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Anyone who has had major surgery may be surprised to learn that being "put to sleep" involves more than a shot of pentothal. Thanks to general anesthesia, people simply cannot remember much after they reach the operating room.

But from the moment surgery begins, the anesthesiologist is constantly busy with tasks that can mean the difference between life and death. He or she must frequently adjust the balance of various drugs used to begin, maintain, and reverse anesthesia; typically, 7 to 10 agents are needed to achieve the desired effects.

The anesthesiologist also regulates basic life functions, such as breathing and heart rate, which unconscious patients are unable to do on their own. And the anesthesiologist watches for medical problems that may arise. In preparation for all of this, anesthesiologists have at least eight years of medical education, with intensive training in giving anesthesia and in caring for anesthetized patients. Nurse anesthetists - registered nurses who have had additional training and certification in anesthesiology - also may anesthetize patients under the supervision of an anesthesiologist or the surgeon.

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General Anesthesia

Years ago it was necessary to give large doses of anesthetic drugs to achieve the deep level of muscle relaxation required for surgery. Modern anesthetic methods work differently. Induction of anesthesia with a mask and anesthetic gas or vapor is rare these days, although vapors can be used that are pleasant to inhale and rapid in their action. But mostly the anesthetist puts you to sleep (if you are not already asleep from a preoperative injection) by giving a small injection of a rapidly acting and powerful drug.

Modern induction agents work so quickly and efficiently that, from the patient's point of view, the injection has no sooner started than he or she is waking up in the recovery room, or back in bed, astonished to find that it is all over.

Local Anesthesia

Methods of removing all pain sensation from limited areas of the body have improved so much in recent years that many operations, formerly possible only under general anesthesia, can now be done using some form of local anesthesia or regional nerve block. This is often accomplished through injection into skin, mucous membranes (mouth), etc. via a small needle. This is common for dental procedures, lump and bump removal and other minor surgeries.

There is no loss of consciousness with local anesthesia, although sometimes this method is combined with a sedative such as diazepam so that one feels thoroughly relaxed. Patients under local anesthesia are able to talk to their surgeon, and some may even watch the operation taking place by means of a video monitor above the operating table.

Injections into The Spine

Because the nerves relaying sensation to the brain are all packed closely together as they enter the spinal cord, a small injection in this area can cause temporary anesthesia over a wide area of the body below the point of the injection. In epidural anesthesia (which is widely used in childbirth) and spinal block anesthesia, the anesthetic drug is concentrated in the region of the back part of the lower end of the spinal cord. These methods are used mainly for surgery on the legs and lower abdomen.

Surface Anesthesia

This can be used in parts of the body that are able to absorb local anesthetic drugs, by spraying or by applying it as a cream. Types of surface anesthesia include creams, gels, lozenges, sprays and suppositories.

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In general anesthesia, two new devices have made the crucial measurement of ventilatory function more precise: the capnometer, which keeps track of the carbon dioxide that a patient is exhaling - and thus provides a measure of whether or not the patient is breathing properly - and the pulse oximeter, which measures oxygen levels in the bloodstream.

The capnometer consists of a small plastic thimble that fits over the patient's fingertip and shines an infrared light through it. The blood cells in the finger that are rich in oxygen diffract the light differently than those rich in carbon dioxide. Oxygen saturation in the blood can be gauged from this difference.

The American Society of Anesthesiologists (ASA) recommends that both of these devices be used to monitor general anesthesia. Capnometers are used in nearly all hospitals these days, though pulse oximeters are not as common. New York and New Jersey require the use of oximeters, but other states do not. It is important to note that a good deal of cosmetic surgery, dental surgery, and surgery performed in ambulatory surgical centers is performed without an anesthesiologist present, and without following the ASA recommendations.

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Questions to Ask Your Doctor

What type of method will you be recommending?

What are the advantages and disadvantages of each?

Will any preoperative medication be given?

What are the side effects?

Are there certain foods that interfere with anesthesia?

What type of anesthesia will you be using? What are the side effects?

What are the possible complications that may be experienced due to age, health condition or type of surgery and anesthetic?

How long does it take for the anesthesia to wear off?

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