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How Anesthesia Works

How Anesthesia Works

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03/18/2014

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How Anesthesia Works

If you are faced with the possibility of needing surgery in the
future, chances are you will need some type ofanesthesia
to go along with it. There are many different types of
anesthesia. Which one you will need depends on a variety
of factors such as the type of surgery you are having and
your state of health. Some surgical procedures require only
an injection of local anesthesia into the incision area. Other

procedures cannot be
performed unless you are
completelyanesthetize d --
unconscious and unaware of

pain. Youranesthesiolo gist will tell you which type of anesthesia you need.

In this article, we will look at the
many types of anesthesia so
that you can understand what it
is, how it works, and how the
anesthesiologist determines
which type of anesthesia to use
for your particular situation. By
addressing this topic, we hope
that you will have a better
understanding of what happens
to you while you're anesthetized
and perhaps make the process
a little less mysterious.

The Basics
Anesthesia is divided into four basic categories:
\u2022
generalanesthesia
\u2022
regionalanesthesia
\u2022
localanesthesia
\u2022
sedation

Each type of anesthesia has an effect on a part of the nervous system, which results in a
depression or numbing of nerve pathways. General anesthesia affects the brain cells, which
causes you to lose consciousness. Regional anesthesia has an effect on a large bundle of
nerves to a particular area of the body, which results in losing sensation to that area without
affecting your level of consciousness. Local anesthesia causes you to lose sensation in a
very specific area.

Definitions
Consciousness is being
clearly aware of yourself and
your environment.
Unconsciousness is when

you are completely or partially
unaware of yourself and your
environment, or you don't
respond to sensory stimuli.

Conscious sedationis

caused when an anesthesiologist
administers depressant drugs
and/or analgesics in addition to
anesthesia during surgery.
Consciousness is depressed and
you may fall asleep, but are not
unconscious.

Sleep is a state of reduced

consciousness, depressed
metabolism, and little activity of
the skeletal muscles. Strong
stimuli such as loud noise, bright
light or shaking can arouse the
sleeper.

Some of the drugs that produce general anesthesia in large doses can be used to produce sedation, or "twilight sleep" in lower doses. Sedation can be given in many ways. A common example of an anesthetic gas that is used for sedation is nitrous oxide or laughing gas.

If you are scheduled to have surgery, you may be told not to eat anything for eight hours. It is
very important that you follow whatever instructions you are given for not eating or drinking
anything prior to surgery. Why? Because when you are given anesthesia, you lose the ability
to protect yourlungs from inhaling something you're not supposed to inhale. When you are
awake, you can usually swallow saliva and food without choking because part of the
swallowing mechanism involves a reflex that results in covering the opening into the lungs.
When you are anesthetized, you lose that reflex. So, if you have any solids or liquids in your
stomach, they could come up into your mouth and be inhaled into your lungs. The result
could be very serious lung damage.

General Anesthesia
General anesthetics produce an unconscious state. In this state a person is:
\u2022
unaware of what is happening
\u2022
pain-free
\u2022
immobile
\u2022
free from any memory of the period of time during which he or she is anesthetized

It is not completely clear exactly how general anesthetics work at a cellular level, but it is
speculated that general anesthetics affect the spinal cord (resulting in immobility), the brain-
stem reticular activating system (resulting in unconsciousness) and the cerebral cortex (seen
as changes in electrical activity on an electroencephalogram).

Photo courtesy Department of Defense: Defense Visual Information Center
Lt. Brenda Shealy checks a piece of anesthesia equipment in
an operating room during Operation Desert Shield.

General anesthesia can be administered as an inhaled gas or as an injected liquid. There
are several drugs and gases that can be combined or used alone to produce general
anesthesia. The potency of a given anesthetic is measured as minimum alveolar

concentration (MAC). This term describes the potency of anesthetic gases. (Aveolar is the

area in the lung where gases enter and exit thebloodstre am via the capillary system).
Technically, MAC is the alveolar partial pressure of a gas at which 50 percent of humans will
not move to a painful stimulus (e.g. skin incision). Injected liquid anesthetics have a "MAC
equivalent" which is the blood concentration of the liquid anesthetic that provides the same
effect. Using MAC as a guideline, the amount of anesthetic given to a patient depends on
that particular patient's needs.

When anesthetics reach the bloodstream, the drugs that affect thebr ain pass through other
blood vessels and organs so they are often affected too. Therefore, patients must be
carefully monitored. The anesthesiologist continuously monitors the patient'sh eart rate,
heart rhythm, blood pressure, respiratory rate, and oxygen saturation. Some patients may
have even more extensive monitoring depending on their health and which type of procedure
or surgery they are having.

Most adults are first anesthetized with liquid intravenous anesthetics followed by anesthetic
gases after they are asleep. Children, however, may not like having an injection or
intravenous catheter placed in them while they are awake. Therefore, they often breathe
themselves to sleep with anesthetic gases given through a mask.

Inhaled Anesthetics

Many adults may remember havingeth er for their anesthetic when they were young. Ether is ani nflammable anesthetic that is no longer used in the United States. Today, the commonly used inhaled anesthetics are nitrous oxide (also known as laughing gas),s evoflurane ,

desflurane, isofluraneand halothane.

Why do we have so many different kinds of gases? Because each gas has its own special
properties. For example, sevoflurane and halothane are easy to inhale while desflurane is
very irritating to inhale and has a shorter duration of action. If you need to breathe yourself to
sleep, halothane or sevoflurane would be easiest to inhale. If a very short-acting anesthetic
is needed, the anesthesiologist can switch to desflurane after you fall asleep. Nitrous oxide is
easy to inhale, but when used alone is not potent enough to be a complete general
anesthetic. However, it can be used alone for sedation, or combined with one of the other
inhaled anesthetics or injected liquid anesthetics for general anesthesia.

These gases have different effects on other organs as well. For example, halothane may
cause theheart rate to slow down and the blood pressure to decrease while desflurane may
cause the heart rate to speed up and the blood pressure to increase. How do these inhaled
anesthetics reach thebrain? When an anesthetic gas is inhaled into thel ungs, theblood that
travels through the lungs carries the anesthetic gas to central nervous system cells. The rate
at which the bloodstream takes up the anesthetic is dependent on many factors including the
concentration of the inspired gas, the rate of flow of the gas from the anesthesia machine,
the solubility of the gas in blood, the rate and depth of breathing, and the amount of blood
the heart pumps each minute in the person breathing the gas.

An important property of anesthetics is reversibility. When the surgery is over, the
anesthesiologist wants to shut off the anesthetic and have the patient wake up from the
anesthetic-induced sleep. Once the anesthetic gas is turned off, the blood stream brings the
gas back to the lungs where it is eliminated. The more soluble the gas is in blood, the longer
it takes to eliminate. Nitrous oxide and desflurane are the shortest-acting anesthetic gases
because they are the least soluble in blood.

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