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General anesthesia is a technique administered when the operation requires or the patient desires to be completely asleep. Prior to beginning anesthesia, an intravenous line or IV is started and the anesthesiologist applies monitors for blood pressure, heart rhythm and oxygen saturation of the blood. Often body temperature is also monitored and warm air blankets and fluid warmers are used as needed.
Usually, you will first breathe pure oxygen through a face mask, after which IV medications will be given to produce a rapid and pleasant sleep. Then additional IV medications and vapor (gas) anesthetics will be added to keep you asleep during the entire operation. Typical inhaled anesthestic gases are nitrous oxide, sevoflurane, isoflurane and desflurane. Intravenous medications may include sodium pentothal, propofol and a muscle relaxant.
After you are asleep, we may insert a breathing device in your mouth to assure that you are breathing well or to protect your lungs from stomach acid. This may be a laryngeal mask airway that rests on top of your vocal cords or a hollow plastic endotracheal tube that is gently passed through your vocal cords. You are normally totally unaware of this breathing device, but may have a scratchy throat for a few days.
When awakening from anesthesia, you may naturally react by biting down on these airways. If your teeth are weakened, diseased, or loose, there is a definite possibility they may be damaged. Please discuss any such dental problems with your anesthesiologist during the pre-operative visit. Capped teeth, bridges, and other dental devices can also be damaged in this way. Unfortunately, despite our care, dental problems cannot always be avoided.
Patients are frequently given prophylactic anti-nausea medication during the anesthetic. If postoperative pain is anticipated, the anesthesiologist can also administer intravenous narcotics such a morphine, meperidine (Demerol), hydromorphone (Dilaudid) or fentanyl.
At the end of the operation, the anesthetic medications and gases are discontinued and you begin to wake up within a few minutes. With modern anesthetics, many patients are awake enough to talk with us on the way to the post-anesthesia care area (PACU or recovery room).
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