anesthesiologist makes an injection near a cluster of nerves to numb the area of the body that requires surgery. The patient may remain awake or be given a sedative. Either way, the patient does not feel the surgery taking place. In local anesthesia, the medication is usually injected into the tissue to numb just the location of the body requiring the minor surgery or procedure.
During surgery, the physician anesthesiologist will closely monitor the patient’s vital signs, regulate critical life functions, and respond to adverse events. They serve as the patient’s advocate and typically are the first to diagnose and treat medical problems or complications that may arise before, during and after surgery. Additionally, during moderate and deep sedation the patient’s level of consciousness will be supervised.
Certain health conditions may increase the risks of surgery and the potential for complications from anesthesia. These conditions include: high blood pressure, heart disease (angina, valve disease, heart failure or a previous heart attack), diabetes, stroke, seizures or other neurological disorders, obesity, obstructive sleep apnea, lung conditions (asthma and chronic obstructive pulmonary disease, or COPD), kidney problems, allergies to anesthesia or a history of adverse reactions to anesthesia. Smoking or drinking two or more alcoholic beverages a day also can increase the risks of surgery and complications from anesthesia.
Anesthesia and the Elderly
Half of people 65 and older will have at least one surgery and advanced age can increase the associated surgical risks. One concern receiving recent attention is that the aging brain is more vulnerable to anesthesia. Two anesthesia-related surgery risks that are more common in older people are:
Postoperative delirium – This temporary condition may not develop until a few days after surgery, when a patient can become confused, disoriented, have problems remembering things or focusing and may be unaware of their surroundings. Postoperative delirium may come and go, and usually disappears after about a week.
Postoperative cognitive dysfunction (POCD) – This condition can be serious with symptoms such as long-term memory loss and decreased ability to learn, concentrate and think. Those at highest risk are seniors with heart disease (particularly congestive heart failure), lung disease, Alzheimer’s disease and Parkinson’s disease or seniors who have had a stroke.
Thankfully, researchers and anesthesiologists now know how to decrease the risk of developing these conditions.
To ensure anesthesia-related safety during surgery and decrease a patient’s risk of cognitive delirium or dysfunction, plan ahead and:
Let the physician anesthesiologist know about any health problems or if the patient has had memory and thinking problems after having anesthesia in the past. The physician anesthesiologist may choose to avoid certain anesthesia medications, decreasing the potential risk of these issues.
Be sure the patient’s caregiver carefully observes his or her physical and mental activity after surgery. If anything troubling occurs, it should be reported to the physician. Talk to the physician anesthesiologist before taking medications after surgery that can affect the nervous system, such as those for anxiety, seizures, muscle spasms and difficulty falling asleep.
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