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Just 10 years since getting off the plane at San Francisco International Airport, I was about to start podiatry school. Immigrating from former Soviet Union, I had very limited knowledge of English language and very little family support. Because of their grueling work schedule, my parents, unfortunately, started to develop serious health problems by this time. My father developed coronary artery disease requiring cardiac surgery.
That was a terrifying time. Having some medical knowledge was not helpful in this case. As I was sitting in the lobby waiting for my father to come out of surgery, my mind was racing. I was considering all the possible risks and complications associated with the procedure. Even if the surgeon was excellent ,there was still a concern for anesthesia related complications. It took my father over 24 hours to “get his mind back” and become oriented to time, place and person. This was because it took a while for the anesthetic to wear out. The surgery saved his life! Anesthesia gave him the peace and comfort experience to undergo a horribly painful procedure.
This experience helped me appreciate Anesthesia. It gave me a glimpse of what is involved in providing comfort to a surgical patient.
I am a podiatrist and not an anesthesiologist. So, my intent here is not to give you all the nitty gritty of anesthesia! Instead, I simply want you to be educated and aware of your options. This way you can have an increased awareness of what is available to you as a patient. This should help you have a more beneficial discussion of anesthesia and pain control with your Anesthesia provider.
Unlike Local anesthesia, Regional Anesthesia, General Anesthesia, Conscious Sedation, and Monitored Anesthesia Care are not usually done by surgeons.
How does Anesthesia Work?
Anesthesia is a combination of drugs and techniques used to prevent pain and other sensations during medical procedures. Anesthesiologists and nurse anesthetists use a variety of drugs. These include inhaled gases, intravenous medications, and local anesthetics, to induce and maintain anesthesia. They also monitor the patient’s vital signs and adjust the level of anesthesia as needed.
Who can give Anesthesia?
Anesthesiologists and nurse anesthetists are the primary healthcare professionals trained to administer anesthesia. Anesthesiologists are medical doctors who have completed at least a four-year residency in anesthesiology after medical school. They are responsible for the overall care of the patient during the procedure. This includes administering the anesthesia, monitoring the patient’s vital signs, and managing pain and other symptoms after the procedure. They will also supervise your recovery in terms of pain control in the post operative suite.
Nurse anesthetists are advanced practice registered nurses (APRNs) who have completed a master’s or doctoral degree program in nurse anesthesia and passed a certification examination.
They work under the supervision of an anesthesiologist and are responsible for administering anesthesia, monitoring the patient’s vital signs, and managing pain and other symptoms.
In some cases, anesthesiologists and nurse anesthetists may work together as a team to provide anesthesia care during a procedure.
What is Regional Anesthesia?
Regional anesthesia is a technique used to provide anesthesia and pain relief to a specific region of the body by blocking nerve signals.
Unlike general anesthesia, which affects the entire body and renders the patient unconscious, regional anesthesia targets a specific area while allowing the patient to remain awake or lightly sedated.
In regional anesthesia, local anesthetic medications are injected near the nerves that supply the targeted region. These medications block the transmission of pain signals from that area to the brain. This results in numbness and loss of sensation. The patient may also receive additional sedation or analgesics to help them relax and manage any discomfort or anxiety.
There are different types of regional anesthesia, including:
1. Epidural anesthesia: In this technique, the anesthetic is injected into the epidural space surrounding the spinal cord. It is commonly used for pain relief during childbirth (epidural analgesia) or for surgical procedures involving the lower abdomen, pelvis, or lower limbs.
2. Spinal anesthesia: Also known as a spinal block. This involves injecting the anesthetic directly into the cerebrospinal fluid surrounding the spinal cord. It provides rapid and profound anesthesia for surgeries below the level of injection.
3. Peripheral nerve blocks: In this technique, the anesthetic is injected near a specific nerve or group of nerves that innervate a particular area of the body, such as an arm or leg. Peripheral nerve blocks can be used for procedures like orthopedic surgeries, foot surgeries, or pain management in specific areas. This is a level up from local anesthesia.
Regional anesthesia offers several advantages: effective pain control, reduced opioid consumption, quicker recovery, and fewer side effects compared to general anesthesia.
It allows patients to avoid the risks associated with general anesthesia, such as postoperative confusion, nausea, and prolonged recovery times.
However, regional anesthesia also carries certain risks and potential complications. These include nerve damage, infection, bleeding, and allergic reactions to the medications used. It is, therefore, crucial to have regional anesthesia performed by skilled healthcare professionals who are experienced in this technique and can ensure patient safety.
What is Conscious sedation?
Conscious sedation, also known as procedural sedation or moderate sedation, is a medical technique used to relax and calm a patient during certain medical procedures or interventions.
It involves administering sedative medications to achieve a state of decreased anxiety, stress, and discomfort, while still allowing the patient to maintain consciousness and the ability to respond to verbal or physical stimuli.
Conscious sedation is typically employed for procedures that may cause pain or anxiety but do not require general anesthesia. It helps patients feel more comfortable and cooperative during the procedure. It can also facilitate the work of healthcare providers by reducing patient movement and improving the overall experience.
During conscious sedation, the patient may receive medications to induce relaxation and reduce anxiety. Opioid analgesics may also be administered for pain relief. The medications are usually given intravenously, but in some cases, they may be delivered orally or through other routes.
While under conscious sedation, patients typically remain awake and responsive, but their level of consciousness and awareness may be altered.
They may experience a state of drowsiness, reduced sensation, and impaired memory of the procedure. The patient’s vital signs, such as heart rate, blood pressure, and oxygen levels, are continuously monitored throughout the procedure to ensure their safety.
It is important to note that conscious sedation should be administered by trained healthcare professionals who are experienced in managing sedated patients and monitoring their well-being. The specific protocols and medications used may vary depending on the procedure, the patient’s medical condition, and the healthcare provider’s judgment.
What is Monitored Anesthesia Care (MAC)?
Monitored Anesthesia Care (MAC) is a type of anesthesia that combines local anesthesia with intravenous sedation and analgesia to provide a safe and comfortable experience for patients undergoing certain surgical or diagnostic procedures.
MAC is different from general anesthesia in that it allows the patient to remain conscious, although they may experience varying levels of sedation and may not have memory of the procedure.
During MAC, an anesthesia provider monitors the patient’s vital signs, including heart rate, blood pressure, oxygen levels, and breathing, throughout the procedure. They also continuously assess the patient’s level of sedation and pain control, adjusting the medications as needed.
The components of MAC include:
- Local anesthesia: The targeted area or specific nerve is numbed using a local anesthetic. This helps reduce pain and discomfort associated with the procedure. This may involve the injection of a numbing medication or the application of a topical anesthetic.
- Intravenous sedation and analgesia: Medications are administered through an intravenous (IV) line to induce a state of relaxation and reduce anxiety. The sedatives used can range from mild to moderate, depending on the patient’s needs and the nature of the procedure. Analgesic medications may also be given to manage pain during and after the procedure.
- Patient monitoring: The patient’s vital signs, such as heart rate, blood pressure, oxygen saturation, and breathing, are continuously monitored to ensure their safety and well-being. The anesthesiologist or nurse anesthetist closely observes the patient’s level of consciousness, sedation, and pain control throughout the procedure.
MAC is commonly used for procedures that do not require full muscle relaxation or that involve moderate pain.
It is often employed for surgeries such as endoscopies, cataract surgeries, plastic surgeries, or minor orthopedic and podiatry procedures. MAC offers several benefits, including reduced risks compared to general anesthesia, faster recovery times, and the ability for patients to participate in their care and follow instructions during the procedure.
It is important to note that the specific protocols and medications used in MAC can vary based on the patient’s medical condition, the nature of the procedure, and the judgment of the anesthesia provider.
The goal is to tailor the anesthesia plan to meet the individual needs of each patient, providing optimal comfort and safety throughout the procedure!
So, What is the Difference between MAC and Conscious sedation?
Monitored Anesthesia Care (MAC) and conscious sedation are similar in that they both aim to provide sedation, analgesia, and patient comfort during certain medical procedures. However, there are some differences between the two:
Level of sedation:
Conscious sedation typically refers to a lighter level of sedation where the patient is relaxed and may experience decreased anxiety and discomfort but remains conscious and able to respond to verbal or physical stimuli. It may involve the use of medications such as benzodiazepines and opioids.
MAC, on the other hand, can encompass a broader range of sedation levels, including deeper sedation. MAC allows for a continuum of sedation, from minimal to moderate sedation, depending on the patient’s needs and the nature of the procedure. It involves the administration of local anesthesia combined with intravenous sedation and analgesia.
The patient may experience a higher level of sedation than with conscious sedation but is still able to respond to stimuli and maintain protective reflexes.
Administration and monitoring
Conscious sedation is often performed by healthcare providers, such as nurses or physicians, who are trained in the administration of sedative medications and monitoring the patient’s vital signs during the procedure. Monitoring typically includes continuous assessment of the patient’s level of consciousness, heart rate, blood pressure, oxygen levels, and respiratory status.
MAC is usually performed by anesthesiologists or specially trained nurse anesthetists. They are responsible for administering the medications, monitoring the patient’s vital signs, and ensuring the patient’s safety and comfort throughout the procedure.
The monitoring in MAC is typically more comprehensive and may involve additional equipment and expertise due to the potential for deeper sedation levels.
Scope of procedures
Conscious sedation is commonly used for minor procedures or interventions that do not require full anesthesia, such as dental procedures, minor surgeries, or diagnostic tests like endoscopies.
MAC is often used for more complex procedures that may require a higher level of sedation and analgesia, such as certain surgical procedures, invasive diagnostic tests, or longer and more invasive interventions.
Conscious sedation generally refers to lighter sedation levels where the patient remains conscious, while MAC encompasses a wider range of sedation levels and may involve deeper sedation. MAC is typically administered and monitored by anesthesiologists or nurse anesthetists, and it is often used for more complex procedures.
What Happens During Surgery?
Before surgery, the patient will meet with the anesthesiologist to discuss their medical history and any allergies they may have. The anesthesiologist will also discuss the type of anesthesia that will be used during the procedure and the potential risks and benefits associated with that type of anesthesia.
During the surgery, the patient’s vital signs such as heart rate, blood pressure, and oxygen levels will be closely monitored by an anesthesiologist and a nurse anesthetist. This is to ensure the patient’s safety and well-being throughout the procedure. The anesthesiologist will also adjust the level of anesthesia as needed to ensure that the patient remains comfortable and pain-free throughout the procedure.
After the surgery is completed, the patient will be transferred to the recovery room. There, the patient will be closely monitored until they have regained consciousness and are stable enough to be discharged from the hospital.
RECOVERY
Recovery time can vary depending on the type of anesthesia used, the length of the surgery, and the patient’s overall health. After general anesthesia, it may take a few hours for the patient to fully wake up and be able to walk and eat. After local or regional anesthesia, the patient may be able to go home the same day.
Anesthesia carries some risks, including allergic reactions, breathing problems, and blood clots. However, the risk of complications is low, and most patients experience few or no complications from anesthesia.
In conclusion, Anesthesia is a medical technique used to prevent pain and discomfort during surgical procedures. There are several different types of anesthesia that can be used during surgery, including local, regional, and general anesthesia. Anesthesia providers are responsible for administering the anesthesia and monitoring the patient’s vital signs during the surgery.
Recovery time can vary, but most patients are able to go home the same day. Although there are some risks associated with anesthesia, the majority of patients experience few or no complications. It is important for patients to discuss any concerns or questions about anesthesia with their anesthesiologist before their procedure.
I hope you enjoyed learning about different anesthesia options available to you. I believe you should now be able to have an educated discussion about what anesthesia you would like to have for your upcoming surgical procedure.
In the next blog, I will cover the topic of General Anesthesia!
Author bio:
My name is Dr. Marat Kazak. I have been working as a professional Podiatrist serving Northern California community since 2014. My extensive medical and surgical knowledge combined with an ongoing curiosity to learn about the latest trends define my success in the field of foot, ankle and leg medical and surgical care.