Options for daysurgical anaesthesia
Anaesthetists suggest the form of anaesthesia they deem as suitable for you, depending on:
- The procedure
- Your health
- The practices of the Unit
- Your wishes, if possible.
General anaesthesia results in complete loss of consciousness and sensation of pain. The anaesthetics include intravenous and inhaled agents. To ensure that the airways remain open, a plastic tube is inserted and breathing is secured by a medical ventilator. General anaesthesia is used in procedures of the upper body and head, such as abdominal operations and tonsillectomies, but it can also be used in all other procedures.
In a regional anaesthesia, the nerves to the operation site are anaesthetized so that sensation of pain is blocked. The anaesthetized limb can not be moved.
Patients are usually awake during the procedure, but relaxing medication can be given if needed to relieve tension.
Regional anaesthesia includes central techniques (spinal and epidural anaesthesia), and peripheral techniques (plexus blocks.)
The most common technique in day case surgery is the spinal anaesthesia, which anaesthetizes the lower part of the body. The technique suits well for operations of the legs and pelvic area.
Plexus anaesthesia or single nerve blocks anaesthetizes an entire limb or a smaller area, such as a thigh, a foot, or fingers. The nerves are located with a so called neural stimulator, which delivers small electric impulses to the nerve. These create involuntary, painless muscle jerks on the area to be anaesthetized, and they stop immediately as the anaesthetic agent is injected.
The agent is injected near the nerve and the nerve begins to grow numb slowly. This form of anaesthesia lasts long, even up to 12 hours.
Intravenous regional anaesthesia (Bier’s block)
Intravenous regional anaesthesia is used in small procedures of the hand that require the area to be excluded from blood circulation. A compressive device restricts the anaesthetized area.
If a procedure is limited to a small area, it can be locally anaesthetized. In addition pain killers and calming medication (sedatives) are often given. If the only medication is the local anaesthetic agent, the patient may leave the hospital without an escort.
General or regional?
General anaesthesia is usually free of complications. However, you may have a sore throat, hoarseness and, in some cases, nausea afterwards. Minor damages to the mucous membrane, and more sparsely, to tooth enamel may occur due to the use of a ventilation tube. Allergic reactions are rare. Possible effects to the heart (e.g. decline in blood pressure) are detected quickly due to careful monitoring and are therefore easily treated in most cases.
Anaesthetizing a single part of the body is usually the easier option for your system compared to general anaesthesia. You will remain active during and after the procedure and be able to follow the progress of, for example, a keyhole surgery. You will not feel any pain immediately after the surgery and do not experience the fatigue, nausea, or vomiting that sometimes accompany general anaesthesia.
Serious side effects of regional and local anaesthesia are extremely rare. Sometimes itching and difficulties in urinating occur after a spinal anaesthesia. Later a headache may appear, which is felt especially in an upright position, but it disappears or declines when lying down. It usually ends in a few days, but if it is severe or long-lasting, a so called blood patch can be inserted into the point of injection. Sometimes also radiating or local back pain may occur. An infection in the point of injection is rare, but possible. Allergic reactions to the anaesthetics are extremely rare.
A nerve contact and the resulting symptoms are a possibility in a nerve plexus anaesthesia. Sensation of severe pain while the agent is injected may suggest nerve damage.
Regional anaesthesia may be difficult to administer and is not always entirely successful. When insufficient, the doctor improves regional anaesthesia using additional local anaesthesia or general anaesthesia.